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Subject:
From:
Pamela Morrison IBCLC <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 1 Mar 1999 16:17:27 +0200
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Thanks to all who posted so fully about the radio programme on the Vit A
project in Zimbabwe.  The Zvitambo Project (Zimbabwe Vit A to Mothers and
Babies) is a two-year study which commenced late in 1997 to study the effect
of Vit A supplementation on (2) vertical HIV transmission during lactation,
(2) Horizontal HIV transmission, (3) infant mortality (4) plasma and
breastmilk viral load and lymphocyte subsets in HIV+ mothers (5) Vit A
status of mothers and babies (6) the acute phase response and its
relationship to serum retinol as an indicator of Vit A status.

This is a collaborative project between the University of Zimbabwe, various
municipal and government clinics/hospitals,  Johns Hopkins University and
McGill University.  The budget for this study is more than the entire health
budget for the city of Harare.

The project plans to recruit 14000 mother-baby pairs, test their HIV status,
and divide them into 4 groups of 3000 each, with an additional 2000 pairs
for sub-studies.  In one group both mother and baby will receive Vit A at
delivery.  The dosage is 400,000 IU for mothers and 50,000 IU for the
babies. In the other groups only the mother or only the baby will receive
the Vit A and in the last group neither will receive it.  Placebos will be
given to all participants not receiving Vit A.  I do hear that reporters who
recently interviewed some of the mothers were concerned to find that they
did not realize that some of them were receiving placebos.  The fact that
project personnel follow these mothers up very diligently, event to the
extent of making numerous home visits (an unusual occurrence here!) is also
making many of them anxious.

Preliminary results seem to indicate that although all mothers recruited are
tested for HIV only 11% of them wish to know their status. So far mothers
are not given information on the risks/benefits of breastfeeding or
replacement feeding, but a proposal for an innovation is in the pipeline
whereby mothers may be counselled *at delivery* and "helped" to feed their
babies replacements.  The details are still being worked out, but some of us
are concerned about this.

To answer some of the comments that were made. The current cost of formula
feeding one baby with the least expensive brand of formula exceeds 50% of
the minimum wage. However the cost of the formula is only a part of the
problem.  My belief is that the risks to the babies of *not* breastfeeding
in the conditions that most of the women in this study live in (endure)
would exceed the risks of HIV transmission (5.4%).  I have also heard that
where HIV+ mothers have been persuaded not to breastfeed, they may indeed
give replacement feeds at home, but still breastfeed outside the home
because of the stigma of being branded HIV+ by others.  There are many cases
on record of domestic violence towards women who have tested positive
because yes, the husband will believe that his wife has been unfaithful.
Most mothers will breastfeed for about l8 months, approx one quarter will
continue to two years.

Any comments are welcome, on Lactnet, or privately.

Pamela Morrison IBCLC, Zimbabwe
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