Ajayi Maimuna is a young mother in her 30’s. She became HIV positive after her first three children and it remains a puzzle to her how she contacted the disease.
Maimuna, who spoke to our correspondent at the Heart to Heart Centre,(H2H) of the Badagry General Hospital, Lagos State, said, “I was scared my son might contact the HIV virus and as a result of that, I only breastfed him for one month and three days.
“The first day I was told of my HIV status, I almost died. Then I was pregnant for the fourth child, a baby boy but I nearly lost him because I refused to take my drugs. I also lost the fifth pregnancy which was twin. My thought then was whether I use the drug or not, I will die and this made me stay away from home several times. I was seriously affected psychologically.
“After the mistake of losing my fourth and fifth pregnancy, during the sixth pregnancy, I took my drugs religiously and my boy came out HIV negative. This is my seventh pregnancy and by the grace of God, will be my fifth child. My husband is HIV negative and has promised to be there for me and I promise to breastfeed him exclusively.”
The story of Maimuna is one out of millions of nursing mothers who are living in HIV denial and deny the child the benefit of Exclusive Breastfeeding,(EBF) due to fear of infecting the child with the virus but for Nigeria to achieve Elimination From Mother To Child Transmission, (EMTCT) of Human Immune Virus,(HIV), there is need to correct the misconceptions of breastfeeding generally.
In order to eliminate this misconceptions, health care centres who occasionally attend to People Living With HIV and AIDS, ( PLWHA) should properly educate these mothers and work in accordance with recommendations by World Health Organization, (WHO).
According to WHO recommendations, breastfeeding mothers who are HIV positive should Exclusively Breastfeed, (EBF) for the first six months and should continue breastfeeding especially if the mother has access to anti-retroviral therapy.
However, Exclusive Breastfeeding helps in reducing child mortality by 13 per cent. Sadly, Nigeria loses about 2,300 under-five year olds every day, and over two-thirds of these deaths are often associated with inappropriate feeding and poor practices
Emphasis has been on the fact that adequate and exclusive breastfeeding is not only an investment in improving children’s health and saving lives, but also an investment in human capital development that can benefit a country’s economy.
Giving an expert opinion, Professor Chinyere Ezeaka, a consultant pediatrician and Head, Neonatalogy unit at the Lagos State University Teaching Hospital, LASUTH, and College of Medicine, University of Lagos as well as National president, Nigerian Society of Neonatal Medicine, said most issues around HIV mothers vis a vis is being able to prevent transmission from mother to child.
Usually, it was said that HIV nursing mothers can give formula food if it can be sustained but there were a lot of reports both from Nigeria and some Sub-Sahara African countries that many babies were actually dying from not giving breast milk or giving contaminated formula milk because when you are not giving breast milk you are denying the child all the immunity the child will have.
According to her, “the child who is not on breast milk is likely to have 14 times more diarrhea, vomiting and 10 times more bronchopneumonia and many of these mothers when giving formula milk, are using contaminated water and feeding bottles that might be infected by flies. So, these children were dieing more from some of these disease that can be prevented rather than from the HIV. If there is no intervention, the risk will be upto 35 to 45 percent but with intervention, the mother and child must be on Anti-Retroviral Therapy, (ARV), the transmission can be reduced to two percent.”
Now that the country is moving with global standard, Ezeaka said, “the HIV mothers now do Exclusive Breastfeeding and on no account should these mothers mix exclusive breastfeeding with formula feed because that is the worst scenario. If she decides to breast feed and give formula milk, with formula milk, there is a lot of inflammation around the gut and bowel of the child, leaving the pulse of the child open and when the baby now takes the breast milk, if there is any little infection, the baby gets infected.
“The HIV positive mother must be on her drugs likewise the child in order to continue Exclusive Breastfeeding. She has to be sure the child is well positioned and attached so that she doesn’t have cracks on her breast. She should make sure the child doesn’t have sores around the mouth, oral thrush, e.t.c so that there won’t be any form of mixture of matetnal blood with the child’s blood. This is very critical and with that, Nigeria has been sustaining and moving forward around infant feeding vis a vis around HIV prevention from mother to child transmission.”
Prof. Ezeaka said, following the current guideline, the HIV positive mother breastfeeds for one year, adding that, by that time, the child has gotten all the immunity and protection from the breast milk and has established complementary feeds.
Corroborating Professor Ezeaka, Dr Clifford Lo, Associate Professor at Boston University said “the issue with HIV has changed quite a bit because now we have treatments for mothers who are HIV positive. If they are on treatment, there is no problem with them continuing to breastfeed. If they are untreated then, it’s a major problem.
“I used to see a lot of HIV positive persons as children 10 years ago but now we treat all mothers who are pregnant and are HIV positive so that we wont record HIV positive babies anymore. There is almost no record of children with HIV in the United States and that should be the case for Africa. Hospitals should test and treat every mother with HIV so that there will be no child with HIV in Africa.”
He also stressed that mothers living with HIV should not be afraid of breastfeeding their children ones they are on treatment as their viral load goes down, adding that ones the mother and baby are on treatment there is very little chance that the baby could contact HIV from the mother.
Data from the United Nations AIDS,(UNAIDS), record shows that about 34 million people worldwide are living with HIV and AIDS; 3.4 million people infected with HIV and AIDS were children younger than 15years old; 3.1 million children living with HIV and AIDS were from Sub-Saharan Africa.
About 390,000 children worldwide were newly infected; 250,000 child deaths are estimated to have occurred as a result of HIV and AIDS; and most of the infection in children younger than 15years occurred through Mother To Child Transmission, (MTCT). Globally, Nigeria alone accounts for 21 percent of new infections in children.
Similarly, a World Health Organisation (WHO) statistics in 2011, Nigeria alone contributes 29 percent to global gap in reaching 90 percent of pregnant women living with HIV in need of ARVs for
In a country of about 150 million people and six million births annually, 3.14 million Nigerians are living with HIV, 10 percent of HIV infections are as a result of MTCT and 154,920 new infections are in children out of an estimated 281,180 new infections. The statistics shows that about 229,480 pregnant women are HIV positive annually. This means that if proper and adequate intervention measures are not put in place, about 57,000 infants will be born with the virus annually.
More worrisome was the increasing number of infected women and children, and the fact that most of the children infected with the virus contacted it from their mothers.
With the current 1,216 Prevention from Mother-To-Child Transmission (PMTCT) sites in the country, there is need for government to create more sites especially in hard to reach areas for more accessibility.
It is noteworthy that nearly all such infections can be prevented by PMTCT programmes providing highly effective Anti Retro Viral Therapy (ART) and ARV prophylaxis intervention.
According to the National Demographic Health Survey, 2013, the prevalence of EBF in children below the age of six months was only 17 per cent which means that at least 5.4 million Nigerian children each year do not get the benefits of breastfeeding.
However, imagining poor breastfeeding rate is one thing, but beholding the number of deaths (103,742 child deaths each year) caused by low breastfeeding rate and the economic cost to the nation which is estimated to the tune of $21 billion per year, equivalent of 4.1 per cent of Gross National Income, GNI, cost is another. The poor breastfeeding habit is largely becoming an emergency.
From the South to the North, there is no cheering news about breastfeeding. According to the 2013, Multiple Indicator Survey, MICS, percentage of EBF nationally is still 15.0 percent. Ekiti State tops the list with over 45.0 percent, followed by Osun 40.0 per cent, Lagos was 25.0 per cent, Delta 10.0 per cent, Ogun 15.0 per cent, Ondo 10.0 per cent and Edo 25.0 per cent amongst others.
Currently, to meet the World Health Assembly target of increasing the percentage of children under six months of age who are exclusively breastfed to at least 50 per cent by 2025, it is expected that an additional $4.70 per newborn is required.
So what needs to be done to achieve the UN 50 percent Exclusive Breastfeeding target? Health watchers say with the right level of ambition, the right policies and investment, countries can fully realise the potential gains from breastfeeding.