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IFE in cholera

This question was posted the Infant and young child feeding interventions forum area and has 8 replies.

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Astrid Klomp

Health and Nutrition Coordinator

Normal user

17 Oct 2022, 09:06

Dear all,

There seems to be a message in several documents that a mother should wash her breasts with soap and water before breastfeeding if she has cholera. This goes against anything I have been tought as an IBCLC (makes it more difficult for the baby to find the breast; barrier to putting the baby to the breast when it needs to; could cause the breasts to dry out and so cracked nipples; soap residues that might be harmful etc) and I don't understand how this could be a source of transmission. Does anybody have any evidence behind this advice, or is this just something that was thought to be good, but actually other evidence could point in the other direction?

Here are the sources where I found this recommendation: https://resourcecentre.savethechildren.net/pdf/b._breastfeeding_mothers_in_cholera_treatment_centres.pdf/ and https://reliefweb.int/sites/reliefweb.int/files/resources/UNICEF-Cholera-Toolkit-2013.pdf (page 208)

I am asking since this message is now being spread in the cholera response in Lebanon, and worried we continue to share something that could be possibly harmful.

Thanks!

Rukhsana

Chair, TAHN Foundation

Normal user

17 Oct 2022, 09:51

Dear Astrid,

Thank you for asking this question. In fact where health staff have not received basic/updated training on breastfeeding, mothers with newborns are often given this advice. As you have rightly pointed out, this advice is quite harmful. I have worked for several years at the International Diarrhoeal Disease Hospital in Bangladesh, and I am sure there is no evidence to support this kind of advice! Mothers admitted with diarrhoea, including suspected or confirmed cholera, are advised to continue breastfeeding their infants ad libitum. General hygienic practices (bathing when possible, and handwashing) should be enough.  

I hope this helps. Thanks again.

Bindi Borg

Normal user

17 Oct 2022, 10:44

Hi Astrid

Your concerns are very valid and thanks for the clear response Rukhsana.  As I understand the history of this recommendation, breastwashing was in some much earlier, now outdated and refuted advice.  However, where old documents are still about, or as Rukhsana said, when training is not updated, it pops up again.  

Maybe it would be a useful endeavour to track down the original document and have the author/s put out a clear statement that breastwashing is NOT recommended.

Best

bindi

CAB

Health Advisor

Normal user

31 Oct 2022, 07:39

Dear all,

Thanks a lot to have put this in front line.

Any expert on IFE (Mija?) may give their advice on this? I had the confirmation it's  spread out as a good practice in Lebanon but the fact are debating as good or not.

Best

Chantal

André Briend

Frequent user

31 Oct 2022, 07:50

Dear Chantal,

Please refer to the post above by Rukhsana. She is very humble in describing her career but I can tell you she is a leading international expert in IFE with a deep knowledge of cholera. You can really trust her advice.

Kirrily de Polnay

Nutrition department, WHO HQ

Normal user

31 Oct 2022, 08:35

Dear Astrid, 

There is currently no WHO guidance from WHO HQ which recommends washing the breasts before breastfeeding for a woman who has cholera. There is of course a considerable amount of mention (in many pieces of WHO guidance) of the importance of washing hands at all the normal appropriate moments, including before breastfeeding. There is also a lot of mention of the importance of continued breastfeeding for children with all types of diarrhoea including cholera. Hope this helps.

CAB

Health Advisor

Normal user

31 Oct 2022, 13:38

Dear  Adrien, Rukhsana, thanks a lot for both feedback, believe me I do not doubt at all on guidance of Rukhsana or any of us, but as usual concerning EB there is so many tends and believe that sometimes it's hard to convince or influence people in front of us. I have to admit that I do not know Rukhsana and it seem it's an error, but when I am discussing with Lebanon, it seem that it's a believe already spread before cholera outbreak which might influence decision as of now even the official guide I have seen seem not really clear for now on. BEst C.

Mija Ververs

JHU and CDC

Normal user

31 Oct 2022, 14:43

Hi all, I have just been made aware of this extremely useful conversation. So where is the exact disagreement?

1. We all agree that breastfeeding is essential in a cholera setting, whether the mother or infant is positive, or both. Correct?

2. We all agree that handwashing with water and soap is essential too in that scenario.

The question is whether the breast needs to be washed with water and soap - correct? 

What would be against washing the breast with water and soap but not the nipple and areola? (I am not referring here to a newborn, but a child that is already initiated and breastfed). 

Jodine Chase

IFE Core Group Facilitator *

Technical expert

15 Nov 2022, 13:16

Thanks all for your contributions to this important discussion. I am popping into this thread to let you all know that IFE Core Group members engaged with global guidance on cholera and breastfeeding are taking steps to address the concerns that have been raised, and will report back here when progress has been made.

If you have any problem posting a response, please contact the moderator at post@en-net.org.

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