Nutrition and HIV/AIDS: A Training Manual - Linkages Project

depending on the context. The promotion of improved women’s nutrition may alsobe important for PMTCT.Consistent with the ENA approach, experience has shown that a full antenatalservice package for PMTCT should include VCT, maternal tetanus toxoidimmunization, screening and treatment for sexually transmitted infections, iron andfolic acid supplementation, malaria preventive intermittent treatment, tuberculosistreatment where appropriate, basic obstetric care, and information on HIVprevention, infant feeding counseling, and family planning (Dabis et al 2000a).Ensuring good nutrition during pregnancy and lactationVitamin A deficiency has been associated with a significant increase of HIV inbreastmilk and increased mortality of HIV-infected adults (Nduati et al 1995).Vitamin A supplementation, however, has not resulted in reduced MTCT (Coutsoudiset al 1999). Iron deficiency is associated with low birth weight and prematurity. Bothare risk factors of infant HIV infection. One study (Fawzi et al 1998) found thatmultivitamin supplements resulted in a 44 percent reduction in low birth weight, 39percent reduction in prematurity, and improved maternal hemoglobin and CD4counts after delivery.The risks to the HIV-infected breastfeeding mother have been a subject of somedebate. One study in Nairobi (Nduati et al 2001) included 425 HIV-infected pregnantwomen who were randomly assigned to breastfeed or formula feed. The study wasdesigned to examine modes of infant feeding and associated rate of MTCT. Asecondary analysis, however, revealed that the relative risk of death forbreastfeeding mothers compared with formula feeding was 3.2. There was also anassociation with maternal death and subsequent infant death. A WHO statement(2001) advised that the results of this study pertaining to mortality should beinterpreted with caution. However, the study highlights the importance of care andsupport to the HIV-infected mother.Although MCH clinics are an excellent entry point for PMTCT interventions, they donot necessarily reach men. Outreach to men and communities should be integral toMCH interventions, so the burden is not only on mother.196