Harriette Onyalla and Irene Nabusoba
Kampala

WHAT mother would not want to protect her baby? To hold the tiny bundle that was once safely tacked away in her womb for nine months and shower him with love, knowing that she could put her very life on line for him. But what if the danger is from within? What if she is the danger?

Despite research showing that 14% to 20% of babies born to HIV-positive mothers get infected through breastfeeding, experts insist that HIV-positive mothers breastfeed their babies. This puts the mothers at crossroads given the current campaign for mothers to breastfeed exclusively for the first six months.

A 2005 World Health Organisation report says breastfeeding remains an important route of HIV infection among infants. The report titled Mother - to - Child Transmission of HIV-1 infections during exclusive breastfeeding in the first six months of life: an intervention cohort study, says an estimated 630,000 to 820,000 infants get HIV infection annually. Of these, between 280,000 to 360,000 are said to have been infected with HIV through breastfeeding.

The report originates from a study carried out among 2,722 HIV-infected and non-infected pregnant women attending antenatal clinics in KwaZulu Natal in South Africa.

“After birth, infant feeding data were obtained every week from mothers and blood samples from infants were taken monthly at the clinics to establish HIV infection status,” the report says.

The researchers found that 83% of the babies born to 1,372 HIV-infected mothers initiated exclusive breastfeeding from birth. According to the Ministry of Health guidelines, exclusive breastfeeding means giving a baby only breast milk and no other food or drinks, not even water, for the first six months. After this, the HIV-positive mother should stop breastfeeding completely and start the baby on other foods.

About 14% of these babies were infected with HIV by the age of six weeks, while 19.5% were infected by the sixth month.

However, the researchers noted that babies who breastfed while receiving other solid foods or formula milk were at a higher risk of HIV infection than those who breastfed exclusively.

Dr. Kenya Mugisha, the director of health services, says this is the basis for the ministry’s drive to encourage all mothers, whether HIV-positive or not, to breastfeed exclusively in the first six months after birth.

“We have to balance that with the dangers of not breastfeeding at all,” he says.

Mugisha says even then, the average Ugandan mother cannot afford alternative feeding for the baby. The ministry estimates that replacing breast milk with infant formula would on average cost sh600,000 every month, which an average Ugandan family cannot afford. Unlike cow’s milk, formula milk has been modified for the baby’s tender stomach and digestive system.

However, cow’s milk is widely used in rural areas, especially for babies whose mothers die during childbirth or after. In cases where families do not have a cow, it is estimated that about sh30,000 is required for the cow’s milk and feeding utensils. This is unaffordable for many families both in rural and urban areas.

Mugisha says children whose mothers have opted for alternative feeding are at risk of becoming malnourished as families try to economise the milk to fit within the budget.

Coupled with the fact that babies are not receiving the vital nutrients to fight disease, this is perhaps the reason why the Government is insisting that mothers breastfeed.

He says breast milk is important because it is rich in antibodies which help babies to fight diseases.

“This is the first immunisation for babies, especially the first yellowish milk called colostrums.”

Breast milk is also rich in vitamin A which protects the baby from infection, especially eye infections and blindness. It is vital in the baby’s growth and does not disorganise the baby’s bowl system.

Apart from the health benefits, breastfeeding enhances the bond between mother and child, a thing which is important for the child’s emotional growth.

However, Mugisha, says even in the event that the mothers can afford milk supplements, most of the children get diarrhoea due to poor hygiene.

With the national safe water coverage at 67%, some mothers cannot find clean water to prepare the infant’s milk.

“If you decide on breastfeeding, then it should be done exclusively for the first six months,” he says.

Experts say alternative feeding while breastfeeding increases chances of babies getting infected with HIV by their mothers.