Heat treatment of expressed breast milk as in-home procedure to limit mother-to-child transmission of HIV : a systematic review
Ten Ham, Wilhelmina Hendrika
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Mother-to-child transmission (MTCT) of HIV is the most significant source of HIV infection in young children. As the HI virus has been identified in cell-free and cell-associated compartments of breast milk, it is clear that breast milk is one of the ways in which mother-to-child transmission of HIV can take place in addition to in utero and intrapartum transmission. While breastfeeding carries the risk of HIV transmission, not breastfeeding carries significant health risks for infants and young children, such as an increased risk of diarrhoea and pneumonia, morbidity and mortality. When an HIV-positive mother decides to breastfeed her baby, pasteurisation of expressed breast milk (EBM) could be a possible infant-feeding option to limit transmission of the HI virus through breast milk, since this method has shown to effectively inactivate HIV type 1. Three methods of pasteurisation of human milk were investigated in this study: Holder pasteurisation, flash-heating and Pretoria pasteurisation. The systematic review is a helpful method to summarise the best-quality empirical evidence of the benefits and limitations of a specific method, such as heat treatment, and to provide recommendations for future research. Therefore, the aim of this study was to critically synthesise by means of a systematic review the best available existing evidence and to provide a clear overview of the effectiveness of heat treatment of EBM as an in-home procedure to inactivate the HI virus, and in so doing limit mother-to-child transmission of HIV. This study provides the clinical practitioner with accessible information on the effectiveness of heat treatment of EBM as an in-home procedure in terms of (1) safety, inactivation of the HI virus and retaining the protective and nutritional value of the EBM; (2) feasibility as an in-home procedure; and (3) acceptability by the mothers and their communities. This information could be used to improve clinical practitioners‟ knowledge and include it in their health education to contribute to the prevention of mother-to-child transmission. This study is based on the framework of the model for evidence-based clinical decisions of Haynes, Devereaux and Guyatt (2002). The search strategy was conducted in March/April 2009. The initial search resulted in 574 articles. After thorough screening of potentially relevant studies on heat treatment of EBM, the studies that met the inclusion criteria were critically appraised and scored based on their methodological qualities using standardised instruments. After 6 months, the search was updated. The search obtained 1 article. The final sample involved 12 articles. Conclusions were integrated and synthesised as a basis for developing a clear overview of the best available existing evidence. Finally, the findings of the study were synthesised and the research was evaluated, a conclusion was given, limitations were identified and recommendations were formulated for nursing practice, education and research. The bottom-line answer concluded that heat treatment of EBM should be emphasised as a safe alternative for feeding exposed infants (those of an HIV-positive mother, those of uncertain HIV status or during weaning if the mother cannot afford formula or cow‟s milk), but should be supported with appropriate information to the individual mother, her family and the community. Overall it can be concluded that existing evidence of the effectiveness (in terms of safety, feasibility and acceptability) of heat treatment of EBM, particularly Pretoria pasteurisation, used as a simple in-home procedure, is insufficient, and further research is required.
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