Breastfeeding In Pmtct Services; Tilting The Balance In Favour Of Cost-Effective Programme

Abstract

By 2005, the world's estimated population of people living with HIV/AIDS (PLWHA) was 40.3 million. Sub-Saharan Africa (SSA) contributed 25.8 million (over 64%) and almost one million more than in 2003. Of the estimated 4.9 million people newly infected with the virus in 2005, SSA contributed 3.2million (over 65%).1 With an estimated population of 3.7million people infected with the virus,3 Nigeria has the third largest population of PLWHA, being next to India and South Africa in that order.1The implication of this is that the devastation of the disease was yet to take a downward trend. It is estimated that over 14% of all new HIV infections are in paediatric patients compared with 10% in 2003. Over 90% of these infections are from vertical transmission. World-wide, over 95% of the under-5 infected with HIV are Africans without preventive measures, about 35% of all children born to HIV-positive mothers will be infected. HIV infection is now a chronic treatable but yet incurable disease in developed countries but this is not so in SSA where the preponderance of the infection is on the increase and mortality of the infection is most severe. Preventing vertical transmission (VT) is the noble goal of Prevention of Mother-to-Child Transmission (PMTCT) Programmes. In the absence of a cure, it is a cost-effective way of reducing the HIV burden and ensuring a future HIV- free generation. The interventions are targeted at the antenatal, intrapartum and the post natal periods.4-9 Post natal interventions target optimal child feeding options and paediatric antiretroviral therapy for post exposure prophylaxis in addition to counseling on other harmful socio-cultural practices. Of all the interventions aimed at reducing VT, breastfeeding is the only one that is most influenced by culture and social belief and dichotomized by racial and socio-economic factors. Fortunately, it is also the only one that the would- be-mother can positively or negatively influence its effect on the outcome on the infant. Though, the Nigerian PMTCT programme started since 2002, no scientific figures are available for VT for breastfed and non-breastfed infants. In spite of this, mothers are often left to make the choice between breastfeeding and formula feeding of their infants in the so called informed choice. But records available from Africa and elsewhere have often revealed the deleterious effects of breast feeding in good PMTCT programmes. From our practical experience, the issue of breastfeeding is still contentious can easily cause a divide among counselors themselves and clinicians too. This review focuses on the issue of breastfeeding, the past, the present and a look into the future as it is likely to affect the PMTCT programme and its implications for the Nigeria populace. It also examined factors that may be militating against success of interventions aimed at reduction of VT in the programme. We are of the view that those women who are electing for breastfeeding may not be getting enough information on the implication of their decisions. Also, socioeconomic pressures may be the most compelling factor for their choice of infant feeding. We suggest that interventions should urgently be targeted at the militating factors for timely realization of the goal 4 in the Millennium Development Goals of Nigeria. Encouraging breastfeeding under any guise will amount to tilting the balance in favour of a less cost- effective PMTCT Programme. Keywords : Breastfeeding, PMTCT, Vertical Transmission, Cost Effective Programme. Annals of Biomedical Science Vol. 4 (1) 2005: pp. 1-9