Ameena Goga of the Medical Research Council had not delivered her results at the time of going to press, but Government was due to announce the findings with great fanfare this morning.
Goga and her co-researchers’ national survey of infants attending 6 week immunisation clinic visits show that nine years after implementing a national Prevention of Mother to Child Transmission (PMTCT) program, the country’s transmission rate among babies four to six weeks after birth was around 3.5%.
The results are being hailed as good news in the light of the South African National Strategic plan (2007-2011) which prioritises the scaling up of PMTCT to reduce MTCT to less than 5% by 2011.
Researchers collected samples at 580 state facilities across the country after trained nurses interviewed mothers and tested almost 10 000 babies for HIV.
Developed countries in Europe and the US are heading towards MTCT rates close to 1% with paediatric HIV virtually eliminated in some areas.
Khayelitsha in the Western Cape has been hailed for achieving an MTCT rate of 2,5%. Dr Eric Goemaere of Medecins Sans Frontieres (Doctors without Borders) in the Cape Town suburb said they were already treating less children with HIV.
Goga and her colleagues said that reducing unplanned pregnancies among HIV-infected women, and reducing mixed feeding might reduce MTCT rates even further.
Public health expert Professor David Sanders claimed that the issue of infant feeding was always ignored in AIDS discourse including at conferences.
‘35% of SA under-5 deaths are associated with HIV. This leaves 65% of child deaths due to other conditions. South Africa’s under 5 mortality rate of 67/1000 live births is worse than Bangladesh (54/1000),’ said Sanders.
He said diarrhoea and pneumonia were the top two killers (as well as newborn problems) and that all of these causes were much higher in a non breast-fed population.
‘HIV has further undermined breastfeeding in this country. We find in our research that most infants (HIV positive and HIV negative) are being given formula from very early. Most HIV positive women practice mixed feeding (77% by 12 weeks post partum) despite receiving free formula through the health service (except KwaZulu-Natal which has recently decided to phase out free formula).’
Sanders said this meant many children were dying unnecessarily from infections and that the HIV community had unwittingly contributed to this.
‘Now there is no excuse. With new antiretroviral therapy regimes for pregnant and lactating women, breastfeeding is definitely the safest option, but the question we need to ask is whether the HIV community has shifted,’ Sanders questioned.
Dr Tanya Doherty, an expert researcher on PMTCT at the MRC, said there had to be an unequivocal message that breastfeeding was best. ‘It is concerning that South African PMTCT guidelines still recommend the provision of free formula milk through public health facilities despite WHO recommendations that governments should promote a single feeding method that is likely to provide the greatest chance of child survival. In South Africa, this is breastfeeding,’ said Doherty.
She said the lack of clear national guidance was now seeing provinces make their own policy decisions causing confusion at health facility and community level.
‘The current lack of a clear message about breastfeeding could reverse the gains made in the PMTCT arena,’ she warned.