Children who had not been breastfed were more at risk during the diarrhoea outbreak of November 2005/February 2006 after major flooding in Botswana, says the United Kingdom-based National Aids Map (NAM) organisation.
In its September HIV and Aids treatment in practice newsletter, it said 470 children who were under five years old died in the 12 health districts of Botswana surveyed. Indications were that the total could have been as high as 574.
”One village we visited lost 30% of formula-fed babies — none other — during the outbreak,” the United States Centre for Disease Control’s (CDC) Dr Tracey Creek said.
Based on the results of investigations by the CDC, which was called in by the Botswana government, the NAM report says that not having been breastfed was the most significant risk factor associated with children visiting emergency rooms during the outbreak.
”The country had trouble blaming the outbreak on any one pathogen and proposed that it was caused by a gastro-enteric virus. However, when it was clear that most of the cases appeared to be associated with bottle feeding, Botswana requested assistance from the CDC,” NAM said.
Formula feeding of babies in Botswana is closely associated with the country’s HIV/Aids pandemic. It is claimed that it prevents mother-to-child transmission of HIV, but its promotion is increasingly controversial.
Creek argues that most studies show that replacement feeding in resource-limited settings leads to unacceptably high rates of mortality among HIV-exposed children, and that the surviving infants wind up weak and malnourished.
”Because research has shown that prolonged periods of mixed feeding pose a greater risk of HIV transmission to the infant, mothers who do choose to breastfeed are being told to wean the infant as quickly as possible.
”However, recently published data showing that abrupt weaning itself increases the risk of transmission by dramatically increasing HIV levels in the breast milk may force many programmes to re-evaluate their recommendations,” reported NAM.
”There have been several reports of malnutrition and high rates of morbidity and mortality among infants fed replacement foods in several different countries, notably Botswana, where infant formula is freely provided for a year and the water supply has been generally regarded as safe.”
The CDC did find widespread water contamination in four northern districts of Botswana, but considered this ”not surprising” as the water came from a variety of sources and a number of strategies were used to treat the water.
Other factors which could have put the children at risk were also identified — caregivers not washing their hands, the use of standing water, overflowing latrines, drinking water having been stored — but concluded that the most significant risk factor was that the children had not been breastfed.
”The true extent of the mortality from this outbreak remains unknown, since many infants died outside of the health facilities. According to CDC estimates, in three districts alone there were a total of 547 deaths more than during normal years,” NAM said. — Sapa