Year : 2012 | Volume
: 56 | Issue : 1 | Page : 73--74
Home-modified animal milk for infant and young child feeding: Is it adequate, appropriate, and safe?
Secretary General, Indian Public Health Association and Director Professor, Department of Health Education, All India Institute of Hygiene and Public Health, Kolkata, India
Secretary General, Indian Public Health Association and Director Professor, Department of Health Education, All India Institute of Hygiene and Public Health, Kolkata
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Dobe M. Home-modified animal milk for infant and young child feeding: Is it adequate, appropriate, and safe?.Indian J Public Health 2012;56:73-74
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Dobe M. Home-modified animal milk for infant and young child feeding: Is it adequate, appropriate, and safe?. Indian J Public Health [serial online] 2012 [cited 2020 Sep 26 ];56:73-74
Available from: http://www.ijph.in/text.asp?2012/56/1/73/96981
According to current infant and young child feeding (IYCF) recommendations, infants should be exclusively breastfed for the first 6 months of life, and thereafter should receive appropriate complementary feeding with continued breastfeeding up to 2 years of age or beyond.
Despite the recommendation that babies should be exclusively breastfed for the first 6 months, according to National Family Health Survey (NFHS) 3 Report, in India, only 69% of children under 2 months of age are exclusively breastfed against the 10th Plan target of 80%. Exclusive breastfeeding drops to 51% at 2-3 months of age and 28% at 4-5 months of age. The declining rate of exclusive breastfeeding with age could be attributed to supplementation with plain water in early months and milk other than breastmilk in later months. Studies from different parts of the country shown that the practice of early introduction of top feeds in the form of dilute animal milk is widely prevalent.
Animal milk used for "top feeding" is usually modified at home as per traditional wisdom and earlier recommendations from healthcare providers. Medical recommendations such as Thomas Morgan Rotch's "percentage method" (published in 1890) gained widespread popularity in the early nineties. These recommended that parents mix cow's milk, water, and sugar or honey in specific ratios to achieve the nutritional balance are believed to approximate human milk reformulated in such a way as to accommodate the believed digestive capability of the infant.
These practices adversely affect the health and nutrition status of infants and young children, resulting in varying degrees of malnutrition that affects almost half of the nation's children.
Concerns have been voiced regarding the safety of preparation for home-modified animal milk. Additional concerns about health effects and the safety aspects of storage and feeding of home-modified animal milk have also been mentioned. Problems, including the risk of dilution error when modifying the milk, the risk of bacterial contamination, and the risk that it will cause occult bleeding in the gut if not adequately boiled, are acknowledged. A study of infant feeding practices in a rural area of Delhi revealed that the practice of diluting animal milk was nearly universal (95.3%). Dilution was irrespective of age of child and diluted milk was mainly given for economic reasons and belief that a child cannot digest undiluted animal milk.
Economic reasons therefore would also preclude safe and hygienic preparation, storage, and feeding practices among large majority of Indian population.
Also, a group that calls for particular attention is the infants of mothers who are known to be HIV-positive. To reduce the risk of transmission, UN Guidance on HIV and infant feeding issued in October 2000 recommends that when replacement feeding is acceptable, feasible, affordable, sustainable, and safe (AFASS), HIV positive mothers, who choose not to breastfeed, could include the use of home-modified animal milk as one of the feeding options. However, since the guidance was issued, concerns have been raised on the suitability of home-modified animal milk for replacement feeding for infants aged less than 6 months. A study from India showed that children who received replacement feeding, predominantly cow or buffalo home-modified milk, had a highly increased rate of hospital admission, mainly due to gastroenteritis with dehydration.
In the following articles/papers, studies have focused on these topics especially on the type of milk purchased, type and quantity of milk feeds given to the infant, and the storage, processing, modification, and consumption procedures, the effect of household practices on the microbiological and nutritional profile, and contaminants of milk.
The findings have serious implications for IYCF counseling. As in earlier studies, children have been commonly initiated on bovine milk post 3 months of age. The milk was mostly not covered while boiling and boiled at suboptimal temperature. Boiled milk was mostly kept outside openly in the kitchen or rooms and modified in majority of cases before being fed. Modification of the milk was often done with sugar and water and biscuits, fennel seeds, cardamom or infant cereals were added before feeding the baby. Addition of water was more prevalent amongst mothers of infants between 3 and 6 months. Every step during household practices in the handling of milk was found to reduce its nutritional profile, especially, the vitamin content, thus, significantly affecting the quality. The findings demand reemphasis on the need to utilize every opportunity to educate mothers on importance of exclusive breastfeeding for first 6 months and the benefits of implementing appropriate processing, storage, and consumption practices of bovine milk.
In the studies, the average Standard Plate Count (SPC) in vendor's milk was found to be very high as compared to pasteurized milk. Although boiling the milk reduced SPC and killed other microorganisms, storage of boiled milk at room temperature or refrigerated condition resulted in increase in SPC at the end of 24 h, which was significantly more in unboiled milk even under refrigerated conditions. The contaminant Aflatoxin M1 (AFM1) was detected at a concentration ranging from 0.071 to 0.075 ppb in unpasteurized as well as pasteurized milk samples analyzed during the course of study. Moreover, boiling had no impact on the quantity of AFM1 present in the milk.
This necessitates relook and strengthening of pasteurization process and hygienic conditions at the milk processing units along with the strict maintenance of cold chain of milk from suppliers to end users. Awareness programs and education for the dairy farmers and milk processors may be helpful in this regard.
WHO. Global Strategy for Infant and Young Child Feeding. Geneva, 2003. Available from: http://www.who.int/child-adolescent-. [Last accessed on 2012 Apr 15].Taneja DK, Saha R, Dabas P, Gautam VP, Tripathy Y, Mehra M. A study of infant feeding practices and the underlying factors in a rural area of Delhi. Int J Clin Med 2003;28:107-11. WHO Discussion Paper Prepared for HIV and infant feeding technical consultation 25-27 October 2006 home-modified animal milk for replacement feeding: Is it feasible and safe?Phadke MA, Gadgil B, Bharucha KE, Shrotri AN, Sastry J, Gupte NA, et al. Replacement-fed infants born to HIV-infected mothers in India have a high early postpartum rate of hospitalization. J Nutr 2003;133:3153-7. WHO/UNICEF/UNFPA/UNAIDS/World Bank/UNHCR/WFP/FAO/IAEA. 2003. HIV and Infant Feeding: Framework for priority action. Available from: http://www.who.int/child-adolescent-health/New_Publications/NUTRITION/HIV_IF_Framework_pp.pdf. [Last accessed on 2012 Apr 15]. Schuman A (2003-02-01). A concise history of infant formula (twists and turns included). Contemporary Pediatric. Available from: http://www.contemporarypediatrics.com/contpeds/article/articleDetail.jsp?id=111702. [Last accessed on 2012 Apr 15].Planning Commission of India Tenth five year plan (2002-2007). V. 2. Chap. 3. New Delhi: Government of India; 2001. p. 337.