Infants, Children, Nutrition and HIV Victor M' Aguayo, PhD, MPH Regional Nutrition Adviser UNICEFWCA

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Infants,Children,Nutritionand HIVVictor M.
Aguayo, PhD, MPHRegional Nutrition
AdviserUNICEF-WCARODakar. July 7th, 2004
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Prevalence of underweight in children 0-59
months old
5th Report World Nutrition Situation , 2004
Percentage
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Prevalence of stunting in children 0-59 months
old
5th Report World Nutrition Situation , 2004
Percentage
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Prevalence and number of underweight in children
0-59 months old in Africa (1980-2005)
5th Report World Nutrition Situation , 2004
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Prevalence and number of stunted children 0-59
months old in Africa (1980-2005)
5th Report World Nutrition Situation , 2004
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Attributable causes of mortality in children
0-59 months old in SSA
WHO World Health Report, 2002
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When does malnutrition happen?
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and what about children born to HIV mothers?

• Children born to HIV-positive mothers are at a
  higher risk of
• Low birth weight (lt2,500 grams)
• Growth failure
• Malnutrition
• Disease
• Death
• Compared to children born to HIV-negative
  mothers
• Children born to HIV-positive mothers need
• special nutrition care and support

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Infant feeding options in the context of HIV
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Infant feeding options in the context of HIV

• Objectives
• 1) To prevent mother-to-child transmission of
  HIV
• 2) To maximize HIV-free child survival
• Infant feeding options are presented for two
  groups of women
• HIV-negative women and
• women of unknown HIV-status
• HIV-positive women
• Guidelines are based on UN-2003 infant feeding
  recommendations and informed choice policy

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Recommended infant feeding practices for women
who are HIV-negative or do not know their
HIV-status
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Recommendations for the first six months

• Practice exclusive breastfeeding
• Avoid mixed feeding
• Ensure proper attachment and positioning
• Prevent cracked nipples, mastitis, abscesses
• Treat immediately all breast conditions
• Avoid HIV infection
• Avoid (potential) HIV re-infection
• Safer breastfeeding practices are optimal for
  the health of the HIV-negative mother and her
  infant.
• Safer breastfeeding may reduce the risk of
  transmission among infected mothers who do not
  know their HIV-status

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Why breastfeeding?
Lancet 2000 55 451-5
Relative risk of death from infectious disease
in non-breastfed children
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Why exclusive breastfeeding?
Popkin 1990 Philippines
Risk of diarrhea by feeding method in infants 0-2
months
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Recommendations for successful exclusive
breastfeeding (0-6 mo)

• Ensure immediate skin-to-skin contact
• Initiate BF within one hour after birth
• Ensure good positioning and attachment
• Breastfeed frequently (on demand)
• Breastfeed day and night (8-12 times/day)
• Offer second breast when first is empty
• Avoid pacifiers and bottles (cup feed)
• Express milk if mother away for extended period
• Continue BF when infant is sick / convalescent
• Continue BF when mother is sick / convalescent

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Recommendations for 6-24 months

• Continue frequent (on demand) breastfeeding
• Introduce age-appropriate complementary foods and
  ensure
• Nutrient quality (nutrient-rich foods)
• Nutrient quantity (gradually increase
  amount/variety)
• Nutrient density (gradually increase thickness)
• Avoidance of drinks with low nutrient value
  (teas)
• Feeding frequency (gradually introduce
  meals/snacks)
• Good hygiene and proper food handling
• Active and responsive feeding
• Transition to the family diet at 12 months
• Continue breastfeeding

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Recommended infant feeding practices for women
who are HIV-positive
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Recommendations for the first months

• Avoid breastfeeding if replacement feeding is
• Acceptable
• Feasible
• Affordable
• Sustainable
• Safe
• Avoid mixed feeding
• If AFASS criteria not met
• Practice exclusive breastfeeding
• Until AFASS met
• Until infant is six months old
• Practice cup-feeding of expressed/heat-treated BM
• Practice wet-nursing
• In all three cases avoid mixed feeding

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how many months are the first months?

• Under conditions common in countries with high
  HIV prevalence, replacement feeding by
  HIV-infected mothers should not be generally
  encouraged until after the infant is
  approximately six months old.
• Ross J and Labbok M. Modeling the effects of
  different infant feeding strategies on infant
  survival and mother-to-child transmission of HIV.
  American Journal of Public Health. July, 2004.

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Recommendations for 6-24 months

• Transition to exclusive replacement feeding
  (ASAP)
• Avoid mixed feeding once transition period is
  finished
• Continue providing milk products
• Introduce age-appropriate complementary foods and
  ensure
• Quality
• Quantity
• Density
• Frequency
• Active and responsive feeding
• Transition to the family diet at 12 months

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Recommended nutrition care and support for
children gt 24 months old who are HIV-positive
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Effects of HIV on childrens nutrition
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HIV children greater needs greater attention

• HIV children are at a greater risk of
• Common childhood illnesses diarrhea, acute
  respiratory infection, and malaria
• Reduced food intake and nutrient utilization due
  to anorexia, swallowing difficulties, and nausea.
  
• Malnutrition, growth retardation, and death
• As such, HIV children should be given special
  attention to ensure that they receive
• Adequate amounts of both macro/micronutrients
• Adequate care and support

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Nutrition support for children gt 24 months old
who are HIV-positive

• Start nutrition intervention early
• Provide foods rich in energy and nutrients
• Increase feeding frequency and food portions
• Manage anorexia, diarrhea, nausea, and vomiting
• Ensure deworming every 6 months
• Ensure VA supplementation every 4-6 months
• Provide a daily multivitamin supplement if
  available
• Use fortified foods if available
• Promote good hygiene and proper food/water safety
• Manage ARV side effects anorexia, nausea,
  vomiting, and diarrhea
• Monitor (and promote) growth
• Treat severe malnutrition

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Recommended reading (included in your package)

• Infant feeding options in the context of HIV.
  Linkages Project
• Nutrition care and support for PLWHA in Uganda.
  RCQHC
• HIV and infant feeding. Framework for priority
  action. UN-agencies
• Breastfeeding and HIV. FAQ. Linkages Project
• Integrated PMTCT of HIV and support for IF.
  Linkages Project

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