The Australian Milk Biscuit Project

Melbourne - November, 2004

Global Dairy Industry Initiative to Combat Post-Natal HIV/AIDS Mother-to-Child-Transmission & Malnutrition
Milk Biscuit Project - Fact Sheet

Mother-to-child-transmission (MTCT) of HIV/AIDS is by far one of the greatest threats to infant wellbeing in high-HIV prevalent environments. Infection carries with it many social and psychological problems, not the mention the adverse health consequences associated with the virus. In developing countries, MTCT rates range from 25-40%. Overall, MTCT is responsible for more than 90% of infant HIV infections 1, of which 1/3 are attributable to breastfeeding, while the remainder of infections occurs during pregnancy and delivery. HIV positive children are at much greater risk of suffering malnutrition, growth failure and mortality because of the deterioration in their personal health. In sub-Saharan Africa, a staggering 25-40% of infected children die before their 5th birthday.

HIV infection works in tandem with malnutrition, and the two further exacerbate their respective conditions and symptoms. Malnutrition intensifies the effects of infection, while HIV infection increases susceptibility to malnutrition and illness caused by opportunistic infections such as pneumonia and diarrhoea, which again further exacerbate the conditions. Prolonged periods of undernourishment and disease also pose negative future social and health consequences, especially in the developing world.

However, recent research by Professor Coovadia and his team (Durban), and the validation of these findings by Humphrey et al (Zimbabwe - presented at 2004 World AIDS Conference, Bangkok), now offer a new glimmer of hope for the future. Both groups have conclusively demonstrated that exclusive breastfeeding during the first six months of life poses no excess risk of HIV infection compared with infants whom were never breastfed, provided they were not infected in utero or during birth 2, 3. However, the most critical and dangerous period associated with MTCT via breastmilk is weaning, when a reduction in breastmilk supply (due to a reduced feeding frequency and duration) causes a sharp increase in breastmilk viral load, making it extremely infective 4.

Based on this information, women are also advised to wean abruptly after this initial six-month period, but not much effort has been focussed on the issue of supplementary feeding at this crucial stage? So what should women do once the six months is over? Obviously there is a need for a versatile, safe, cheap and relatively efficacious weaning food supplement that is energy and protein dense, and is fortified with a range of micronutrients, and does not pose further health risks to the infant. The Australian Milk Biscuit is one such product that fits this description, and represents an innovative and attractive dairy based option aimed at alleviating the detrimental impact of HIV/AIDS in infants at risk.

The milk biscuit is a high protein (20%), high energy (20%), milk protein based biscuit that can supply a significant proportion of energy, protein, and micronutrients (which can be customised to suit specific deficiencies), hence making a considerable contribution to the diets of beneficiaries. The biscuits are:

• lactose-free and well tolerated by indigenous groups
• require no further reconstitution or preparation
• suitable for use as not only a weaning food, but a general nutritional supplement for infants, which can be further integrated easily to include adults, pregnant and lactating women, and even the elderly.
• require no knowledge of hygiene and sterilisation of feeding vessels
• eliminate the need for preparation and mixture procedures
• easy to transport, store and distribute
• ready for immediate consumption
• can be associated with health programs and used on an incentive basis

The Australian Milk Biscuit can be considered as an energy and nutrient dense weaning/nutritional supplement food, which overcomes the major obstacles that render the safe reconstitution and preparation of other products (in resource-poor communities) almost impossible, hazardous and prone to contamination.

Originally, the biscuit was designed with emergency feeding in mind, however there is a huge potential for a product of this calibre in a number of different applications; even in our own societies were obesity is a huge health concern. The recipe could easily be varied and the biscuit could be introduced as a health/snack in canteens, cafeteria's, tuck shops and food bars.

With funding support from the Gardiner Foundation (Dairy Research Co-Op, Vic-Aust.), and with the generous support of Arnott's Biscuit's Ltd and Murray-Goulburn Nutritionals (who've agreed to bake the biscuits and provide assistance with recipe formulation), we are currently co-operating with Professor Coovadia and his team to set up a clinical trial to assess the Australian Milk Biscuit against the Ready-To-Use-Food (RUTF) Nutrient-Dense Paste in Durban (South Africa), scheduled to commence early next year. Also, Hope for Children Foundation (Addis Ababa, Ethiopia) is keen for us to commence trials within their orphanage; and we are keen to locate a prospective trial centre in South-East Asia.

The milk biscuit has the potential to play a significant and long-term remedial role in improving the outcomes for young children affected by malnutrition and HIV/AIDS. And although improved nutrition is by no means a cure for HIV infection, enhanced nutrition can certainly delay the onset of full-blown AIDS, improve treatment efficacy, prevent further malnutrition, and improve the quality of life for many disadvantaged children. Although it is not good public health policy to encourage dependency on artificial, synthetic, or non-natural foods in resource-poor populations, we still need to address the issue of supplementary feeding during the weaning period, and practical solutions such as the Australian Milk Biscuit, need to be found. Any interventive protocol that has the capacity to limit the severity of suffering in resource-poor environments, and reduce the incidence of MTCT via breastmilk, warrants further investigation and consideration.

1. UNAIDS/World Health Organisation (WHO) Dec 1998. HIV and infant feeding: A review of HIV transmission through breastfeeding. UNICEF-UNAIDS-WHO.

2. Coutsoudis, A et al. Method of infant feeding and transmission of HIV-1 from mothers to children by 15 months age: A prospective cohort study from Durban, South Africa. AIDS (2001) 15(3): 379-387.

3. Humphrey, J et al. Early introduction of non-human milk and solid foods increases the risk of postnatal HIV-1 transmission in Zimbabwe. The XV International AIDS Conference, 2004 Abstract no. MoPpB2008. MedGenMed. 2004 Jul 11;6(3):MoPpB2008 [eJIAS. 2004 Jul 11;1(1):MoPpB2008]

4. Willumsen, JF et al. Breastmilk RNA viral load in HIV-infected South African women: effects of subclinical mastitis and infant feeding. AIDS (2001) 17: 407-414.