Flash‐heating breastmilk is feasible in Dar es Salaam, Tanzania

Abstract

WHO recommends HIV+ mothers exclusively breastfeed (EBF) for 6 mos unless replacement feeding is acceptable, feasible, affordable, sustainable and safe. After 6 mos, adequate replacement foods are often unavailable and are immunologically inferior. Heat‐treating breastmilk is currently recommended by WHO as an infant feeding option for PMTCT of HIV but its feasibility has not been evaluated. Flash‐heating (FH) is a simple method for home pasteurizing breastmilk that inactivates HIV while preserving milk's nutritional and anti‐infective properties. Our objective is to determine the feasibility of FH once complementary foods are introduced. In this ongoing, longitudinal study, community health workers (CHWs) in Dar es Salaam, Tanzania, visit 100 HIV(+) mothers weekly from 2‐9 mos postpartum and counsel on FH if infant is HIV(‐) at introduction of complementary foods. Mothers are surveyed weekly about infant health and feeding practices and unheated and heated milk samples are collected biweekly. 24/61 (39%) mothers with HIV(‐) infants have chosen FH. Mean frequency of manual expression is 4.8 times daily (range 1‐7). Mean daily milk volume is 435 mL (range 60‐1080mL). 23/73 unheated milk samples contained pathogens; all FH samples are bacteriologically negative. 50% of FH mothers have disclosed their HIV status to their spouse; CHWs observed that stigma may be an obstacle to FH for some women. These data suggest that FH is a simple method for reducing MTCT of HIV that women can successfully use during times of high risk to potentially improve their infant's health and diet. FH may be most successful among women who have disclosed their status. Based on this feasibility data an efficacy study of FH on infant health outcomes is warranted.