Wednesday, September 23, 2020

MoH response to article about PMTCT

Dear Editor

We refer to the article published in The Sunday Standard of March 4, 2007 entitled ?Hundreds more died from bottle feeding ? expert.?
The Ministry of Health objects to the misrepresentation of facts and negative insinuation in the article about the Botswana Prevention of Mother to Child Transmission of HIV (PMTCT) program. Indeed, as a country, we are regarded very highly internationally because of our successful and truly national PMTCT program.

No other country on the African continent has implemented this program to the extent achieved by Botswana. In the developing world, we are only comparable to Thailand and Brazil. Before the inception of PMTCT in 1998, the transmission of HIV from mother to child was estimated at 30 to 40 percent amongst HIV infected pregnant women, and this translated to at least 5500 infected children every year. With PMTCT, HIV transmission rates are less than 6 percent with rates as low as 3 percent recorded recently. In effect, this program is achieving more than 90 percent reduction in transmission rates. This is commendable by any standard.

The major routes of HIV transmission from mother to child are:

During pregnancy (in utero)
During delivery (peri partum)
During breastfeeding (post partum)

The strategies employed by Botswana are scientifically based, and have been accepted intentionally including by WHO, UNICEF and CDC.

The first strategy is to reduce the risk of HIV infection by potential mothers. Recent data from Sentinel Surveillance amongst pregnant mothers shows a decline in HIV prevalence rates. For those who are already infected there is solid evidence that various ARV drugs can significantly reduce transmission of HIV to the baby during pregnancy and delivery. This is the cornerstone of our PMTCT program. The third strategy is to minimize or eliminate the chances of HIV transmission to the baby after delivery through breast feeding. The Botswana PMTCT program provides free infant formula for babies born to HIV positive mothers.

All these strategies were started in consultation and in agreement with our major partners namely, WHO, UNICEF and CDC. The claim in the article that Botswana went against WHO advice is simply false.
The Ministry of Health believes that breastfeeding remains the best method to feed newborns and young infants. Breastfeeding should, therefore, be actively promoted. It provides not only nutritionally balanced diet for the infant but also important immunity against common infections.

However, there are times when breastfeeding is not advisable on medical grounds, and an HIV infected mother is one of those conditions. A mother who has to formula feed needs extensive counseling and support in making this choice, so that the known risks of formula feeding may be minimized.

Therefore HIV positive mothers, who have made a decision to use formula after counseling, are guided on how to safely and appropriately prepare and use the formula including emphasis on overall sanitation and hygiene. Cup feeding is recommended over bottle feeding to minimize chances of contamination because cleaning a cup is easier than cleaning a bottle. However, if bottle feeding is still preferred after counseling on the dangers of bottle feeding, mothers are shown how best to clean and use the bottle. It is in this regard that Botswana ascribes to the AFASS (Acceptability, Affordability, Feasibility, Sustainability and Safety) principles as contained in the WHO guidelines. The allegation that we have not followed WHO guidelines is simply not true.

This is our eighth year of a successful PMTCT program. Out of these eight years, we had one year (2006) with a severe diarrhea outbreak. To blame the 2006 diarrhea outbreak simply on PMTCT is being economical with the truth. In our view, the heavy rains and floods clearly contributed to this outbreak.

According to our statistics 568 children died of diarrhea during week 1 to 18 in 2006. We are confident that this figure represents most children who died of diarrhea during that period. The figure was compiled from hospital and District Health Team reports. Most deaths in Botswana occur in health facilities. We strongly dispute the claim by the so called CDC expert that there was as much as 50 percent underreporting. We challenge the expert to substantiate her claims.

The vicious cycle of diarrhoea causing malnutrition and malnutrition leading to diarrhoea is well known to health workers. That we had more malnutrition associated with the diarrhoea outbreak of 2006 is, therefore, not new nor a discovery by the esteemed CDC expert.

We are making progress against HIV in children through PMTCT. Let us all work together to keep these children alive by educating parents on hygienic ways of feeding their babies so that by 2016 these babies will not only be HIV negative but alive.

Dr L Mazhani


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The Telegraph September 23

Digital edition of The Telegraph, September 23, 2020.