Desclaux Alice
Laboratoire d'écologie humaine et d'anthropologie, Université d'Aix-Marseille, 38, avenue de l'Europe, 13090 Aix-en-Provence, France.
Sante. 2002 Jan-Mar;12(1):73-5.
In the 1990s, many programs and actions were set up for promoting breastfeeding in Africa, more or less successfully in different countries. The main achievements of these programs were the training of health professionals and the apparent ending of the distribution of formula in Health services. The impact of these programs on breastfeeding practices in countries with prevalent prolonged mixed feeding is less obvious, as many programs did not emphasize "best practices". Health messages delivered on this topic have been poor, because they were often conceived at the international level rather than adapted to African contexts, and because the consensus about the promotion of breastfeeding is so strong that the programs have rarely undergone a critical evaluation. The HIV/AIDS pandemic could be an opportunity to rethink these programs. "Baby friendly" Health services are now considered as the most knowledgeable to deal with breastfeeding in the context of HIV, through the reinforcement of the promotion of "best feeding practices" and through the follow-up of formula-feeding for some HIV-positive mothers. To prevent HIV transmission, health messages will have to promote some practices that are useful for HIV-negative, as well as HIV-positive, mothers, such as exclusive breastfeeding, the prevention, early diagnosis and treatment of abscesses and mastitis, and the management of weaning - all strategies that were undervalued until now. For children of HIV-positive mothers and for orphans, Health services will have to set up a medical follow-up of artificial feeding. These new goals mean that breastfeeding promotion programs will have to develop complementary strategies with an emphasis on care, coordinated with other vertical programs such as AIDS and malnutrition programs.
20世纪90年代，非洲设立了许多促进母乳喂养的项目和行动，在不同国家取得了不同程度的成功。这些项目的主要成就是对卫生专业人员的培训以及在卫生服务中明显停止了配方奶粉的分发。这些项目对长期普遍存在混合喂养的国家的母乳喂养行为的影响不太明显，因为许多项目没有强调“最佳做法”。关于这个主题传递的健康信息质量不佳，这是因为这些信息往往是在国际层面构思的，而非根据非洲的实际情况进行调整，还因为促进母乳喂养的共识非常强烈，以至于这些项目很少接受批判性评估。艾滋病毒/艾滋病大流行可能是重新思考这些项目的一个契机。现在，“爱婴”卫生服务被认为在处理艾滋病毒背景下的母乳喂养问题方面最具专业知识，这是通过加强对“最佳喂养做法”的推广以及对一些艾滋病毒呈阳性母亲的配方奶喂养进行跟踪实现的。为了预防艾滋病毒传播，健康信息将必须推广一些对艾滋病毒阴性和阳性母亲都有用的做法，比如纯母乳喂养、脓肿和乳腺炎的预防、早期诊断和治疗以及断奶管理——所有这些策略迄今为止都未得到足够重视。对于艾滋病毒呈阳性母亲的孩子和孤儿，卫生服务将必须建立人工喂养的医疗跟踪。这些新目标意味着母乳喂养促进项目将必须制定以护理为重点的补充策略，并与艾滋病和营养不良项目等其他垂直项目相协调。
