News (Updated January 19,
2003)
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Fri Jan 17,11:37 AM ET
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By Merritt McKinney
NEW YORK (Reuters Health) - Companies that make baby formula are violating international guidelines in the way they market their products in West Africa, the authors of a new study released Thursday claim.
"Manufacturers of breast-milk substitutes are using national health care systems in Togo and Burkina Faso to promote their products," the study's lead author, Dr. Victor M. Aguayo, told Reuters Health.
Aguayo, of the Helen Keller International Regional Office for Africa, and his colleagues report that several manufacturers provided free samples of breast-milk substitutes, a practice prohibited by World Health Organization (WHO) code.
The survey also identified 40 products--not only infant formulas but other products for young children--whose labeling did not conform with the guidelines. For instance, several labels recommended an inappropriate age for starting infant formula, according to a report in the January 18th issue of the British Medical Journal.
Several products also did not advise parents to check with a physician before giving them to a child, according to the report.
There is a need for "urgent policy action" to make sure that families receive objective information about how to feed their children, Aguayo said. He noted that the two countries surveyed, Togo and Burkina Faso, have some of the highest infant mortality rates in the world. Inadequate breast-feeding is to blame for a considerable proportion of those deaths, Aguayo said.
The report provides more evidence that many companies "fly in the face" of the international code on the marketing of breast-milk substitutes, according to Drs. Tony Waterston of Newcastle General Hospital in the UK and James Tumwine of Makerere Medical School in Kampala, Uganda.
In an editorial that accompanies the study, Waterston and Tumwine describe breast feeding as "one of the most cost effective interventions to improve health and prevent illness in early childhood." Even in most poor countries with many cases of HIV, the virus that causes AIDS, the risk of bottle feeding outweighs the risk that a child will contract HIV by breast feeding, according to the editorialists.
Waterston and Tumwine call the WHO code "central" to promoting children's health, but they conclude that enforcement of these standards needs to be improved.
But a spokesman for Switzerland-based Nestle, which is mentioned as running afoul of the WHO code in the report, said that the company abides by the international rules in all developing countries.
Francois-Xavier Perroud said in an interview that Nestle has a national ombudsman in each country where it markets its products. The role of this ombudsman is to look at any alleged violations and take any necessary steps to correct them.
He added that most of the products mentioned in the study were not infant formula, but "complementary food," such as cereals and fruit juices. They also included formulas designed to nourish premature babies, he said.
"These are not breast-milk substitutes and are not covered by the code," according to Perraud.
In a written statement, Danone, which was also mentioned in the report, said it was "very surprised" by the article. The company declared that the assertions of the article "are not in accordance" with the practices of the Paris-based company.
According to the Danone statement, the international code applies only to breast-milk substitutes, not other food products.
"As a consequence, only 3 out of the 21 Danone products mentioned in the article are actually concerned by this code," the company said.
Regarding the three Danone breast-milk substitutes that were mentioned in the report, the company said that since 1998, all Danone breast-milk substitutes have included the following message: "Breast milk is the ideal food for your baby; however, if your child needs a milk supplement, first consult your doctor."
In the study, researchers surveyed health facilities and places where breast-milk substitutes were sold and distributed in Burkina Faso and Togo.
Burkina Faso, but not Togo, has enacted legislation in accordance with the international guidelines. However, the level of violations, according to the report, was equivalent in both countries.
Aguayo said that governments should make sure that officials are adequately trained to make sure that the international code on breast-milk substitutes is followed.
But, ultimately, Aguayo said that the responsibility of complying with the code falls on the manufacturers themselves.
SOURCE: British Medical Journal 2003;326:113-114,127-130.
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Fri Jan 17, 6:05 PM ET
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By Alan Mozes
NEW YORK (Reuters Health) - Indigenous people in Western Canada who use injection drugs appear to have twice the risk for contracting HIV as non-native IV drug users, say researchers.
"At least in this particular area, the aboriginal people who use injection drugs are experiencing HIV infection rates that we wouldn't normally see even in sub-Saharan Africa," said study co-author Dr. Martin T. Schechter of the University of British Columbia in Vancouver, Canada. "So we have a developing world situation right here in North America."
Schechter and his colleagues analyzed the sexual and drug-taking behavior of more than 1,400 male and female injection drug users living in the Vancouver area. The data had been collected between 1996 and 2001 as part of the Vancouver Injection Drug User Study. All participants were 14 or older, and all had injected an illicit drug at least once in the month prior to signing up for the study.
The researchers focused on the interview and questionnaire responses of the 941 participants found to be HIV negative at the study's outset. Nearly one quarter of the group were classified as Aboriginal Canadians--commonly referred to as Native Americans in the US.
After analyzing blood samples taken during a series of follow-up exams, Schecter and his team found that by May 2001 nearly 12% of the HIV-negative group had become infected with HIV.
When breaking down the HIV infection rate along aboriginal and non-aboriginal lines, the research team found that 3.5 years into the study, the HIV infection rate was about twice as high among the indigenous injection drug users as among the non-native men and women. The increased risk was seen equally among men and women.
In the January 7 issue of the Canadian Medical Association Journal, the researchers report that among indigenous men and women an increased risk of becoming infected with HIV was associated with frequent cocaine injections and frequent speedball injections--the latter being a combination of cocaine and heroin.
Native Canadian women who went through periods during which they injected an illicit drug more often then usual--referred to as "bingeing"--were at higher risk for HIV infection, while a similarly elevated risk was seen among native Canadian men who frequently used heroin.
Schechter and his colleagues concluded that the Vancouver-based native Canadian population is at particularly high risk for HIV infection, given that injection drug use is known to be higher in this group than among non-natives.
The researchers noted that prior research has suggested that Canadian Aboriginals are vulnerable to the lure of injection drug use due to widespread poverty and social instability.
"Basically we know that HIV has an uncanny ability to seek out marginalized and disadvantaged people," Schechter told Reuters Health. "It has long been associated with entrenched poverty, for example. And that's why there have been warnings about the potential for HIV to spread among native people...in Canada, but in the US as well.
"For this particular group, much greater attention needs to be paid urgently," he added. "And from a cultural point of view the prevention efforts need to be done in total partnership with the native community. It's not something that white people can simply thrust upon them. They have to be given the resources to do it."
Schechter and his team further recommended that future AIDS prevention strategies--including needle exchanges and methadone treatments--be tailored to account for risk differences between the male and female native populations.
SOURCE: Canadian Medical Association Journal 2003;168:19-24.