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Entwicklungen und Herausforderungen der Stillpraxis in den Ländern des südlichen Afrikas

Development and challenges to breastfeeding in sub-Saharan Africa

  • Leitthema
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Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz Aims and scope

Zusammenfassung

Da es an der Überlegenheit des Stillens gegenüber anderen Formen der Säuglingsernährung keinen Zweifel mehr gibt, stehen die Förderung des „ausschließlichen Stillens bis zu 6 Monaten und fortgesetzten Stillens bis zu 2 Jahren und darüber hinaus“ auf der höchsten weltweiten Ernährungsagenda; zuletzt im Beschluss der „Dekade für Ernährung“ (2016–2025) der Vereinten Nationen (UN). Diese Wertschätzung des Stillens resultiert aus Forschungsergebnissen und der Arbeit der Weltgesundheitsorganisation (WHO) während der letzten 20 Jahre sowie einer ausführlichen gesellschaftlichen, klinischen und akademischen Diskussion zum Thema „Stillen“.

Während rund um die Jahrtausendwende die Diskussion um die optimale Dauer des ausschließlichen Stillens geführt wurde, stehen zum gegenwärtigen Zeitpunkt die Frage nach effektiven Maßnahmen, die die Stillpraxis verbessern, im Vordergrund, da die gegenwärtige Stillpraxis weit hinter den Zielen zurückliegt. Obwohl in den Ländern des südlichen Afrikas fast alle Kinder gestillt werden, sind die Raten des ausschließlichen Stillens deutlich niedriger und unzureichend. Trotz der kulturellen Vielfalt auf dem afrikanischen Kontinent finden sich hier gemeinsame Haltungen zu Themen wie Mutterschaft, Muttermilch, Säuglingsernährung und zur Verantwortung der Familie.

In der Region ergeben sich durch die hohen mütterlichen HIV-Infektionsraten und die immer noch hohe Säuglings- und Kindersterblichkeit besondere Herausforderungen. Durch die effektive antiretrovirale Therapie ist es inzwischen auch für HIV-infizierte Frauen möglich und sicher, ihre Kinder zu stillen und ihnen ein HIV-freies Überleben zu ermöglichen. Hier gibt es aber noch Verbesserungsbedarf bezüglich der Verfügbarkeit der antiretroviralen Therapie und der Compliance sowie Forschungsbedarf zu den langfristigen Auswirkungen der antiretroviralen Therapie auf Gesundheit, Wachstum und Entwicklung der betroffenen Säuglinge und Kinder.

Abstract

Since there is no doubt concerning the superiority of breastfeeding compared to other forms of infant feeding, the promotion of exclusive breastfeeding up to six months and continued breastfeeding up to two years and beyond are again embraced at the highest global nutrition agenda. The latest is the United Nations decade of action on nutrition 2016–2025, building on research results and the work by the World Health Organization (WHO) over the last two decades, and extensive societal, clinical, and academic discussions in the field of breastfeeding.

While the discussion was about the optimal duration of exclusive breastfeeding around the millennium shift, the focus is on the most effective measures for the promotion and protection of breastfeeding. Contemporary breastfeeding rates are well behind the goals. In sub-Saharan Africa, almost all infants are breastfed, while exclusive breastfeeding is more seldom and not sufficient. Africa, being a vast and diverse continent with a myriad of cultural practices, has had some shared attitudes ranging from the west to east regarding views on motherhood, body fluids, including milk, infant feeding, and responsible others.

The region still faces high maternal HIV infection rates and high infant and child mortality rates. However, due to effective antiretroviral therapies, it is now possible and safe for women living with HIV to breastfeed their infants and to ensure them HIV-free survival. However, there is need for improvement regarding availability, compliance, and adherence to these drugs. Research gaps include the long-term effects of antiretroviral therapy on the growth, health, and development of the exposed children.

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Authors and Affiliations

  1. Centre for International Health, Department of Global Health and Primary Care, University of Bergen, Bergen, Norwegen

    Ingunn M. S. Engebretsen & Karen Marie Moland

  2. Health Systems Research Unit, South African Medical Research Council, Kapstadt, Südafrika

    Tanya Doherty

  3. School of Public Health, University of the Western Cape, Kapstadt, Südafrika

    Tanya Doherty

  4. Centre for Rural Health, University of KwaZulu-Natal, Durban, Südafrika

    Christiane Horwood

  5. Department of Clinical Medicine, Center for Nutrition, University of Bergen, Jonas Lies vei 68, 5021, Bergen, Norwegen

    Jutta Dierkes

  6. Laboratory Medicine and Pathology, Haukeland University Hospital, Bergen, Norwegen

    Jutta Dierkes

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  1. Ingunn M. S. Engebretsen
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Correspondence to Jutta Dierkes.

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Interessenkonflikt

I. M. S. Engebretsen, T. Doherty, C. Horwood, K. M. Moland und J. Dierkes geben an, dass kein Interessenkonflikt besteht.

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Engebretsen, I.M.S., Doherty, T., Horwood, C. et al. Entwicklungen und Herausforderungen der Stillpraxis in den Ländern des südlichen Afrikas. Bundesgesundheitsbl 61, 937–944 (2018). https://doi.org/10.1007/s00103-018-2783-2

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