----- Original Message -----
From: "Renfrew, M.J." <[log in to unmask]>
To: "Soo Downe" <[log in to unmask]>; "Jane Sandall"
<[log in to unmask]>
Sent: Thursday, November 30, 2006 3:01 PM
Subject: [Fwd: E1. World AIDS Day statement]
>
> I attach a statement for World AIDS day on 1st December, issued by the
> World Alliance for Breastfeeding Action. Can you send out through your
> email lists please?
> Thank you
> Best wishes
> Mary
>
Increasing babies' HIV-free survival
Is formula-feeding the solution?
Evidence in 2006 continued to accumulate to favour a more rational approach
to
prevention of postnatal paediatric HIV.
Worldwide, HIV-infection among young women is far outstripping infection in
men and the health of
tomorrow's mothers is crucial to child survival. But while nine-tenths of
pregnant women and most
infected children still do not have access to antiretroviral therapy,1 and
findings presented at major
conferences this year2 3 confirm that up to 96-99% of babies are not
infected after birth when mothers
breastfeed exclusively, the provision of free formula may swallow up 25% -
60% of Prevention of Motherto-
Child Transmission (PMTCT) Programme budgets.4 Research from Nigeria,
Uganda, South Africa and
Botswana documents high rates of young child morbidity and elevated
mortality due to diarrhoea, acute
respiratory infection and sepsis when formula-feeding replaces
breastfeeding. 5 Even as the absence of
research on HIV risk attributable to later mixed breastfeeding following 6
months' exclusive breastfeeding
precludes a rational recommendation for early cessation of breastfeeding,
prematurely weaned babies in
Mozambique, Uganda, South Africa, Malawi and Zimbabwe suffer high rates of
malnutrition and illness.5
Indeed, in most PMTCT programmes, for reasons of cost, HIV-free survival of
infants is only ascertained
at 12-18 months and the number of infants who do not survive formula-feeding
long enough to be tested
remains unknown.
A stark reality check from Botswana early this year showed how horribly
things can go wrong when bottlefeeding
becomes well entrenched in an African country. When the national PMTCT
programme was
launched in 1999 a UNICEF-funded survey showed that only 3% of children were
never breastfed; 55%
were breastfed until 24 months, 7% until 35 months, and 2% until 59 months.6
In an effort to prevent
paediatric HIV infection, and as one of Africa's wealthiest countries, with
a water supply generally regarded
as safe, Botswana recommended replacement feeding by all HIV-positive women,
accompanied by
provision of a year's supply of free formula.5 Its success in providing free
PMTCT services to a higher
percentage of pregnant mothers than any other country has been hailed as an
example for the rest of Africa
to follow.7 Today, one-third of pregnant women are living with HIV and ~98%
of HIV-infected mothers
formula-feed their babies. Indeed, formula has been promoted so strongly
that one in five uninfected or
untested mothers have also stopped breastfeeding before their babies reach
six months of age.5 8
But late last year Botswana suffered a catastrophic outbreak of
gastrointestinal illness. Hospitals throughout
the country were overwhelmed by 35 000 cases and 532 deaths. 9 The most
affected group was infants aged
0 - 12 months who were not breastfed. Assistance was requested from the US
Centers for Disease
1/2
Control, WHO and UNICEF.10 A closer evaluation found that a variety of
pathogens was responsible,
including cryptosporidium, enteropathogenic e coli and salmonella.8 Over
half the affected infants were
already malnourished, and despite mothers returning to the clinic several
times per month, had received only
51% of the quantity of formula they needed before their illness. However,
the most significant risk factor
was that 93% were not breastfeeding, resulting in a 50-fold higher risk of
diarrhoea and an 8-fold risk of
dying from diarrhoeal illness.9 The final death toll remains unknown, since
many babies died at home, with
one village reporting the loss of 30% of its formula-fed babies.8
Botswana may not be alone. Outside the research setting, little is known of
the fate of babies served by
hundreds of PMTCT sites around the world where formula feeding has yet to be
demonstrated as
acceptable, feasible, affordable, sustainable and safe. Calls have been made
for ethical and standardised
research including operational research, monitoring and evaluation at all
levels, and dissemination of
findings.11 In the face of inequitably distributed resources in an unequal
world the events of 2006 constitute a
tipping point for re-assessment of the competing risks of postnatal HIV
transmission and formula feeding.
The recent WHO Technical Consultation on HIV and infant feeding, held in
Geneva on 25-27 October
2006, was the first to be convened in six years to discuss this issue. WABA
calls for formula feeding not to
be recommended in communities that cannot safely support it, and that
optimal breastfeeding to be
revitalised and recommended where appropriate to maximise HIV-free young
child survival in each
different setting.
* Endorse the Joint Statement on Gender, Child Survival and HIV/AIDS: From
Evidence to Policy at
http://www.waba.org.my/hiv/conference2006.htm
For more information, kindly contact:
Pamela Morrison
Co-coordinator, HIV and Breastfeeding Task Force
World Alliance for Breastfeeding Action (WABA)
PO Box 1200, 10850 Penang, Malaysia
Tel: 604-658 4816 Fax: 604-657 2655
Email: [log in to unmask], [log in to unmask]
Website: www.waba.org.my
>
> **********************************************************************************************************
> The World Alliance for Breastfeeding Action (WABA) is a global network
> of individuals and organisations concerned with the protection,
> promotion and support of breastfeeding worldwide based on the Innocenti
> Declaration, the Ten Links for Nurturing the Future and the WHO/UNICEF
> Global Strategy for Infant and Young Child Feeding. Its core partners
> are International Baby Food Action Network (IBFAN), La Leche League
> International (LLLI), International Lactation Consultant Association
> (ILCA), Wellstart International, Academy of Breastfeeding Medicine (ABM)
> and LINKAGES. WABA is in consultative status with UNICEF and an NGO in
> Special Consultative Status with the Economic and Social Council of the
> United Nations (ECOSOC).
> WABA, PO Box 1200, 10850 Penang, Malaysia
> Tel: 604-658 4816 Fax: 604-657 2655
> Email: [log in to unmask] <mailto:[log in to unmask]>
> Website:www.waba.org.my
>
> --
> Professor Mary Renfrew
> Director, Mother and Infant Research Unit
> University of York
> Department of Health Sciences
> Area 4, Seebohm Rowntree Building
> York YO10 5DD
> Tel: 44-(0)1904 321832
> email: [log in to unmask]
> Fax: 44-(0)1904 321820
> For urgent messages contact J Brown: [log in to unmask]
>
>
>
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