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Impact on children: safe infant feeding and child survival

© UNICEF/SouthAfrica/2006/Jantilal
Bongiwe* with her baby and a UNICEF visitor learn about safe infant feeding.


Safe infant feeding and child survival

Of the 1.1 million babies born every year in South Africa, 300,000 are born to HIV positive mothers. About 93,000 of these babies will be infected by HIV; with 72,000 being HIV positive at birth and 21,000 becoming HIV positive through breastfeeding from the infected mother.  Some 50% of these two groups of babies will die before their second birthday if mother to child transmission of HIV is not prevented.


Scaling up safe infant feeding practices through initiatives like breast milk banking
UNICEF efforts have been focused on improving the quality of counseling provided by health care providers and lay counselors as it relates to infant feeding and HIV. 

Training on safe infant feeding practices and choices, mentoring and supervision on site was provided to more than 5000 health workers and lay counselors.

UNICEF alsw supported the Department of Health to produce a much-needed Comprehensive Policy and Guidelines on Infant and Young Child Feeding, covering the appropriate dietary management at home, health facilities and educational centres for children and learners living with HIV and Aids. 

The PMTCT programme has now expended to a total of 70% of all health facilities, though provinces such as Kwa-Zulu Natal have reached 100% coverage rates of PMTCT service provision. More than 60% of babies born to HIV infected mothers receive anti-retroviral prophylaxis under the PMTCT programme and more than 65% of all pregnant HIV infected women receive counseling on safe infant feeding and are supported in their choice.

UNICEF believes in a comprehensive PMTCT-plus approach that provides ARVs to pregnant HIV-positive women to prevent transmission to their babies, while contributing to longer healthier lives for the mothers.  As a result, the quality of life of their babies will equally be improved through an enhanced maternal care and protection.

According to UNICEF partner and pediatrician, Professor Anna Coutsoudis of the University of Natal and founder of the iThemba Lethu Baby Sanctuary and Breast Milk Bank, breastfeeding is “a pillar of child survival”.  

If scaled up, it could prevent up to 13 % of infant mortality, she says, noting the evidence she sees every day in the thriving babies, many abandoned and HIV+, who are fed on donated breast milk at the baby sanctuary.  South Africa needs more human milk banks based in neonatal units of hospitals and in communities to help meet the needs of its HIV+ mothers and infants.

Professor Coutsoudis and the University of Natal, are leading proponents of this intervention to link breast milk banking to a broader child survival strategy, such as the Baby Friendly Hospitals Initiative (BFHI), developing for the country “home grown evidence” and data that can contribute towards the fiinal draft of the infant and young child policy.

UNICEF has worked on PMTCT+ for several years, focusing on the Baby-Friendly Hospital Initiative, and capacity and skills development of lay counselors to support safe infant feeding and to assist mothers to assess all available options to facilitate safe and sustainable infant feeding.

UNICEF has provided support in the past to develop the evidence base that will support breastfeeding through laboratory and microbiological research on the safety, efficacy and effectiveness of heat treatment to inactivate HIV in expressed breast milk.

Further, UNICEF has supported operational research on the sustainability of heat treatment at household level and the efficacy of the flash heating method being done in homes by HIV positive moms, who pasteurise their own milk using their small paraffin stove and boiling water.


Heat treating breast milk to protect baby

Within the tight cluster of small shack dwellings that mark the Cato Manor informal settlement, situated about 10km from the Durban city centre, life can be pretty wretched. 

Cato Manor residents include some of the poorest of the urban poor. The area remains characterized by a high unemployment rate and social degradation. 

Poor sanitation and lack of running water in most parts of this dirt poor community means young children are constantly exposed to life threatening, infectious diseases and the very real threat of HIV infection.

Yet residents are increasingly taking the initiative in their own development and have formed community organizations for citizen action and participation to improve their lives and those of their children. 

It is here that Professor Anna Coutsoudis of the University of Natal and her team of volunteers work with HIV infected mothers to provide what she calls the “best protection for their children”.

Through the commitment of their Durban breast milk banking project, new HIV+ Moms have found an easier way to safely feed their babies.

The team teaches the poor mothers how to practice “flash heating” a method by which HIV positive mothers express and heat their own milk to 62 degrees celcius – a form of pasteurization – that destroys the HIV virus, while retaining all the benefits of the nutrients and the immunological protection against infectious diseases that a mother passes on through her milk, to keep her baby healthy.

The method was pioneered by scientists at the University of Pretoria in 2001, with UNICEF support.

Bongiwe, a young mother of two, with an infant eleven months old, was tested for the first time during her pregnancy and has known her status for 12 months.  She started practicing the heat treated method of pasteurization six months after her baby was born. Dr. Coutsoudis and her volunteers taught Bongie how to heat the milk, a method she is still using today.  “I wanted to give my child the breast feeding. All the women in my family always do that.  So when I realised I could protect him from HIV from me in this way, I was so happy, because I don’t have a job and I cannot afford to travel far to collect the baby formula for him,” she says. 

Bongiwe’s community has no water and transportation is difficult and expensive for a mother of two.  Many people must walk far to find sanitation.  Even though there is free infant formula available at the clinic, a dearth of clean water could lead to contamination of the baby’s food while mixing. The breast milk is the safest.

Still many mothers do make the trek to collect the free tins of infant formula that are available at the only local clinic some 5 kilometres away, only to dilute it with unclean water. 

With her other responsibilities in the home which include another young child, providing the heat treated milk for her baby has helped make life just a little easier and safer for Bongiwe and has improved the chances of survival of her baby.  

Now she is helping to teach seven other HIV+ new moms how to practise the heat treatment to keep the babies healthy.

*not her real name






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