Monday, July 16, 2007

A little knowledge can be dangerous

A rather sad and tragic story today. A Yale student working in a poor community in Rwanda found a mother infected with HIV breastfeeding her 4-month-old child and so sent word home for money and bought a cow so the child can be fed cow's milk instead.

Sad because the student knew of the risk of transmission of HIV through breastfeeding and thought what she was doing would help, but didn't investigate the risk factors and didn't know or ignored the recommendations of the World Health Organisation. Tragic because the infants are more likely to contract HIV and to succumb to other possibly fatal infections.

The article reporting this states: "Marie's HIV-infected mother, too poor to buy formula or animal milk, was breast-feeding the infant, putting her at substantial risk for contracting the virus, with the likelihood rising once she reached 6 months."

I posted a comment to try to direct people to expert sources of information:

It is unfortunate that this article and the advice given contradicts the recommendations of the World Health Organisation and the research on risks of transmission of HIV. See:

The mother was in fact following the recommendation of WHO, if she was exclusively breastfeeding. Introducing other substances, such as cow's milk, increases the risk of HIV transmission. Infants who are not breastfed are at far greater risk of dying from other illnesses as they are denied the protective factors of breastmilk.

New research from South Africa found that infants of HIV-infected infants living in poor conditions are more likely to survive if exclusively breastfed for the first six months. See:

Field workers can obtain expert training and information on supporting mothers and infants in difficult circumstances at:

The WHO position has recently been strengthened and adopted as a UN Consensus Statement following the results of a major study from South Africa. It states:

Exclusive breastfeeding is recommended for HIV-infected women for the first 6 months of life unless replacement feeding is acceptable, feasible, affordable, sustainable and safe for them and their infants before that time.... Breastfeeding mothers of infants and young children who are known to be HIV-infected should be strongly encouraged to continue breastfeeding.... Governments should ensure that the package of interventions referenced above, as well as the conditions described in current guidance, are available before any distribution of free commercial infant formula is considered.

Possibly cow's milk could have a role after the period of exclusive breastfeeding as rapid cessation when introducing other foods is recommended to minimise the period of mixed feeding, but should not be a replacement for breastfeeding. As Marie McGrath of the Emergency Nutrition Network comments on the article cow's milk has "high sodium and protein, inadequate micronutrients" and in practice its introduction may lead to mixed feeding as well as increased risk of other infections.

Another comment refers to the South Africa study we reference in our newsletter (link above) and states:

Remember: not all infants that are breastfed by HIV+ mothers get HIV; the risk of getting HIV decreases with exclusive breastfeeding; breastmilk protects against infections, take away that and increase the number of infective agents that are fed to the child through the cows milk, feeding method, etc and the likely hood of that child becoming ill and possibly dying are raised enormously - depending on the situation, much more than the risk of getting HIV. It is this because of this high risk of morbidity and mortality from not being breastfed in places where providing infant formula (and other breast-milk substitutes, such as cows milk) is not affordable, feasible, acceptable, sustainable and safe (places like rural Rwanda) that the guidelines have come down so heavily on the side of exclusive breastfeeding.

It is wonderful that she managed to fund raise but perhaps it could have been used to teach local community health workers and others how to counsel women to exclusively breastfeed - studies in S.Africa and else where clearly show that quality counselling can improve exclusive breastfeeding rates and therefore reduce HIV transmission.

For more on the South Africa study (the Coovardia study, published in the Lancet) see:

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