AFASS Guidelines for HIV positive mothers.pdf

7/29/2019 AFASS Guidelines for HIV positive mothers.pdf

1/12

AFASS Guidelines for HIV positive mothers

to Assess Appropriateness of

Replacement Feeding for their Infants

Will Replacement Feeding be ACCEPTABLE?

The mother perceives no barrier to choosing the optionfor social and cultural reasons or for fear of stigma anddiscrimination

The mother has adequate support to cope with family,community and social pressures

e.g: Will a mother who doesnt breastfeed beaccepted in the community?

Will Replacement Feeding be FEASIBLE?

The mother (and family) have adequate time, knowledge,skills, and other resources to prepare and feed the infant

e.g: Can a mother prepare fresh home formulaevery three hours, day and night?

Will Replacement Feeding be AFFORDABLE?

The mother and family (with available community and/orhealth system support), can pay for the costs for thepurchase/production, preparation, and use of the feedingoption, including all ingredients, equipments, fuel, andclean water

HO4.8


2/12

e.g: Can the mother afford to pay 160 Birr thefirst month to feed the baby (or 240-320

Birr from the second month onwards)?e.g: Will the purchase of formula compromise the

health & nutrition of other family members?

Will Replacement Feeding be SUSTAINABLE?

Replacement Feeding option must be practiced exclusivelyduring six months, and day & night

Supply and distribution of all ingredients is continuous,uninterrupted and dependable for as long as infants needit

e.g: Can the mother /family buy formula (or milk)and equipments for six months and more?

e.g: Can the mother accept, even under familypressure, NEVER to put the baby on the

breast?

Will Replacement Feeding be SAFE?

Replacement foods are correctly and hygienically storedprepared in nutritionally adequate quantities

e.g: Does mother have easy access to clean water?

e.g: Does mother have easy access to electricity or

other source of energy?e.g: Does mother have access to a refrigerator?

e.g: Does mother have clean hands and clean

utensils for preparation (use a cup)general population


3/12

Replacement Feeding

Preparation guide for home prepared replacement

feedings for infants

Commercial formula Home-prepared formula Wash hands with soap and water. Clean all utensils, containers, and

cups with soap and water. Read or have someone read

instructions on the formula tin. Boil water for 10 minutes and let

it cool. Boil as much water as youwill need for the whole day andstore in a clean covered container.

Measure the amount of milkpowder needed for one feed andmix it with the correct amount ofboiled water.

Prepare fresh commercial formulabefore each feed if refrigeration isnot available

Feed the infant by cup about 150milliliters (ml) of correctlyprepared formula per kg per day,

divided into 68 feeds. The infantwill have to learn to drink from acup.

Wash hands with soap and water. Clean all utensils, containers, and

cups with soap and water. Boil water for 10 minutes and let it

cool. Boil as much water as youwill need for the whole day andstore in a clean, covered container.

Measure the amount of water andmilk that you will need (see table2).

Measure the exact amount of sugarand mix it with the liquid (see table2).

Prepare formula before each feed ifrefrigeration is not available.

Feed the infant by cup theappropriate amount based on theinfants weight. The infant willhave to learn to drink from a cup.

Give the infant multivitaminsspecially formulated for the non-breastfed child. The multivitamincan be in the form of liquid syrup(5 ml per day) or powder. Themultivitamin can be mixed withthe formula or given separately.

HO4.9a


4/12

Replacement Feeding:

Recipes and amounts for replacement feedings

needed at different ages

Age

(months)

Number

of

Feedings

and Daily

Milk

Require-

ments

Cow (fresh or

UHT), goat,

or camel

(per feeding)

Sheep and

buffalo milk

(per feeding)

Evaporated

milk

(per

feeding)

Powdered

full cream

milk (per

feeding)

Commer-cial

formula

(per month)

0


5/12

720ml/day teaspoons)sugar

4


6/12

OPTION: Exclusive Breastfeeding

Advantages/Motivations:

Breast milk is the perfect food for babies. It gives babies all of thenutrition and water that they need. They do not need any other liquidor food.

Breast milk is free, it is always available and it does not need anyspecial preparation.

Exclusive breastfeeding protects infants from diseases, particularlydiarrhea and pneumonia.

Exclusive breastfeeding may also reduce the risk of HIV transmission. Many women breastfeed, and exclusive breastfeeding is recommended

for HIV-negative women. People may be less likely to becomesuspicious about this feeding practice (compared with the otheroptions).

Exclusive breastfeeding delays ovulation, preventing sexually activewomen from becoming pregnant.

Disadvantages/Constraints:

The risk of HIV transmission exists for as long as the HIV-infectedmother breastfeeds. This is because the infant continues to beexposed to HIV through breastfeeding.

This risk of HIV transmission increases if the mother has a breastinfection (e.g., mastitis) or cracked and bleeding nipples.

Although exclusive breastfeeding is recommended, it is not the normin most cultures. Family, friends, and neighbors may pressure mothersto give water, other liquids, or foods to the baby.

Many mothers are concerned that they do not have enough milk tobreastfeed exclusively

Mothers who breastfeed exclusively must feed on demand, at least 8-10 times per day. It may be difficult for working mothers to feed ondemand.

Mothers who breastfeed have increased nutritional requirements.They require an additional 500-750 kcal/day to support exclusivebreastfeeding in the first 6 months.

Advantages and Disadvantages of

Different Infant Feeding Options

under HIV and AIDS

HO4.10a


7/12

OPTION: Wet-nursing


There is no risk of HIV transmission if the wet nurse is not HIV-positive.

Disadvantages/Constraints:

The wet nurse must be tested and confirmed to be HIV-negative. She must protect herself from HIV the entire time while

breastfeeding. She must be available to breastfeed the baby frequently throughout

the day and night, or she must also be able to express milk if she andthe baby are separated.

If the baby is infected with HIV, there is a very small chance thathe/she could pass the virus to the wet nurse.

People may ask mothers why someone else is breastfeeding her baby. The HIV-infected mother is at risk of becoming pregnant if sexually

active.

HO4.10b


8/12

OPTION: Expressed and Heat-Treated Breast Milk


Heat-treating breast milk prevents HIV replication, reducing the riskof transmission.

Breast milk is the perfect food for babies, and most nutrients remainin breast milk after heating.

This method may be appropriate for breastfeeding mothers with sickand low-birth weight babies being fed in hospitals, mothers withbreast infections, and during the transition from exclusivebreastfeeding to replacement feeding.

Other adult family members can help to feed the baby.

Disadvantages/Constraints: Expressing and heating breast milk takes time and it must be done

frequently. The baby will need to drink from a cup. Babies can learn how to do

this even when they are very young, but it takes time. The breast milk needs to be stored in a cool place and used within an

hour of heating. Fuel for heating the milk, and clean water and soap for washing all

utensils are required. Some anti-infective (protective) cells in breast milk are destroyed

with heating. This practice is only recommended for mothers with HIV. It is a new

and unusual practice that may cause people to suspect HIV.

HO4.10c


9/12

OPTION: Replacement Feeding with Commercial Infant

Formula


There is no risk of transmitting HIV through formula. Commercial infant formula is made especially for infants. Most of the nutrients that a baby needs have already been added to

the formula. Other adult family members can help to feed the babyDisadvantages/Constraints: If the formula is not prepared correctly, an infant is more likely to

get sick from diarrhea and pneumonia, and develop malnutrition.

Formula is expensive. An infant needs a total of forty 500g tins (orforty-four 450g tins) for the first six months. This will cost between1400 to 2600 Birr. A continuous/reliable supply of formula will beneeded to prevent malnutrition.

From 6-24 months, a suitable breast milk substitute (formula oranimals milk) will still be required. This will represent a similar cost.

Formula takes time to prepare, and it must be made fresh for eachfeed.

The mother must stop breastfeeding completely, or the risk of givingHIV to her baby will be greater.

The baby needs to drink from a cup. Babies can learn how to do thiseven when they are very young, but it takes time.

Safe preparation requires clean water (boiled for 10 minutes), fuel,and soap for cleaning utensils.

Formula does not contain antibodies, which protect infants frominfection.

If a mother does not breastfeed, it may arouse suspicion and evenanger among family, neighbors, and friends.

Formula feeding does not protect from pregnancy.Commercial infant formula requirements in first 6 months

Month No. 500 g tins per month No. 450 g tins per month

First month 4 tins 5 tins

Second month 6 tins 6 tins

Third month 7 tins 8 tins

Fourth month 7 tins 8 tins

Fifth month 8 tins 8 tins

Sixth month 8 tins 9 tins

HO4.10d


10/12

OPTION: Replacement Feeding with

Home-prepared modified animal milk

Home-prepared formula can be made with fresh animal milks, with driedmilk powder or with evaporated milk. Preparation of formula with any of

these types of milk involves modification to make it suitable for infantsfrom birth to 6 months. This modification includes dilution with boiledwater in precise amounts to reduce solute concentration and the additionof sugar to increase energy density. The amount of dilution requiredvaries for different animal milks. Dilution is not required for infants 6months and older.

Infants fed on home modified animal milk require additional micronutrientsupplements because animals milks are relatively low in iron, zinc, vitamin

A, vitamin C and folic acid.

These milks are suitable for home-modified formula: Fresh cow, goat, sheep, buffalo milk Full-cream, dried milk powder Evaporated milk Ultra-heat treated milk (UHT)

These milks/liquids are not suitable for home-modified formula Unmodified fresh animal milk Skimmed or low-fat milk powder Sweetened or condensed milk Thin cereal-based gruels Fruit juice


There is no risk of transmitting HIV through home-prepared formula. Home prepared formula may be less expensive than commercial infant

formula and it is easily available if the family has milk-producinganimals.

Home-prepared formula can be used on days when commercial infantformula supplies run out.

Other adult family members can help to feed the baby.Disadvantages/Constraints:

Animal milk is difficult for infants to digest.

HO4.10e


11/12

Formulated for animals, these milks do not contain the nutrients thathuman babies need. Infants fed regularly on home-modified animalmilk must also take a specially formulated multivitamin supplement(liquid or powder for infants) to prevent anemia and other forms ofmalnutrition.

Fresh animal milk must be boiled. All animal milk must be diluted with boiled water. Sugar must also be

added in correct amounts. Care must be taken to correctly mix theseingredients in order to prevent malnutrition and diarrhea.

If the formula is not prepared correctly, an infant is more likely toget sick from diarrhea and pneumonia, and develop malnutrition.

Formula takes time to prepare, and it must be made fresh each timeyou feed your baby.

Infants require about 15 liters of milk per month for the first sixmonths if fed on home-modified animal milk. Families will also need tobuy sugar and multi-vitamin syrup or powder. This will costapproximately (local cost).

The baby needs to drink from a cup. Babies can learn how to do thiseven when they are very young, but it takes time.

Safe preparation requires clean water (boiled for 10 minutes), fuel,and soap for cleaning utensils.

Formula does not contain antibodies, which protect infants frominfection.

If a mother does not breastfeed, it may arouse suspicion and evenanger among family, neighbors, and friends.

Home-prepared formula does not protect from pregnancy.


12/12

Early Breastfeeding Cessation

Advantages/Motivations: The infant is no longer exposed to HIV through breastfeeding.Disadvantages/Constraints:

The infant may become malnourished if suitable breast milksubstitutes are not available and provided appropriately.

The infant may be at increased risk of diarrhea if breast milksubstitutes are not prepared safely.

If breastfeeding cessation is too rapid and infants are not preparedfor the transition, they can become dehydrated, anxious, disoriented,and unhappy. They may cry excessively or refuse food, making thetransition more difficult for themselves and their families.

Infants should learn to cup feed before breastfeeding cessation. Cupfeeding requires caregiver patience and time.

The mothers breasts may become engorged and infected if milk is notexpressed and discarded.

The mother is at risk of becoming pregnant if sexually active. Early breastfeeding cessation is not recommended for infants who are

already infected with HIV.

Early Cessation: Breast milk substitute requirements for

infants after 6 months of age

Age Average amount of milk per day

6-8 months 600 ml

9-11 months 550 ml

12-23 months 500 ml

Mothers who choose to undertake early cessation of breastfeeding whentheir infant is about 6 months of age can either use infant formula oranimal milk. Animal milks do not require dilution after 6 months.

However, special preparation is still required for fresh and powderedmilk: Fresh animals milk: Boil the milk to kill any bacteria. Powdered or evaporated milk: Add clean water according to the

directions on the tin in order to make full strength milk. Processed/pasteurized or ultra-heat treated (UHT) milk: No

preparation needed.

HO4.11

AFASS Guidelines for HIV positive mothers.pdf

Documents

Transcript of AFASS Guidelines for HIV positive mothers.pdf