RE: 10 Year Anniversary of the Right to Food Guidelines

26.04.2014

From an infant point of view, this issue needs to be looked at with keen attention to the policies that address Infant feeding as they are vulnerable and their rights to feeding are either not well enshrined in national legislations for better understanding by parties concerned.

Making popular the Universal declaration of Human Rights will conspicously situate the rights of children with regards to nutrition. In Cameroon many of the International injunctions, policies and declarations merely exist in papers with the academia that has been crippled by bereaucratic bottlenecks,

Advocacy is a long political process while Infant feeding support innovations never survive party allergance. A pilot study conducted by Prime Lactation Center Cameroon demonstrated a huge unawareness of the following by a majoriy of workers in these fields:

The convention on the rights of the child

The International Code of Marketing of Breast Muilk substitutes

The ILO's Maternity Protection Convention Number 103

The Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding

Much has been mentioned in the international scene through policies and declarations what needs to be done at national levels is ratification and enforcements, ungoing capacity builiidiing that includes every memebr in the health care continuum, parents inclusive. One way is workiing directly with NGOs/CSO, interpreting the documents and translating to local languages with non-technical parlance.

Our deepest concern as a center (Prime Lactation Center Cameroon) is Infant Feeding in HIV, the child's right to adequate. appropriate and quality feeding.

“THE PUBLIC HEALTH CHALLENGES OF PMTCT INTERVENTION: EVALUATION OF A FAMILY FOCUSED INFANT FEEDING CARE”.

 

Breastfeeding is a pillar of child survival; it reduces morbidity and mortality in children worldwide. HIV pandemic has threatened to “knock breastfeeding off its pedestal as a pillar of child survival”. For infants, breastfeeding is unequalled in its role in reducing morbidities and improving child growth, development, and survival in developing and industrialized countries. Because lactation is a metabolically expensive process, the initial concern that breastfeeding could be deleterious to HIV-infected mothers’ health has not been demonstrated. However, in general, the major risk of breastfeeding is vertical transmission of HIV and not adverse health effects for the mother. Vertical transmission can take place during pregnancy, labor, and delivery, as well as postpartum, through breastfeeding. The risk of transmission depends on many factors, including the timing of maternal infection, maternal viral load, immune function, nutritional status of the woman and baby, antiretroviral (ARV) use, breast health type of breastfeeding duration of any breastfeeding, and presence of oral lesions in the infant. With currently implemented prenatal and perinatal interventions, one-third to one-half of all MTCT is estimated to occur in the postpartum period, i.e. through breastfeeding.

In general pediatric populations,  replacement of breastfeeding with formula milks, animal milks, and other foods is attended by increased mortality, morbidity, poor growth, and development in both developing and industrialized countries.

PMTCT interventions, postnatal and otherwise, will be better understood and therefore more effective if they are evaluated more holistically, i.e. in terms of their psychosocial and economic consequences as well as their biological ones. Much of the research on postnatal PMTCT to date has focused solely on the biomedical consequences of infant feeding modalities, primarily disease transmission and survival. Yet the spectrum of strategies for reducing MTCT has frequently come with a range of unintended and often unmeasured psychosocial ramifications, from unintended disclosure to physical abuse, rejection by partners, ostracization by families, and abandonment of infants. It is one of my course goals to understand community and family centered strategies and tools to evaluate these interventions and gauge their psychosocial consequences.

On the other hand the magnitude and timing of private costs (individual and household-level expenses), public sector costs and civil society costs of interventions to HIV-affected persons is another component of PMTCT interventions that has frequently been overlooked. Individual costs include opportunity costs, such as income foregone while traveling far distances to clinics or waiting in long lines for care, as well as expenditures required to adhere to recommendations, e.g. to buy medicines, to pay for transportation to facilities, and to buy replacement milks for infants. The economic consequences of participating in PMTCT programs and adhering to prescribed recommendations have also received little attention. Families may sell assets to pay for care, HIV-positive women may engage in transactional sex to pay for formula for their infants, and governments may re-appropriate funds from other programs to fund the purchase of formula and medicine or the training of health care workers. These consequences are not sufficiently documented in most analyses. These costs will influence not only the willingness and ability of women to participate in PMTCT programs but also the amount of time they spend in programs and the degree to which they adhere to program recommendations. This program will expose me and give me the opportunity to understand household-level focus strategies that can be adopted for economic analyses.

Lastly, the enormous consequences need to be considered not just for the mother or the health care system but in the context of the household and community in which the HIV-exposed infant is raised. For example, are community members supportive of EBF? And if not, why? How can mothers strategically navigate barriers to EBF? Is it culturally acceptable to give newborns nevirapine syrup for a prolonged period of time? Does the mother need to conceal this behavior? Can she enlist family member support, e.g. others reminding her to administer it or acquiring more from the clinic?

Our center’s strategic goals for the next 5 years amongst others include enhancing local community health promotion and in-depth research in major health problems affecting Infant and Young Child feeding in our local communities. Most emphatically we are looking at exclusive breastfeeding, newborn feeding and infant nutrition in the context of HIV in a resource poor setting, challenges, local sustainable innovative interventions and public health concerns.