Hundreds of Botswana infants, more than the number recorded in official statistics, are believed to have died as government?s intervention meant to prevent transmission of HIV from infected mothers to their children backfired.
An American medical epidemiologist who was flown into the country to investigate last year?s epidemic, which resulted in the deaths of 532 Batswana infants, believes the death toll was underreported.
Her report, presented at last week?s 14th annual Retrovirus Conference in Los Angeles, further revealed another epidemic in Botswana related to infant formula milk which resulted in more than 100 known deaths but was never publicly reported.
Medical epidemiologist, Dr Tracy Creek, told the conference that in 2005 Botswana authorities counted 9,166 children who were hospitalized for diarrhea illnesses; 21 children died. In 2006, after the floods, 35,046 children were hospitalized for these diseases, and 532 children died between January and March. She said that the figure was an underestimation because it only reports children who died in hospitals.
?A household survey conducted in the area found that 50 percent of infant deaths did not occur in hospital facilities. In one village, 30 percent of formula-fed babies ? but none of the breast-fed babies ? died,? Creek said.
The American epidemiologist revealed another epidemic related to formula milk that was never reported.
?On top of the diarrhea disaster, health authorities found another epidemic had emerged: More than 153 children died from malnutrition, and 93 percent of those children were being bottle fed.?
As part of public policy, Botswana advised that all HIV-infected women use infant formula to avoid transmitting the virus to their babies through breast milk. But a recent study has found that infant formula, as compared to breast-feeding, increased a child?s risk of death by 50 times, likely because of contaminated water used to make the formula. In 2005, a third of the pregnant women in Botswana were infected with HIV, making it one of the hardest-hit countries in the world. Previous studies have shown that breast-feeding, depending on how long it?s done, accounts for 5% to 20% of the transmissions from infected mother to their children. To help curb such transmission rates, the Botswana government advised in 1998 that all HIV-infected women use infant formula as part of a comprehensive strategy that also included the use of anti-HIV drugs during labour and delivery. The formula recommendation went a step beyond World Health Organization (WHO) advice, which cautions that HIV-infected women should use formula only when it is acceptable, feasible, affordable, sustainable, and safe.
In response to the government policy, 63 percent of infected mothers in Botswana now use formula, which is provided free by the government to protect their babies from the virus. But from January to March 2006, 532 children in the country under 5 died from diarrhea, up from 21 the year before.
To probe the reasons behind the outbreak, medical epidemiologist Tracy Creek of the U.S. Centers for Disease Control and Prevention in Atlanta, Georgia, and colleagues examined a cohort of 153 Botswana children, 65 percent of whom had an HIV-infected mother. In this entire group, 22 percent of the children died; only one of them had been breast-fed. The HIV-infected status of the mother and the infant was not associated with any of the deaths. Stool samples taken from children in the study found that several dangerous pathogens had infected the children: 60 percent had Cryptosporidium, 50 percent had Escherichia coli, and 38 percent had salmonella.
Creek suspects that the severe flooding in Botswana in 2005 contributed to the outbreak by increasing the levels of microorganisms in the water supply. Because Botswana mothers use this water to make infant formula, the ?safety [of infant formula] may vary dramatically with the weather,? Creek warned.
Breast-feeding clearly carries a risk of transmission, but Creek stressed that it had to be balanced against the risks of formula in such settings. ?A recommendation to all HIV-infected women to formula-feed is not based on the WHO guidelines,? said Creek, whose team has advised Botswana to reevaluate its universal policy.