WHO AFASS criteria for replacement feeding

Many families can not have an equal chance of buying replacement feed, so they are choosing one of the replacement feed according to the AFASS criteria. These criteria help you to counsel HIV-positive mothers about feeding options for their newborns.

• Acceptable: replacement feeding for breast milk is acceptable by the mothers. It means that the mothers accept the replacement food is whether adequate or not to the newborn.
• Feasible: the mother has access to clean and safe water for cleaning the feeding-measuring cup and spoon, and diluting the formula milk if it comes as a powder.
• Affordable: the family can afford to buy enough formula milk or animal milk to feed the baby adequately.
• Sustainable: the mother can prepare feeds for the child as frequently as recommended and as the baby demands and it should not be interrupted.
• Safe: the formula milk should be safe, nutritious and good for the health of the baby

Recommendations of replacement feeding

• Mothers should be taught about safe preparation of breast-milk substitute.
• The instructions for mixing the commercial formula need to be followed exactly according to the supplier recommendations.
• Possible breast-milk substitutes include:
  • Commercial infant formula feed.
  • Liquid animal milk (cow or goat).
  • Powdered animal milk.
• All other kinds of milk are unsuitable for small infants.
• For all breast-milk substitutes, it is recommended to follow basic hygienic measures for preventing infections.
  • Wash hands with soap and clean water.
  • Clean all utensils, containers, and cups with soap and clean water.
• Mothers should give the infant a micronutrient supplement every day.
• The breast-milk substitute should be fed by a cup.

Safe preparation of formula feeding

• Always use a marked cup or glass and spoon to measure water and the scoop to measure the formula powder.
• Wash your hands before preparing a feed.
• Bring the water to the boil and then let it cool. Keep it covered while it cools.
• Measure the formula powder into a marked cup or glass according to the preparation advice on the package of the formula milk.
• Add a small amount of the cooled boiled water and stir. Fill the cup or glass to the mark with the water. Stir well.
• Feed the baby by using a cup.
• Wash the utensils.

The mother or caretaker should have received full counselling before making this decision

• Assess and ensure that the mother or caretaker has an adequate supply of commercial infant formula (at least for 12 months).
• Assess and ensure that the mother or caretaker knows how to prepare milk correctly & safely and has the facility and resources to do it.
• Demonstrate how to feed with a cup and spoon rather than a bottle
• Make sure that the mother or caretaker understands that mixing breastfeeding with replacement feeding may increase the risk of HIV infection.
• Advise the mother to come for monthly feeding assessment.

The recommendations when using liquid cow or goat milk in infants less than six months old and for each feed are the following:

• For the one-month-old mix 40 ml of milk with 20 ml of boiled water and add 4 gr of sugar.
• For a two-months-old mix 60 ml of milk with 30 ml of boiled water and add 6 gr of sugar.
• For infants 3-4 months old mix 80 ml of milk with 40 ml of boiled water and add 8 gr of sugar.
• For infants 5-6 months old mix 100 ml of milk with 50 ml of boiled water and add 10 gr of sugar.

If the substitute is going to be prepared using powdered cow's milk the following is recommended for each feed

• For the one-month-old infant mix 5 gr of milk with 60 ml of boiled water and add 4 gr of sugar.
• For the two-month-old mix 7.5 gr of milk with 90 ml of boiled water and add 6 gr of sugar.
• For infants 3-4 months old mix 10 gr of milk with 120 ml of boiled water and add 8 gr of sugar.
• For infants 5-6 months old mix 12.5 gr of milk with 150 ml of boiled water and add 10 gr of sugar.