#11 PH 150A Feb12 Infant Feeding HIV

#11 PH 150A Feb12 Infant Feeding HIV - Mother-to-Child...

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1 Barbara Abrams, DrPH School of Public Health University of California, Berkeley Mother-to-Child Transmission of HIV: Infant Feeding 2 Feeding Infants of HIV Positive Mothers in Sub-Saharan Africa: A Desperate Dilemma • Why breast is (usually) best • Maternal to Child Transmission of HIV • Competing risks: breastfeeding’s benefits vs HIV transmission • The Role of exclusive breastfeeding • Is expressed heat treated breast milk acceptable? • Is expressed heat treated breast milk safe? • Future Directions 4 Benefits of Breastfeeding • Optimal Nutrition • Enhances Immunity • Short and long-term child health benefits • Short and long-term maternal health benefits http:// www.time.com/time/photogal ery/0,29307,1626519_1373690,00.html 6 7 Breastfeeding Reduces Risk of Infectious Disease Mortality Lancet, 2000; 355: 451-455 Meta-analysis of 6 studies (1223 deaths of children < 2 yrs)
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8 Major Causes of Death among Children around the World Deaths associated with undernutrition 60% Sources: EIP/WHO, Caulfield LE, Black RE. Year 2000 9 10 Benefits of Breastfeeding • Nutrition • Immunology • Short and long-term child health • Short and long-term maternal health • Sterile • Affordable, Sustainable • Child Spacing 11 “Breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants; it is also an integral part of the reproductive process with important implication for the health of mothers. As a global public health recommendation, infants should be exclusively breastfed for the first 6 months of life to provide optimal growth, development and health.” WHO 2003 12 13 Western & Central Europe <1000 [630 – 3100] Middle East & North Africa 5500 [3800 – 8200] Sub-Saharan Africa 370 000 [320 000 – 470 000] Eastern Europe & Central Asia 3500 [2200 – 6400] South & South-East Asia 24 000 [14 000 – 31 000] Oceania <1000 [<1000 – 1400] North America 1600 [<1000] Latin America 6700 [5500 – 12 000] East Asia 2100 [<1000 – 2100] Caribbean 2000 [1800 – 3400] Estimated number of children (<15 years) newly infected with HIV, 2007 Total: 420 000 (350 000 – 540 000)
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14 Maternal to Child Transmission primarily occurs in sub-saharan Africa UNAIDS, 2003 Risk of transmitting HIV with breastfeeding • Each liter of breast milk = 1 unprotected sex act • Breastfeeding risk similar to having unprotected sex with infected partner 5 times per week 16 25-50% of infants for HIV positive mothers will be infected with HIV with 24 months of breastfeeding and no ARV treatment Pregnancy Late Postpartum (6-24 months) Early Postpartum (0-6 months) Adapted from N Shaffer, CDC 5-10% 10-20% 10-20% Labor and Delivery Breastfeeding (24mos) 17 HIV Transmission by Feeding Method First Author, yr Location Follow-up Breastfed Not Breastfed Tess, 1999 Brazil 18 months 21% 13% Coutsoudis, 2000 S.Africa 15 months 32% 19% Nduati, 2000 Kenya 24 months 38% 21% 60% of breastfeeders also used formula 18 MTCT virtually eliminated in developed countries • Maternal HIV testing • ARV during pregnancy and delivery • Cesarean Delivery • No breastfeeding 19
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20 Breastfeeding: Definitions
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#11 PH 150A Feb12 Infant Feeding HIV - Mother-to-Child...

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