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Promotion of WHO feeding recommendations: A model evaluating the effects on HIV-free survival in African children.
Journal of Human Lactation. 2008 May; 24(2):140-149.In Africa, HIV and feeding practices deeply affect child mortality. To prevent mother-to-child transmission, the World Health Organization recommends exclusive breastfeeding for 6 months and replacement feeding when acceptable, feasible, affordable, and sustainable. Determining the proportion and number of children saved with exclusive breastfeeding and replacement feeding is essential to design and implement crucial nationwide policies. Using data on 31 sub-Saharan countries and a decision tree for risk assessment, the authors estimated the number of children's lives potentially saved according to 6 scenarios that combine exclusive breastfeeding for 6 months or replacement feeding with 3 promotion strategies. Among all HIV-negative children born to HIV-positive mothers who die in sub-Saharan Africa per year, 52 315 (9.6%) would be saved yearly with exclusive breastfeeding versus 21 638 (4.0%) with replacement feeding. Promotion support would double these numbers (110 625 vs 45 330; ie, 20.3% vs 8.3%), and with additional prenatal group education, 132 633 versus 54 192 lives would be saved (24.3% vs 9.9%). Wherever replacement feeding is not possible, exclusive breastfeeding with promotion support and prenatal group education would save 1 of 4 exposed children. (author's)
Baltimore, Maryland, Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, Information and Knowledge for Optimal Health [INFO], 2007 Apr.  p. (INFO Reports No. 12)This issue of Focus On... is intended to help health care practitioners better understand the current state of knowledge on breastfeeding and HIV transmission. It examines the most recent studies and expert guidance on the topic and provides the key points from recent research trials, literature reviews, and program evaluation studies. For women with HIV, infant feeding decisions are shaped by their access to infant feeding counseling and antiretroviral treatment, on the social stigma surrounding people with HIV, exclusive breastfeeding, and exclusive replacement feeding, on access to clean and safe water and food supplements, and on partner and family support. A woman infected with HIV can pass HIV on to her infant during pregnancy, at the time of labor and delivery, and through breastfeeding. Without treatment, between 15% and 30% of infants born to mothers with HIV become infected with HIV during pregnancy, labor, and delivery. An additional 10% to 20% become infected during breastfeeding depending on how long the infant is breastfed. (excerpt)
Early breastfeeding cessation as an option for reducing postnatal transmission of HIV in Africa: issues, risks, and challenges.
Washington, D.C., Academy for Educational Development [AED], 2001 Aug. 40 p.This document examines the recent WHO recommendations for modifying breastfeeding to reduce postnatal transmission of HIV in Africa. Specifically, it reviews the three-stage strategy for "modified breastfeeding" for HIV- positive mothers that involves exclusive breastfeeding followed by an early transition to exclusive replacement feeding. Organized into six chapters, this document also describes a step-by-step process for making the transition from exclusive breastfeeding to exclusive replacement feeding. However, many of the behaviors discussed in this review represent a major change in traditional infant care practices in Africa, and their feasibility and impact on child survival have yet to be determined. It is recommended, therefore, that these guidelines be subjected to additional research and testing before being implemented.