Download Implications for HIV prevention and child health of diarrhoea

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Implications for HIV prevention and child
health of diarrhoea outbreak in Botswana
Peggy Henderson
Department of Child and Adolescent Health and
Development, WHO
CROI, February 2007
Relative risk of infectious disease mortality
among non-breastfed infants
7
Relative risk
6
5.8
5
4.1
4
2.6
3
1.8
2
1.4
1
<2 m
2-3m
4-5m
6-8m
Age (months)
WHO Collaborative Study Team, Lancet, 2000
9 - 11 m
No Difference in combined 18-Month mortality
+ HIV infection
between Formula and Breastfed Infants
(Thior et al., JAMA, 2006)
FF: 33 infected, 62 deaths
BF: 53 infected, 48 deaths
30%
% HIV-Infected or Dead
Formula
20%
Breast + AZT
p=0.86
p=0.08
12.5% 12.9%
p=0.60
13.9%
15.1%
8.9%
10%
6.1%
0%
1 Month
7 Months
Infant age
18 Months
The Dilemma for HIV-positive women:
Balancing risks
Mortality
HIV transmission
Infectious diseases
through breastfeeding
Malnutrition
from not breastfeeding
To be a better option than exclusive breastfeeding,
replacement feeding has to be AFASS
 Acceptable
 Feasible
 Affordable
 Sustainable AND
 Safe
for the mother and baby
Assessment also needs to
include:
 Health service accessibility
 Counselling and support
available
Countries need to ensure compliance with
International Code of Marketing of Breast-milk Substitutes
 Adopted by WHA, 1981,
subsequent resolutions
expand and clarify
 84 countries reported
measures to implement Code
(2006)
 Ensures proper marketing of  Botswana
breast-milk substitutes
– Enacted Code into law
– Implementation and
 HIV-negative and status
monitoring begun
unknown: National
– Violations of Code still
implementation protects
found (2005)
breastfeeding and prevents
"spillover"
Emerging evidence on HIV and Infant Feeding
 Exclusive breastfeeding associated with
decreased risk of HIV transmission compared
to non-exclusive breastfeeding
 Early cessation of breastfeeding associated
with diarrhoea and mortality in HIV-exposed
children
 Breastfeeding of HIV-infected infants beyond 6
months associated with improved survival
compared to stopping breastfeeding
HIV and Infant Feeding Technical Consultation
Geneva, October 25-27, 2006
CONSENSUS STATEMENT
 The most appropriate infant feeding option for an HIV-infected mother
should continue to depend on her individual circumstances, including her
health status and the local situation, but should take greater
consideration of the health services available and the counselling and
support she is likely to receive.
 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.
 When replacement feeding is acceptable, feasible, affordable, sustainable
and safe, avoidance of all breastfeeding by HIV-infected women is
recommended.
http://www.who.int/child-adolescent-health/NUTRITION/infant.htm