Washington Post Examines Effect of Botswana Infant Formula Program Implemented to Reduce Risk of Mother-to-Child HIV Transmission
July 24, 2007
Providing infant formula to HIV-positive mothers might "cost at least as many lives as it has saved" because the nutrition and antibodies supplied by breastmilk are "so crucial to young children that they outweigh the small risk of transmitting HIV," the Washington Post reports. According to the Post, CDC researchers have found that a decade-long, global initiative to provide infant formula to HIV-positive mothers has "backfired" in Botswana by causing infants to be more susceptible to other, more immediate deadly diseases. The findings join a "growing body of research" on the potential detriment of providing HIV-positive mothers with infant formula, the Post reports (Timberg, Washington Post, 7/23).
The CDC researchers, who presented their findings at a conference in Los Angeles in July, were investigating an outbreak of diarrhea during Botswana's rainy season in early 2006. At least 532 children -- 20 times the usual number of deaths from diarrhea -- died during the outbreak. Only a few of the infants' mothers were breast-feeding. According to the researchers, tests conducted among government water pipes in 26 villages in northeastern Botswana found contamination in each one. In addition, tests of the ill infants' feces also found "dangerous" waterborne pathogens and a virulent form of E. coli, the Post reports.
The researchers found that it primarily was the infants who were not breast-fed who were getting sick from the contaminated water. Among a group of infants at one hospital, those admitted for diarrhea were 50 times more likely to be taking formula or cow's milk compared with those admitted for other illnesses. In addition, the researchers found that in one village, 30% of the infants who received formula had died, while none of those being breast-fed had.
The report reflects the "shifting scientific consensus" on breast-feeding, the Post reports. Since Botswana started its formula program, more and more studies have shown that the risk of mother-to-child HIV transmission primarily comes from the combination of breastmilk and other foods, including formula and solids, that can damage the lining of an infant's intestines. In addition, putting an HIV-positive woman on a combination of antiretroviral drugs can reduce the risk of transmission through breast-feeding to less than 2%, according to Coovadia.
UNICEF after providing training and technical assistance to the formula program in Botswana began phasing out its infant-feeding programs in 2002. Health officials in Botswana remain "unconvinced" that the formula program is not effective, the Post reports. Health Minister Sheila Tlou said that the 2006 outbreak was a one-time occurrence that should not dictate a policy. Officials now are focusing on making formula feeding safer by encouraging women to boil water and feed their infants using cups. Tlou also said the ministry will monitor new studies to determine whether a new policy is needed. "We are amenable to research, especially our own research," she said (Washington Post, 7/23).
This article was provided by Henry J. Kaiser Family Foundation. It is a part of the publication Kaiser Daily HIV/AIDS Report. Visit the Kaiser Family Foundation's website to find out more about their activities, publications and services.