Dop Marie-Claude
Institut de recherche pour le développement UR 106, Nutrition, Alimentation, Sociétés, Centre collaborateur de l'OMS pour la nutrition, IRD, BP 64501, 64394 Montpellier Cedex 5, France.
Sante. 2002 Jan-Mar;12(1):64-72.
In Africa, more than 95% of infants are currently breastfed, but feeding practices are often inadequate: feeding water, and other liquids, to breastfed infants is a widespread practice. Consequently, the rate of exclusive breast-feeding is low, particularly in West Africa. The rate of bottle-feeding is high in some countries (exceeding 30% in Tunisia, Nigeria, Namibia and Sudan). Nevertheless prolonged breastfeeding is common, and the median duration of breastfeeding ranges between 16 and 28 months. Urbanization and mothers' education are the major factors that tend to shorten breastfeeding. Nevertheless recent trends show an increase in early initiation and in duration of breastfeeding as a result of promotion efforts deployed by WHO and Unicef, local governments, and non-governmental organizations. The importance of breastmilk as a food resource of African countries is generally not recognized. In 31 countries where data on prevalence of breastfeeding are available, consumption of breastmilk by children under three years is estimated at 3.5 million tons per year. The AIDS epidemic could threaten breastfeeding because the virus can be transmitted through breastmilk, as demonstrated by numerous studies. A study suggests that feeding breastmilk and other liquids to infants could be the feeding mode associated with the highest rate of transmission. To prevent mother-to-child transmission of HIV, WHO recommends replacement feeding if it is feasible and safe. Otherwise, mothers are encouraged to practice exclusive breastfeeding for the first months of life followed by early and rapid weaning. The feasibility of replacement feeding with breastmilk substitutes, however, is very uncertain. In a study where free substitutes were given to HIV-positive mothers, the mortality of the formula-fed infants was the same as that of the breastfed infants. HIV-positive mothers may find it difficult to cope with the constraints of replacement feeding, in terms of cost, workload and time, and with the additional health care needs of non-breastfed infants. Exclusive breastfeeding for a few months could carry a lower risk of death than replacement feeding. But success in promoting exclusive breastfeeding has been limited in Africa, and new promotion methods are needed. Infants of all mothers, whether HIV-positive or not, will benefit from improving the rate of exclusive breastfeeding. The major problem is to ensure that early and rapid weaning, between 4 and 6 months, does not have a negative impact on the child's health. Early weaning is known to increase susceptibility to infections and can cause malnutrition. The feasibility and safety of this recommendation will have to be monitored carefully. A strong determination of African governments to promote exclusive breastfeeding among all mothers and to protect prolonged breastfeeding among non-infected mothers will limit the mother-to-child transmission of HIV while preserving the benefits of breastfeeding.
在非洲，目前超过95%的婴儿进行母乳喂养，但喂养方式往往并不恰当：给母乳喂养的婴儿喂水及其他液体是一种普遍做法。因此，纯母乳喂养率很低，尤其是在西非。在一些国家奶瓶喂养率很高（突尼斯、尼日利亚、纳米比亚和苏丹超过30%）。不过，长期母乳喂养很常见，母乳喂养的中位持续时间在16至28个月之间。城市化和母亲受教育程度是导致母乳喂养时间缩短的主要因素。然而，近期趋势显示，由于世界卫生组织、联合国儿童基金会、地方政府和非政府组织开展的推广工作，早期开始母乳喂养和母乳喂养持续时间有所增加。母乳作为非洲国家食物来源的重要性普遍未得到认可。在31个有母乳喂养普及率数据的国家，3岁以下儿童的母乳消费量估计为每年350万吨。艾滋病流行可能会威胁母乳喂养，因为众多研究表明，病毒可通过母乳传播。一项研究表明，给婴儿喂母乳和其他液体可能是传播率最高的喂养方式。为预防艾滋病毒母婴传播，世界卫生组织建议在可行且安全的情况下采用替代喂养。否则，鼓励母亲在婴儿出生后的头几个月进行纯母乳喂养，随后尽早快速断奶。然而，用母乳代用品进行替代喂养的可行性非常不确定。在一项向感染艾滋病毒的母亲免费提供代用品的研究中，用配方奶喂养的婴儿死亡率与母乳喂养的婴儿相同。感染艾滋病毒的母亲可能会发现，在成本、工作量和时间方面，难以应对替代喂养的限制，以及非母乳喂养婴儿额外的医疗保健需求。几个月的纯母乳喂养可能比替代喂养死亡风险更低。但在非洲，推广纯母乳喂养的成效有限，需要新的推广方法。所有母亲的婴儿，无论母亲是否感染艾滋病毒，都将从提高纯母乳喂养率中受益。主要问题是要确保在4至6个月之间尽早快速断奶不会对儿童健康产生负面影响。众所周知，过早断奶会增加感染易感性，并可能导致营养不良。必须仔细监测这一建议的可行性和安全性。非洲各国政府坚定决心在所有母亲中推广纯母乳喂养，并保护未感染母亲的长期母乳喂养，这将在保留母乳喂养益处的同时，限制艾滋病毒母婴传播。
