HARARE, 30 July 2010 (IRIN) - Health and nutrition experts in Zimbabwe are worried that one of the lowest exclusive breastfeeding rates in the region could have a negative impact on the country's prevention of mother-to-child HIV transmission (PMTCT) programme.

Just six percent of mothers exclusively breastfeed their child for the first six months, according to the recent Zimbabwe National Nutrition Survey [http://www.plusnews.org/Report.aspx?ReportId=89862] carried out by the United Nations Children's Fund (UNICEF), with the Zimbabwe Food and Nutrition Council, and other partners.

The World Health Organization (WHO) recommends that infants born to HIV-positive women be exclusively breastfed for the first six months, which not only helps safeguard their nutritional status but also significantly reduces their chances of contracting HIV.

Studies in South Africa have shown that babies born to HIV-positive women who are fed solids as well as their mother's milk are almost 11 times more likely to contact HIV than those who are exclusively breastfed.

In keeping with the WHO guidelines, HIV-positive mothers in Zimbabwe are encouraged to breastfeed exclusively for the first six months.

Although Zimbabwean national health surveys in 2005 and 2009 put the figure for exclusively breastfeeding at closer to 25 percent, UNICEF spokesperson Tsitsi Singizi said the nutrition survey used a different and more accurate methodology.

It also found that at least one-third of Zimbabwean children under the age of five were malnourished, with around 12,000 at risk of dying from poor nutrition. The survey associated these widespread nutritional problems in children with the low rate of exclusive breastfeeding.

"The findings of the survey are very disturbing because we know that when HIV-positive mothers practice mixed feeding this greatly increases the risk of them passing on HIV to their babies," Singizi told IRIN/PlusNews.

The latest WHO recommendations also recommend that all HIV-positive pregnant women begin antiretroviral (ARV) treatment at 14 weeks of pregnancy and continue until they stop breastfeeding, but finding resources for implementing this are unlikely in Zimbabwe's cash-strapped public health sector.

The PMTCT programme is also struggling with low uptake of antenatal services - over 93 percent of pregnant women attend clinics, but less than half of those requiring PMTCT services access them - an enormous missed opportunity, UNICEF noted. The low numbers of women practicing exclusive breastfeeding could further jeopardize the programme.

Dr Mduduzi Mbuya, a research scientist with Zvitambo, a research organization working to improve HIV services for women and children, said although women were informed of the benefits of exclusive breastfeeding during antenatal clinic visits, they often received conflicting advice on mixed feeding from decision-makers at home, such as mothers-in-law, aunts and fathers.

"We know that nursing mothers in Zimbabwe are introducing other foods too early - as early as one month, against the recommended six months," he said. "We also know that 10 percent of all under-five mortality is attributable to not exclusively breastfeeding in the first six months of life, and it is the reason why we see high levels of malnutrition, stunting and underweight in children."

Studies by Zvitambo on infant feeding and child nutrition helped inform the Zimbabwe National Nutrition Survey, which also found that some women were unable to exclusively breastfeed due to their own low nutritional status.

Mbuya said if children had already fallen through the cracks of the PMTCT programme, not being exclusively breastfed would further lower their chances of survival. HIV-positive infants are more susceptible to malnutrition, placing them at higher risk from life-threatening opportunistic infections.

"Our studies at Zvitambo showed that mixed feeding before three months ... results in 50 percent more sick clinic visits in the first six months of life," he told IRIN/PlusNews. "This is the reason why we have high child mortality rates in Zimbabwe."

Dr Gerald Gwinji, Permanent Secretary in the Ministry of Health and Child Welfare, said government was disturbed by the poor breastfeeding rates and called on partners to help government expand education about the benefits of breastfeeding.

"I call upon all stakeholders to work hard to ensure that rates of exclusive breastfeeding are increased," he said.

See also: ZIMBABWE: A third of children chronically malnourished [http://www.plusnews.org/Report.aspx?ReportId=89862]

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