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Another mother's milk saves AIDS babies
Reprinted courtesy of S A Medical Journal, January 2002
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A unique nutritional scheme used in the inauspicious Durban home of five AIDS orphans could potentially save hundreds of babies' lives every month. Begun six months ago by Anna Coutsoudis, an associate professor of Paediatrics and Child Health at UND, the Ithembalethu Breastmilk Bank is now attracting widespread interest.
The story began when Coutsoudis saw a sunken-eyed, severely malnourished abandoned infant from Addington Hospital arrive at the infants' home she worked with in Umbilo Road. "I went to a friend who was expressing milk and asked for her help. Over three days, the child overcame chronic diarrhoea. I thought, well, let's see if we can talk to a whole lot of expressing mothers."
Coutsudis got busy, found a way to sterilise the milk, dispatched a funding proposal to UNICEF in Pretoria, and produced a motivational video on how to express breastmilk. The funding was approved and a public relations officer hired to promote the concept to middle-income breastfeeding women living nearby. This approach enabled local mothers to get to know the babies to whom they were donating and thus fostered accountability and motivation.
Coutsoudis said the donors with low HIV-risk were given a typical screening questionnaire, adding that the subsequent sterilisation of the milk eliminated any chance of HIV transmission. Within months, 20 women were donating enough excess milk to provide 750ml per day to each of the five infants at the Umbilo Road home. "A few of the women were so excited to express milk for a particular baby that we've even had a few zealots who said they could lactate at will," chuckles Coutsoudis.
She is carefully documenting the amount of milk expressed by each donor and all costs involved so that her vision of "several little homes" duplicating the Ithembalethu Breastmilk Bank can be realised. Any excess milk is quickly snapped up by other AIDS orphanages and homes. "The is no lack of takers," Coutsoudis said ruefully.
She also said one gratifying side-benefit was involving women not normally exposed to the tragedy of the AIDS epidemic. "They're realising they can be part of the solution. It also creates wonderful opportunities for breastfeeding education and promotion," she added. Keeping the project small and local was practical because, "it's not like blood, which is a one-off donation. This involves donating every day for six months."
She firmly believes that immune system benefits of exclusive breastfeeding in the first six months, even with the risk of HIV, far outweigh any formula feeding benefits. The risk of infants contracting diarrhoea and pneumonia through formula feeding in unhygienic low-income settings is acceptably high. She emphasised that there was 'no way' infants died from formula feeding in a 'normal' setting. Citing a WHO meta-analysis published in The Lancet last year, Coutsoudis said formula-fed children were shown to be six times more likely to die than those who had been breastfed. She said the 15% "bandied about" as the HIV transmission risk was only true if the mother breastfed for up to two years.
One of her own studies had indicated that the risk of transmission through exclusive breastfeeding for six months was "probably zero". "Afterwards we though it might be great for breastfeeding HIV-positive women who sometimes get breast ulcers (and therefore increase the risk of transmission) to use our milk bank - but then we realised it was not feasible to supply milk to every HIV-positive woman."
Her sample sizes are currently too small to indicate whether donated and sterilised breastmilk feeding slowed down progression to full-blown AIDS (only one fo the Umbilo Road orphans is HIV-positive). However, from her previous tudies, she believed it did so.
Among the first to pick up on the life-saving potential of Coutsoudis's project was the Eastern Cape's Dr Costa Gazi, founder and director of Aid Babies Battling AIDS (ABBA). The former pubic service doctor and PAC Health Secretary told the SAMJ that with 22% HIV prevalence rates among pregnant women in the Eastern Cape, over 35 000 infants are born to infected mothers per year.
(Note: Prof Anna Coutsoudis is also HIVAN's Deputy-Director of Biomedical Sciences. e-mail: [email protected])
SAMJ subscriptions or single copies can be ordered via e-mail from the SAMA Health and Medical Publishing Group, e-mail: [email protected] |
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