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Peggy Henderson Department of Child and Adolescent Health and Development, WHO CROI, February 2007

Learn about the implications for HIV prevention and child health due to a recent diarrhoea outbreak in Botswana, including strategies for safe infant feeding. Explore the WHO recommendations and guidelines for HIV-infected mothers to protect themselves and their infants.

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Peggy Henderson Department of Child and Adolescent Health and Development, WHO CROI, February 2007

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  1. EMBARGO UNTIL 00.00GMT on Monday 26 February (Sunday, 16.00H in Los Angeles)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

  2. Relative risk of infectious disease mortality among non-breastfed infants 5.8 Relative risk 4.1 2.6 1.8 1.4 Age (months) WHO Collaborative Study Team, Lancet, 2000

  3. 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 p=0.60 p=0.86 p=0.08 % HIV-Infected or Dead

  4. The Dilemma for HIV-positive women: Balancing risks HIV transmission through breastfeeding Mortality Infectious diseases Malnutrition from not breastfeeding

  5. 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

  6. Countries need to ensure compliance with International Code of Marketing of Breast-milk Substitutes Adopted by WHA, 1981, subsequent resolutions expand and clarify Ensures proper marketing of breast-milk substitutes HIV-negative and status unknown: National implementation protects breastfeeding and prevents "spillover" 84 countries reported measures to implement Code (2006) Botswana Enacted Code into law Implementation and monitoring begun Violations of Code still found (2005)

  7. 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

  8. HIV and Infant Feeding Technical ConsultationGeneva, October 25-27, 2006CONSENSUS 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.

  9. http://www.who.int/child-adolescent-health/NUTRITION/infant.htmhttp://www.who.int/child-adolescent-health/NUTRITION/infant.htm

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