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Florea RM, Sultana CM. COVID-19 and breastfeeding: can SARS-CoV-2 be spread through lactation? Discoveries (Craiova) 2021; 9:e132. [PMID: 34754901 PMCID: PMC8570917 DOI: 10.15190/d.2021.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/06/2021] [Accepted: 06/06/2021] [Indexed: 11/22/2022] Open
Abstract
SARS-CoV-2 is a new betacoronavirus that was first reported in the Hubei province, China, in December 2019. The virus is likely transmitted through air droplets. However, there are reported cases where SARS-CoV-2-RNA was found in other samples, such as blood or stool. Nonetheless, there is limited information concerning the presence of viral RNA in pregnancy-related samples, specifically breast milk. However unlikely, there is still uncertainty regarding the possibility of vertical transmission from mother to infant through breastfeeding. This review aims to synthetize the literature written so far on this topic.
Despite not being extensively researched, vertical transmission through breast milk seems unlikely. Case series showed that milk samples from mothers with COVID-19 were almost entirely negative. So far, there have been only 9 recorded cases of viral shedding in milk samples, uncertain however of the viability of the particles. Furthermore, WHO and UNICEF strongly encourage commencing breastfeeding after parturition, underlining the benefits of lactation. Moreover, some studies have proven the existence of IgG and IgA anti-SARS-CoV-2-antibodies in the maternal milk that could possibly play an important part in the neonate’s protection against the virus.
Vertical transmission through lactation seems unlikely, most studies pointing towards the safety of breastfeeding. However, further larger-scale studies need to be performed in order to clarify a yet uncertain matter.
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Affiliation(s)
| | - Camelia Madalina Sultana
- Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Stefan S. Nicolau Virology Institute, Bucharest, Romania
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2
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Pretorius CE, Asare H, Genuneit J, Kruger HS, Ricci C. Impact of breastfeeding on mortality in sub-Saharan Africa: a systematic review, meta-analysis, and cost-evaluation. Eur J Pediatr 2020; 179:1213-1225. [PMID: 32592027 DOI: 10.1007/s00431-020-03721-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 06/10/2020] [Accepted: 06/15/2020] [Indexed: 10/24/2022]
Abstract
Sub-Saharan Africa has lower breastfeeding rates compared to other low- and middle-income countries, and globally holds the highest under-five mortality rates. The aims of this study were to estimate mortality risk for inappropriate breastfeeding, prevalence of breastfeeding, population attributable fraction, and the economic impact of breastfeeding on child mortality, in sub-Saharan Africa. The systematic review included databases from Medline and CINAHL. Meta-analysis of mortality risk estimates was conducted using random effect methods. The prevalence of breastfeeding in Sub-Saharan African countries was determined using UNICEF's database. Population attributable fraction was derived from the prevalence and relative risk data. The cost attributable to child deaths in relation to inappropriate breastfeeding was calculated using the World Health Statistics data. The pooled relative mortality risk to any kind of infant feeding compared to exclusive and early breastfeeding initiation were 5.71 (95%CI: 2.14, 15.23) and 3.3 (95%CI: 2.49, 4.46), respectively. The overall exclusive and early initiation of breastfeeding prevalence were 35%(95%CI: 32%;37%) and 47%(95%CI: 44%;50%), respectively. The population attributable fraction for non-exclusive and late breastfeeding initiation breastfeeding were 75.7% and 55.3%, respectively. The non-health gross domestic product loss resulted in about 19.5 USB$.Conclusion: Public health interventions should prioritize appropriate breastfeeding practices to decrease the under-five mortality burden and its related costs in sub-Saharan Africa. What is Known: • Globally, sub-Saharan Africa holds the highest under five mortality rates and still has lower breastfeeding rates compared to other low- and middle-income countries. • There is a significant association between child mortality and inappropriate breastfeeding practices. What is New: • A five-fold and three-fold increased risks for under-five mortality were estimated with regard to non-exclusive breastfeeding and delayed breastfeeding initiation, respectively. • 55-75% of under-five deaths can be attributable to inappropriate breastfeeding practices and at least part of them could be potentially prevented with breastfeeding promotion interventions, saving a non-health gross domestic product loss of 19.5 USB$.
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Affiliation(s)
- Cianté E Pretorius
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa.
| | - Hannah Asare
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - Jon Genuneit
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Herculina S Kruger
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa.,Medical Research Council Hypertension and Cardiovascular Disease Research Unit, North-West University, Potchefstroom, South Africa
| | - Cristian Ricci
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa.,Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
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Gribble K, Mathisen R, Ververs MT, Coutsoudis A. Mistakes from the HIV pandemic should inform the COVID-19 response for maternal and newborn care. Int Breastfeed J 2020; 15:67. [PMID: 32711567 PMCID: PMC7381860 DOI: 10.1186/s13006-020-00306-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/09/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In an effort to prevent infants being infected with SARS-CoV-2, some governments, professional organisations, and health facilities are instituting policies that isolate newborns from their mothers and otherwise prevent or impede breastfeeding. WEIGHING OF RISKS IS NECESSARY IN POLICY DEVELOPMENT Such policies are risky as was shown in the early response to the HIV pandemic where efforts to prevent mother to child transmission by replacing breastfeeding with infant formula feeding ultimately resulted in more infant deaths. In the COVID-19 pandemic, the risk of maternal SARS-CoV-2 transmission needs to be weighed against the protection skin-to-skin contact, maternal proximity, and breastfeeding affords infants. CONCLUSION Policy makers and practitioners need to learn from the mistakes of the HIV pandemic and not undermine breastfeeding in the COVID-19 pandemic. It is clear that in order to maximise infant health and wellbeing, COVID-19 policies should support skin-to-skin contact, maternal proximity, and breastfeeding.
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Affiliation(s)
- Karleen Gribble
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Roger Mathisen
- Alive and Thrive Southeast Asia, FHI 360, 60 Ly Thai To Street, Hanoi, Vietnam
| | - Mija-Tesse Ververs
- Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Anna Coutsoudis
- Department of Pediatrics and Child Health, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
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Houle B, Rochat TJ, Newell ML, Stein A, Bland RM. Breastfeeding, HIV exposure, childhood obesity, and prehypertension: A South African cohort study. PLoS Med 2019; 16:e1002889. [PMID: 31454346 PMCID: PMC6711496 DOI: 10.1371/journal.pmed.1002889] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 07/22/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Evidence on the association between breastfeeding and later childhood obesity and blood pressure (BP) is inconsistent, especially in HIV-prevalent areas where, until recently, HIV-infected women were discouraged from breastfeeding, but obesity is increasingly prevalent. METHODS AND FINDINGS The Siyakhula cohort (2012-2014), a population-based prospective cohort study, collected data over 3 visits on HIV-negative children ages 7 to 11 years in rural South Africa. We used weight (body mass index [BMI]), fat, and BP as outcome variables and incorporated early life (including mother's age at delivery and HIV status) and current life factors (including maternal education and current BMI). Our primary exposure was breastfeeding duration. We dichotomized 3 outcome measures using pre-established thresholds for clinical interpretability: (1) overfat: ≥85th percentile of body fat; (2) overweight: >1 SD BMI z score; and (3) prehypertension: ≥90th percentile for systolic BP (SBP) or diastolic BP (DBP). We modelled each outcome using multivariable logistic regression, including stopping breastfeeding, then early life, and finally current life factors. Of 1,536 children (mean age = 9.3 years; 872 girls; 664 boys), 7% were overfat, 13.2% overweight, and 9.1% prehypertensive. Over half (60%) of the mothers reported continued breastfeeding for 12+ months. In multivariable analyses, continued breastfeeding between 6 and 11 months was associated with approximately halved odds of both being overfat (adjusted odds ratio [aOR] = 0.43, 95% confidence interval [CI] 0.21-0.91, P = 0.027) and overweight (aOR = 0.46, CI 0.26-0.82, P = 0.0083), but the association with prehypertension did not reach statistical significance (aOR = 0.72, CI 0.38-1.37, P = 0.32). Children with a mother who was currently obese were 5 times more likely (aOR = 5.02, CI 2.47-10.20, P < 0.001) to be overfat and over 4 times more likely to be overweight (aOR = 4.33, CI 2.65-7.09, P < 0.001) than children with normal weight mothers. Differences between HIV-exposed and unexposed children on any of the outcomes were minimal and not significant. The main study limitation was that duration of breastfeeding was based on maternal recall. CONCLUSIONS To our knowledge, this is the first study examining and quantifying the association between breastfeeding and childhood obesity in an African setting with high HIV prevalence. We observed that breastfeeding was independently associated with reduced childhood obesity for both HIV-exposed and unexposed children, suggesting that promoting optimal nutrition throughout the life course, starting with continued breastfeeding, may be critical to tackling the growing obesity epidemic. In the era of widespread effective antiretroviral treatment for HIV-infected women for life, these data further support the recommendation of breastfeeding for all women.
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Affiliation(s)
- Brian Houle
- School of Demography, The Australian National University, Canberra, Australia
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- CU Population Center, Institute of Behavioral Science, University of Colorado at Boulder, Boulder, Colorado
| | - Tamsen J. Rochat
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- MRC/Developmental Pathways to Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, South Africa
| | - Marie-Louise Newell
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Alan Stein
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Section of Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, United Kingdom
| | - Ruth M. Bland
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Institute of Health and Wellbeing and Royal Hospital for Children, University of Glasgow, Glasgow, United Kingdom
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Ayele AA, Seid KA, Muhammed OS. Determinants of none-exclusive breast feeding practice among HIV positive women at selected Health Institutions in Ethiopia: case control study. BMC Res Notes 2019; 12:400. [PMID: 31300023 PMCID: PMC6626423 DOI: 10.1186/s13104-019-4457-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 07/09/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Exclusive breast feeding (EBF) has been practiced all over the world as the best way of cost effective feeding practice, particularly in the developing countries. This practice is associated with a lower risk of human immunodeficiency virus transmission than mixed feeding. 'Studies focusing on determinants of EBF among women living with HIV are limited. Hence, the current study is aimed at identifying those determinants. RESULT This study showed that being employed (AOR = 4.363, 95% CI 2.324 to 8.191), home delivery (AOR = 0.029, 95% CI 0.004 to 0.235) and secondary education (AOR = 10.351, 95% CI 1.297 to 82.628) are significantly associated with non-EBF. In this study none EBF practice was significantly associated with women who are employed, delivered at home and educational status.
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Affiliation(s)
| | - Kemal Ahmed Seid
- Department of Public Health, Collage of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Oumer Sada Muhammed
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
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Umeobieri AK, Mbachu C, Uzochukwu BSC, Elias A, Omotowo B, Agunwa C, Obi I. Perception and practice of breastfeeding among HIV positive mothers receiving care for prevention of mother to child transmission in South-East, Nigeria. Int Breastfeed J 2018; 13:50. [PMID: 30519275 PMCID: PMC6264606 DOI: 10.1186/s13006-018-0191-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 10/31/2018] [Indexed: 11/24/2022] Open
Abstract
Background Although the risk of HIV transmission through breastfeeding is reduced considerably with the use of antiretroviral therapy, infant feeding by HIV positive mothers remains controversial. Weighing risks against benefits generates intense debate among policymakers, program managers and service providers in sub-Saharan Africa, considering that the major causes of infant death of malnutrition and infectious diseases, could be prevented if mothers breastfeed their babies. Whereas breastfeeding involves some risk of HIV transmission, not breastfeeding poses considerable risk to infant survival. This study investigated perceptions and practice of breastfeeding of HIV-exposed infants among HIV positive mothers. Methods A cross-sectional descriptive study was conducted in Enugu metropolis among HIV positive mothers receiving care for prevention of mother-to-child transmission of HIV from two public and two private hospitals. Interviewer-administered questionnaire survey was done with 550 participants as they exited the final point of service delivery. Descriptive statistics of perception and practice variables and cross tabulation of selected variables was performed. Results Most mothers knew that HIV could be transmitted through breast milk. The majority perceived any type of breastfeeding as beneficial to the infant: 230 (83.6%) in private facilities, and 188 (68.4%) public facilities. Over three-quarters of the mothers breastfed their infants and their reasons for breastfeeding included personal choice, cultural norms, fear of HIV status being disclosed and pressure from family members. A statistical significant association was found between; (i) practice of breastfeeding and marital status, (p < 0.01), and (ii) practice of breastfeeding and household income provider (p = 0.02). However, neither marital status (AOR 1.4; 95% CI 0.3, 6.8) nor being the household income provider (AOR 4.9; 95% CI 0.6, 12.9) is a significant predictor of breastfeeding of HIV-exposed infants. Conclusions Breastfeeding remains a common trend among HIV positive women and it is associated with economic independence of women and social support. Fear of stigma negatively affects practice of breastfeeding. Hence, HIV positive mothers need economic independence and the support of family members to practice recommended infant feeding options.
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Affiliation(s)
- Ancilla-Kate Umeobieri
- 1Department of Community Medicine, College of Medicine, University of Nigeria Enugu campus, Enugu, Nigeria
| | - Chinyere Mbachu
- 1Department of Community Medicine, College of Medicine, University of Nigeria Enugu campus, Enugu, Nigeria.,2Institute of Public Health, University of Nigeria Enugu campus, Enugu, Nigeria
| | - Benjamin S C Uzochukwu
- 1Department of Community Medicine, College of Medicine, University of Nigeria Enugu campus, Enugu, Nigeria.,2Institute of Public Health, University of Nigeria Enugu campus, Enugu, Nigeria
| | - Aniwada Elias
- 1Department of Community Medicine, College of Medicine, University of Nigeria Enugu campus, Enugu, Nigeria
| | - Babatunde Omotowo
- 1Department of Community Medicine, College of Medicine, University of Nigeria Enugu campus, Enugu, Nigeria
| | - Chuka Agunwa
- 1Department of Community Medicine, College of Medicine, University of Nigeria Enugu campus, Enugu, Nigeria
| | - Ikechukwu Obi
- 1Department of Community Medicine, College of Medicine, University of Nigeria Enugu campus, Enugu, Nigeria.,2Institute of Public Health, University of Nigeria Enugu campus, Enugu, Nigeria
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Thomas E, Kuo C, Cohen S, Hoare J, Koen N, Barnett W, Zar HJ, Stein DJ. Mental health predictors of breastfeeding initiation and continuation among HIV infected and uninfected women in a South African birth cohort study. Prev Med 2017; 102:100-111. [PMID: 28694059 PMCID: PMC5802398 DOI: 10.1016/j.ypmed.2017.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 06/26/2017] [Accepted: 07/05/2017] [Indexed: 12/19/2022]
Abstract
Breastfeeding is a cost-effective, yet underutilized strategy to promote maternal and infant health in low and middle income countries (LMICs). Breastfeeding remains challenging for mothers living with HIV in LMICs, yet few studies have examined mental health predictors of breastfeeding initiation and continuation. We investigated breastfeeding among mothers by HIV status in South Africa, evaluating predictors of breastfeeding initiation and continuation to identify intervention-targets. Breastfeeding patterns were investigated in a subsample of 899 breastfeeding mothers from the Drakenstein Child Health Study; a prospective birth cohort of 1225 pregnant women, between March 2012 and March 2015 in a peri-urban area. Breastfeeding was assessed at 5 time-points between 6weeks and 24months' infant age. Cox proportional hazard models evaluated breastfeeding initiation and duration. Logistic regression models with breastfeeding non-initiation as the outcome parameter were performed to determine associations with maternal sociodemographic, psychosocial factors and gestational outcomes. More HIV-uninfected mothers initiated breastfeeding (n=685, 97%) than HIV-infected mothers (n=87, 45%). Median duration of exclusive breastfeeding was short (2months), but HIV-infected mothers engaged in exclusive breastfeeding for longer duration than uninfected mothers (3 vs 2months). Despite concerning high rates, mental disorders were not significant predictors of breastfeeding behaviour. Employment and HIV diagnosis during pregnancy predicted a lower likelihood of breastfeeding initiation among HIV-infected mothers, while employment was associated with earlier breastfeeding-discontinuation in HIV-uninfected mothers. Findings indicate that future interventions should target sub-populations such as HIV-infected women because of distinct needs. Workplace interventions appear particularly key for mothers in our study.
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Affiliation(s)
- Eileen Thomas
- Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town 7925, South Africa.
| | - Caroline Kuo
- Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town 7925, South Africa; Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University, 121 South Main Street, Box G-S121-4th Floor, Room 406, Providence, RI 02912, USA
| | - Sophie Cohen
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Jacqueline Hoare
- Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town 7925, South Africa
| | - Natassja Koen
- Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town 7925, South Africa; Medical Research Council Unit on Anxiety and Stress Disorders, South Africa
| | - Whitney Barnett
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa; Medical Research Council Unit on Child and Adolescent Health, South Africa
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town 7925, South Africa; Medical Research Council Unit on Anxiety and Stress Disorders, South Africa
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A Protocol for a Cluster Randomized Trial on the Effect of a "feeding buddy" Program on adherence to the Prevention of Mother-To-Child-Transmission Guidelines in a Rural Area of KwaZulu-Natal, South Africa. J Acquir Immune Defic Syndr 2017; 72 Suppl 2:S130-6. [PMID: 27355500 PMCID: PMC5113241 DOI: 10.1097/qai.0000000000001059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background: The uptake of prevention of mother-to-child-transmission (PMTCT) services has improved in South Africa but challenges remain, including adherence to the World Health Organization's (WHO) PMTCT recommendations of exclusive breastfeeding (EBF), taking antiretroviral medication (ARV); testing for early infant diagnosis; and reducing stigma. Women who practice EBF for the first 6 months are less likely to transmit HIV to their infants, yet only 7% of women EBF for 6 months in South Africa. Adherence to these recommendations remains challenging because of difficulties relating to disclosure and stigma. To address this challenge, the feeding buddy concept was developed based on studies where ARV buddies have proved effective in providing support for women living with HIV. Buddies have demonstrated a positive effect on providing emotional and social support to adhere to PMTCT guidelines. Methods: A cluster randomized controlled trial was conducted in 16 selected randomly assigned clinics in uMhlathuze and uMlalazi districts of KwaZulu Natal, South Africa. HIV-positive pregnant women (n = 625) who intended to breastfeed were enrolled at 8 control clinics and 8 intervention clinics. The clinics were stratified on the basis of urban/rural/periurban locale and then randomly allocated to either intervention or control. In the intervention clinics, the mother chose a feeding buddy to be enrolled alongside her. Quantitative interviews with mothers and their chosen buddies took place at enrollment during pregnancy and at routine postdelivery visits at day 3 and weeks 6, 14 and 22. Women in the control clinics were followed using the same evaluation schedule. The trial evaluated the effect of a voluntary PMTCT feeding buddy program on HIV-infected women's adherence to PMTCT recommendations and stigma reduction. The proportion of women exclusively feeding at 5.5 months postpartum was the primary end-point of the trial. In-depth interviews were conducted among a convenience sample of PMTCT counselors, community caregivers, mothers, and buddies from intervention clinics and control clinics to document their overall experiences. Discussion: The information collected in this study could be used to guide recommendations on how to build upon the current South Africa. PMTCT “buddy” strategy and to improve safe infant feeding. The information would be applicable to many other similar resource poor settings with poor social support structures.
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Janse van Rensburg L, Nel R, Walsh CM. Knowledge, opinions and practices of healthcare workers related to infant feeding in the context of HIV. Health SA 2016. [DOI: 10.1016/j.hsag.2015.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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10
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Mkontwana P, Steenkamp L, Von der Marwitz J. Challenges in the implementation of the Infant and Young Child Feeding policy to prevent mother-to-child transmission of human immunodeficiency virus in the Nelson Mandela Bay District. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2016. [DOI: 10.1080/16070658.2013.11734447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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11
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Våga BB, Moland KM, Blystad A. Boundaries of confidentiality in nursing care for mother and child in HIV programmes. Nurs Ethics 2015; 23:576-86. [PMID: 25956154 DOI: 10.1177/0969733015576358] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Confidentiality lies at the core of medical ethics and is the cornerstone for developing and keeping a trusting relationship between nurses and patients. In the wake of the HIV epidemic, there has been a heightened focus on confidentiality in healthcare contexts. Nurses' follow-up of HIV-positive women and their susceptible HIV-exposed children has proved to be challenging in this regard, but the ethical dilemmas concerning confidentiality that emerge in the process of ensuring HIV-free survival of the third party - the child - have attracted limited attention. OBJECTIVE The study explores challenges of confidentiality linked to a third party in nurse-patient relationships in a rural Tanzanian HIV/AIDS context. STUDY CONTEXT The study was carried out in rural and semi-urban settings of Tanzania where the population is largely agro-pastoral, the formal educational level is low and poverty is rife. The HIV prevalence of 1.5% is low compared to the national prevalence of 5.1%. METHODS Data were collected during 9 months of ethnographic fieldwork and consisted of participant observation in clinical settings and during home visits combined with in-depth interviews. The main categories of informants were nurses employed in prevention of mother-to-child transmission of HIV programmes and HIV-positive women enrolled in these programmes. ETHICAL CONSIDERATIONS Based on information about the study aims, all informants consented to participate. Ethical approval was granted by ethics review boards in Tanzania and Norway. FINDINGS AND DISCUSSION The material indicates a delicate balance between the nurses' attempt to secure the HIV-free survival of the babies and the mothers' desire to preserve confidentiality. Profound confidentiality-related dilemmas emerged in actual practice, and indications of a lack of thorough consideration of the implication of a patient's restricted disclosure came to light during follow-up of the HIV-positive women and the third party - the child who is at risk of HIV infection through mother's milk. World Health Organization's substantial focus on infant survival (Millennium Development Goal-4) and the strong calls for disclosure among the HIV-positive are reflected on in the discussion.
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Affiliation(s)
- Bodil Bø Våga
- University of Bergen, Norway; University of Stavanger, Norway
| | - Karen Marie Moland
- University of Bergen, Norway; University of Stavanger, NorwayUniversity of Bergen, Norway
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Effect of an integrated community-based package for maternal and newborn care on feeding patterns during the first 12 weeks of life: a cluster-randomized trial in a South African township. Public Health Nutr 2015; 18:2660-8. [PMID: 25660465 DOI: 10.1017/s1368980015000099] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To analyse the effect of community-based counselling on feeding patterns during the first 12 weeks after birth, and to study whether the effect differs by maternal HIV status, educational level or household wealth. DESIGN Cluster-randomized trial with fifteen clusters in each arm to evaluate an integrated package providing two pregnancy and five postnatal home visits delivered by community health workers. Infant feeding data were collected using 24 h recall of nineteen food and fluid items. SETTING A township near Durban, South Africa. SUBJECTS Pregnant women (1894 intervention and 2243 control) aged 17 years or more. RESULTS Twelve weeks after birth, 1629 (intervention) and 1865 (control) mother-infant pairs were available for analysis. Socio-economic conditions differed slightly across intervention groups, which were considered in the analyses. There was no effect on early initiation of breast-feeding. At 12 weeks of age the intervention doubled exclusive breast-feeding (OR=2·29; 95 % CI 1·80, 2·92), increased exclusive formula-feeding (OR=1·70; 95 % CI 1·28, 2·27), increased predominant breast-feeding (OR=1·71; 95 % CI 1·34, 2·19), decreased mixed formula-feeding (OR=0·68; 95 % CI 0·55, 0·83) and decreased mixed breast-feeding (OR=0·54; 95 % CI 0·44, 0·67). The effect on exclusive breast-feeding at 12 weeks was stronger among HIV-negative mothers than HIV-positive mothers (P=0·01), while the effect on mixed formula-feeding was significant only among HIV-positive mothers (P=0·03). The effect on exclusive feeding was not different by household wealth or maternal education levels. CONCLUSIONS A perinatal intervention package delivered by community health workers was effective in increasing exclusive breast-feeding, exclusive formula-feeding and decreasing mixed feeding.
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13
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Sankoh O, Arthur S, Nyide B, Weston M. Prevention, treatment and future challenges of HIV/AIDS: A decade of INDEPTH research. HIV & AIDS REVIEW 2015. [DOI: 10.1016/j.hivar.2014.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Laar AS, Govender V. Individual and Community Perspectives, Attitudes, and Practices to Mother-to-Child-Transmission and Infant Feeding among HIV-Positive Mothers in Sub-Saharan Africa: A Systematic Literature Review. Int J MCH AIDS 2013; 2:153-62. [PMID: 27621968 PMCID: PMC4948140 DOI: 10.21106/ijma.20] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES International guidelines on infant feeding for HIV- positive mothers promote Exclusive Replacement Feeding (ERF) (infant formula or animal milk) or exclusive breastfeeding (with no supplements of any kind). A mixed feeding pattern, where breastfeeding is combined with other milks, liquid foods or solids, has been shown to increase the risk of transmission of HIV and is strongly discouraged. However, little is known about the ability of women to adhere to recommended feeding strategies to prevent mother-to-child transmission (MTCT) of HIV from breast milk. The objective of this study was to assess the individual and community-level factors that affect perspectives, attitudes and practices of HIV-positive mothers on MTCT and infant feeding in sub-Saharan Africa as documented in peer-reviewed and grey literature. METHODS This work is based on an extensive review of peer-reviewed articles and grey literature from the period 2000-2012. The literature search was carried out using electronic databases like Medline Ovid, Google Scholar, PubMed and EBSCOhost. Both quantitative and qualitative studies written in English language on HIV and infant feeding with particular emphasis on Sub-Saharan Africa were included. RESULTS The review found low adherence to the chosen infant feeding method by HIV-positive mothers. The following factors emerged as influencing infant feeding decisions: cultural and social norms; economic conditions; inadequate counselling; and mother's level of education. CONCLUSIONS AND PUBLIC HEALTH IMPLICATIONS Unless local beliefs and customs surrounding infant feeding is understood by policy makers and program implementers, Prevention of Mother-to-Child Transmission (PMTCT) programs will only be partially successful in influencing feeding practices of HIV-positive women. Hence programs should provide affordable, acceptable, feasible, safe and sustainable feeding recommendations that do not erode strong cultural practices. Advice to HIV-positive mothers should be based on local conditions that are acceptable to the community.
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Affiliation(s)
- Alexander Suuk Laar
- Project Fives Alive! Department of Health, National Catholic Health Service, Tamale. Ghana
| | - Veloshnee Govender
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, South Africa, Anzio Road Observatory, 7925
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Våga BB, Moland KM, Evjen-Olsen B, Leshabari SC, Blystad A. Rethinking nursing care: an ethnographic approach to nurse-patient interaction in the context of a HIV prevention programme in rural Tanzania. Int J Nurs Stud 2012; 50:1045-53. [PMID: 23273536 DOI: 10.1016/j.ijnurstu.2012.11.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 11/21/2012] [Accepted: 11/29/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND While care has been described as the essence of nursing, it is generally agreed that care is a complex phenomenon that remains elusive. Literature reviews highlight the centrality of nurse-patient interactions in shaping care. In sub-Saharan Africa, where there is a critical shortage of health workers, nurses remain the core of the health workforce, but the quality of the patient care they provide has been questioned. OBJECTIVE The study explored how care is shaped, expressed and experienced in nurses' everyday communication among HIV positive women in Tanzania. STUDY CONTEXT Data were collected through a prevention of mother-to-child transmission of HIV programme with a comprehensive community component conducted by a church-run hospital in rural Tanzania. The population is largely agro-pastoral, the formal educational level is low and poverty is rampant. METHODS An ethnographic approach was employed. Nurses and women enrolled in the prevention of mother-to-child transmission of HIV programme were followed closely over a period of nine months in order to explore their encounters and interactions. FINDINGS AND DISCUSSION The way care is shaped, expressed and experienced is not globally uniform, and the expectations of what quality care involves differ between settings. In this study the expectations of nurses' instructions and authority, combined with nurses' personal engagement were experienced as caring interactions. The findings from this study demonstrate that the quality of nursing care needs to be explored within the specific historical, socio-cultural context in which it is practised.
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Affiliation(s)
- Bodil Bø Våga
- Department of Public Health and Primary Health Care, University of Bergen, P.O. Box 7804, 5020 Bergen, Norway.
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Ijumba P, Doherty T, Jackson D, Tomlinson M, Sanders D, Persson LÅ. Free formula milk in the prevention of mother-to-child transmission programme: voices of a peri-urban community in South Africa on policy change. Health Policy Plan 2012; 28:761-8. [PMID: 23144227 DOI: 10.1093/heapol/czs114] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In 2001, South Africa began implementing the Prevention of Mother-to-Child Transmission of HIV (PMTCT) programme. This programme included distribution of free formula milk for infants up to 6 months of age at all public health facilities. Effective from 1 January 2011, KwaZulu-Natal became the first province to phase out free formula milk from its PMTCT programme. On 23 August 2011, the South African National Department of Health adopted promotion of exclusive breastfeeding as the national infant feeding strategy and made a decision to withdraw free formula milk from the PMTCT programme. OBJECTIVE To explore the perceptions and understanding of households at community level on the policy decision to phase out free formula milk from the PMTCT programme in South Africa. METHODS An exploratory qualitative study was conducted amongst women enrolled in a community randomized trial known as Good Start III. Focus group discussions were held with grandmothers, fathers and teenage mothers; and in-depth interviews were performed with HIV-positive and HIV-negative mothers. Data were analysed using thematic analysis. RESULTS Identified themes included: (1) variations in awareness and lack of understanding of the basis for the policy change, (2) abuse of and dysfunctional policy as perceived reasons for policy change and (3) proposed strategies for communicating the policy change. CONCLUSION There is an urgent need to develop a multifaceted communication strategy clearly articulating the reasons for the infant feeding policy change and promoting the new breastfeeding strategy. The communication strategy should take into account inputs from the community. With a supportive environment and one national infant feeding strategy, South Africa has an opportunity to reverse years of poor infant feeding practices and to improve the health of all children in the country.
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Affiliation(s)
- Petrida Ijumba
- Health Systems Research Unit, Medical Research Council, 460 Ridge Road, PO Box 70380, Overport 4067, South Africa. E-mail:
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Natchu UCM, Liu E, Duggan C, Msamanga G, Peterson K, Aboud S, Spiegelman D, Fawzi WW. Exclusive breastfeeding reduces risk of mortality in infants up to 6 mo of age born to HIV-positive Tanzanian women. Am J Clin Nutr 2012; 96:1071-8. [PMID: 23053555 PMCID: PMC3471196 DOI: 10.3945/ajcn.111.024356] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Despite the benefits of exclusive breastfeeding (EBF), exposure to HIV from breast milk has relegated EBF to an option only when formula feeding is not affordable, feasible, safe, and sustainable. Mixed feeding remains the norm in sub-Saharan Africa. OBJECTIVE We evaluated whether the duration of EBF was associated with mortality and HIV infection in children followed to ≤5 y of age. METHODS A total of 690 mother-infant pairs from the Trial of Vitamins with information on infant feeding, HIV status, and at least one visit in the first year were included in the analysis. The duration of EBF was defined in months as a time-varying covariate at each follow-up visit. Associations of the duration of EBF with mortality, HIV infection, and HIV infection or death were estimated by using Cox proportional hazards models and Kaplan-Meier survival curves. RESULTS A 1-mo increase in EBF was associated with a 49% reduction in early infant mortality in the first 6 mo of life (RR: 0.51; 95% CI: 0.28, 0.93) and a nonsignificant 15% reduction in risk of HIV infection or death (RR: 0.85; 95% CI: 0.71, 1.01; P = 0.07) over the first 5 y of life. EBF was not associated with HIV infection (RR: 0.93; 95% CI: 0.76, 1.15). CONCLUSION Longer EBF by HIV-positive mothers was associated with reduced mortality in the first 6 mo of life without increased HIV infection, which makes EBF the best option for women who cannot sustain exclusive formula feeding. This trial was registered at clinicaltrials.gov as NCT00197743.
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Affiliation(s)
- Uma Chandra Mouli Natchu
- Department of Nutrition, Harvard School of Public Health, 655 Huntington Avenue, Building II Room 329A, Boston, MA 02115, USA.
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Young SL, Mbuya MNN, Chantry CJ, Geubbels EP, Israel-Ballard K, Cohan D, Vosti SA, Latham MC. Current knowledge and future research on infant feeding in the context of HIV: basic, clinical, behavioral, and programmatic perspectives. Adv Nutr 2011; 2:225-43. [PMID: 22332055 PMCID: PMC3090166 DOI: 10.3945/an.110.000224] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
In 2008, between 129,000 and 194,000 of the 430,000 pediatric HIV infections worldwide were attributable to breastfeeding. Yet in many settings, the health, economic, and social consequences of not breastfeeding would have dire consequences for many more children. In the first part of this review we provide an overview of current knowledge about infant feeding in the context of HIV. Namely, we describe the benefits and risks of breastmilk, the evolution of recommended infant feeding modalities in high-income and low-income countries in the last two decades, and contextualize the recently revised guidelines for infant feeding in the context of HIV current knowledge. In the second section, we suggest areas for future research on the postnatal prevention of mother-to-child transmission of HIV (PMTCT) in developing and industrialized countries. We suggest two shifts in perspective. The first is to evaluate PMTCT interventions more holistically, to include the psychosocial and economic consequences as well as the biomedical ones. The second shift in perspective should be one that contextualizes postnatal PMTCT efforts in the cascade of maternal health services. We conclude by discussing basic, clinical, behavioral, and programmatic research questions pertaining to a number of PMTCT efforts, including extended postnatal ARV prophylaxis, exclusive breastfeeding promotion, counseling, breast milk pasteurization, breast milk banking, novel techniques for making breast milk safer, and optimal breastfeeding practices. We believe the research efforts outlined here will maximize the number of healthy, thriving, HIV-free children around the world.
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Affiliation(s)
- Sera L. Young
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA 94110,Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853,To whom correspondence should be addressed. E-mail:
| | | | - Caroline J. Chantry
- Department of Pediatrics, University of California Davis Medical Center, Sacramento, CA, 95817
| | | | | | - Deborah Cohan
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA 94110
| | - Stephen A. Vosti
- Department of Agricultural and Resource Economics, University of California, Davis, CA 95616
| | - Michael C. Latham
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853
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Kuhn L, Aldrovandi G. Survival and health benefits of breastfeeding versus artificial feeding in infants of HIV-infected women: developing versus developed world. Clin Perinatol 2010; 37:843-62, x. [PMID: 21078454 PMCID: PMC3008406 DOI: 10.1016/j.clp.2010.08.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Infant feeding policies for HIV-infected women in developing countries differ from policies in developed countries. This article summarizes the epidemiologic data on the risks and benefits of various infant feeding practices for HIV-infected women living in different contexts. Artificial feeding can prevent a large proportion of mother-to-child HIV transmission but also is associated with increases in morbidity and mortality among exposed-uninfected and HIV-infected children. Antiretroviral drugs can be used during lactation and reduce risks of transmission. For most of the developing world, the health and survival benefits of breastfeeding exceed the risks of HIV transmission, especially when antiretroviral interventions are provided.
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Affiliation(s)
- Louise Kuhn
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, New York, NY 10032, USA.
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Spaar A, Graber C, Dabis F, Coutsoudis A, Bachmann L, McIntyre J, Schechter M, Prozesky HW, Tuboi S, Dickinson D, Kumarasamy N, Pujdades-Rodriquez M, Sprinz E, Schilthuis HJ, Cahn P, Low N, Egger M. Prioritising prevention strategies for patients in antiretroviral treatment programmes in resource-limited settings. AIDS Care 2010; 22:775-83. [PMID: 20473792 DOI: 10.1080/09540120903349102] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Expanded access to antiretroviral therapy (ART) offers opportunities to strengthen HIV prevention in resource-limited settings. We invited 27 ART programmes from urban settings in Africa, Asia and South America to participate in a survey, with the aim to examine what preventive services had been integrated in ART programmes. Twenty-two programmes participated; eight (36%) from South Africa, two from Brazil, two from Zambia and one each from Argentina, India, Thailand, Botswana, Ivory Coast, Malawi, Morocco, Uganda and Zimbabwe and one occupational programme of a brewery company included five countries (Nigeria, Republic of Congo, Democratic Republic of Congo, Rwanda and Burundi). Twenty-one sites (96%) provided health education and social support, and 18 (82%) provided HIV testing and counselling. All sites encouraged disclosure of HIV infection to spouses and partners, but only 11 (50%) had a protocol for partner notification. Twenty-one sites (96%) supplied male condoms, seven (32%) female condoms and 20 (91%) provided prophylactic ART for the prevention of mother-to child transmission. Seven sites (33%) regularly screened for sexually transmitted infections (STI). Twelve sites (55%) were involved in activities aimed at women or adolescents, and 10 sites (46%) in activities aimed at serodiscordant couples. Stigma and discrimination, gender roles and funding constraints were perceived as the main obstacles to effective prevention in ART programmes. We conclude that preventive services in ART programmes in lower income countries focus on health education and the provision of social support and male condoms. Strategies that might be equally or more important in this setting, including partner notification, prompt diagnosis and treatment of STI and reduction of stigma in the community, have not been implemented widely.
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Affiliation(s)
- A Spaar
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
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Moland KMI, de Paoli MM, Sellen DW, van Esterik P, Leshabari SC, Blystad A. Breastfeeding and HIV: experiences from a decade of prevention of postnatal HIV transmission in sub-Saharan Africa. Int Breastfeed J 2010; 5:10. [PMID: 20977709 PMCID: PMC2987846 DOI: 10.1186/1746-4358-5-10] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Accepted: 10/26/2010] [Indexed: 11/17/2022] Open
Abstract
Infant feeding by HIV-infected mothers has been a major global public health dilemma and a highly controversial matter. The controversy is reflected in the different sets of WHO infant feeding guidelines that have been issued over the last two decades. This thematic series, 'Infant feeding and HIV: lessons learnt and ways ahead' highlights the multiple challenges that HIV-infected women, infant feeding counsellors and health systems have encountered trying to translate and implement the shifting infant feeding recommendations in different local contexts in sub-Saharan Africa. As a background for the papers making up the series, this editorial reviews the changes in the guidelines in view of the roll out of prevention of mother to child transmission (PMTCT) programmes in sub-Saharan Africa between 2001 and 2010.
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Arvelo W, Kim A, Creek T, Legwaila K, Puhr N, Johnston S, Masunge J, Davis M, Mintz E, Bowen A. Case-control study to determine risk factors for diarrhea among children during a large outbreak in a country with a high prevalence of HIV infection. Int J Infect Dis 2010; 14:e1002-7. [PMID: 20932791 DOI: 10.1016/j.ijid.2010.06.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 04/06/2010] [Accepted: 06/16/2010] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Between January and March of 2006, over 35 000 diarrhea cases and 532 deaths were reported among children aged <5 years in Botswana. We conducted an investigation to characterize the outbreak, identify risk factors for diarrhea, and recommend control strategies. METHODS We enrolled children <5 years of age presenting to the emergency department between March 2 and March 20, 2006. Cases had ≥3 loose stools per day and no antecedent diarrhea among household members. Controls had had no diarrhea since January 1, 2006. We conducted a multivariate logistic regression analysis controlling for socioeconomic status, age, and maternal HIV status. RESULTS Forty-nine cases with median age of 12 months (range 0-45 months) and 61 controls with median age of 24 months (range 0-59 months) were enrolled; 33 (30%) were born to HIV-positive mothers. Case-parents were more likely to report storing household drinking water (adjusted odds ratios (AOR) 3.9, 95% confidence interval (CI) 1.2-15.7). Lack of hand washing after using the toilet or latrine (AOR 4.2, 95% CI 1.1-20.4) was more likely to be reported by case-parents. Case-children were less likely to be currently breastfeeding (AOR 30.3, 95% CI 2.0-1000.0). Five (10%) case-patients and no control-patients died. Multiple causal pathogens were identified. CONCLUSIONS During this diarrhea outbreak in a country with a national program to prevent mother-to-child transmission of HIV, ill children were less likely to be breastfed and more likely to have been exposed to environmental factors associated with fecal contamination. These findings underscore the importance of adequate access to safe water, sanitation, hygiene, and nutrition education among populations using breast milk substitutes.
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Affiliation(s)
- Wences Arvelo
- Epidemic Intelligence Service, United States Centers for Disease Control and Prevention, Atlanta, USA.
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Fadnes LT, Engebretsen IMS, Moland KM, Nankunda J, Tumwine JK, Tylleskär T. Infant feeding counselling in Uganda in a changing environment with focus on the general population and HIV-positive mothers - a mixed method approach. BMC Health Serv Res 2010; 10:260. [PMID: 20815932 PMCID: PMC2944269 DOI: 10.1186/1472-6963-10-260] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Accepted: 09/06/2010] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Health workers' counselling practices are essential to improve infant feeding practices. This paper will assess how infant feeding counselling was done and experienced by counsellors and mothers in Eastern Uganda in the context of previous guidelines. This has implications for implementation of the new infant feeding guidelines from 2009. METHODS This paper combines qualitative and quantitative data from Mbale District in Eastern Uganda. Data was collected from 2003 to 2005 in a mixed methods approach. This includes: key-informant interviews among eighteen health workers in the public hospital, health clinics and non-governmental organisations working with people living with HIV, fifteen focus group discussions in the general population and among clients from an HIV clinic, two cross-sectional surveys including 727 mothers from the general population and 235 HIV-positive mothers. RESULTS The counselling sessions were often improvised. Health workers frequently had pragmatic approaches to infant feeding as many clients struggled with poverty, stigma and non-disclosure of HIV. The feasibility of the infant feeding recommendations was perceived as challenging among health workers, both for HIV-positive mothers and in the general population. Group counselling with large groups was common in the public health service. Some extra infant feeding teaching capacities were mobilised for care-takers of undernourished children. A tendency to simplify messages giving one-sided information was seen. Different health workers presented contradicting simplified perspectives in some cases. Outdated training was a common concern with many health workers not being given courses or seminars on infant feeding since professional graduation. Other problems were minimal staffing, lack of resources, and programs being started and subsequently stopped abruptly. Many of the HIV-counsellors in the non-governmental organisations got extended training in counselling which seemed to be beneficial. CONCLUSIONS Health workers were faced with challenges related to workload, resources, scientific updating, and also a need to adjust to frequent changes in programs, recommendations and guidelines. The clients were faced with difficult choices, poverty, lack of education and stigma. Feasibility of the recommendations was a major concern. Systematic approaches to update health workers should be a priority.
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Affiliation(s)
- Lars T Fadnes
- Centre for International Health, University of Bergen, Bergen, Norway
| | | | - Karen Marie Moland
- Centre for International Health, University of Bergen, Bergen, Norway
- Faculty of Health and Social Sciences, Bergen University College, Bergen, Norway
| | - Jolly Nankunda
- Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda
| | - James K Tumwine
- Department of Paediatrics and Child Health, Makerere University, Kampala, Uganda
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Tchendjou P, Same-Ekobo C, Nga A, Tejiokem M, Kfutwah A, Nlend AN, Tsague L, Bissek AC, Ekoa D, Orne-Gliemann J, Rousset D, Pouillot R, Dabis F. Effectiveness of multidrug antiretroviral regimens to prevent mother-to-child transmission of HIV-1 in routine public health services in Cameroon. PLoS One 2010; 5:e10411. [PMID: 20454459 PMCID: PMC2861601 DOI: 10.1371/journal.pone.0010411] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Accepted: 04/02/2010] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Multidrug antiretroviral (ARV) regimens including HAART and short-course dual antiretroviral (sc-dARV) regimens were introduced in 2004 to improve Prevention of Mother-to-Child Transmission (PMTCT) in Cameroon. We assessed the effectiveness of these regimens from 6-10 weeks and 12 months of age, respectively. METHODOLOGY/FINDINGS We conducted a retrospective cohort study covering the period from October 2004 to March 2008 in a reference hospital in Cameroon. HIV-positive pregnant women with CD4 < or = 350 cells/mm(3) received first-line HAART [regimen 1] while the others received ARV prophylaxis including sc-dARV or single dose nevirapine (sd-NVP). Sc-dARV included at least two drugs according to different gestational ages: zidovudine (ZDV) from 28-32 weeks plus sd-NVP [regimen 2], ZDV and lamuvidine (3TC) from 33-36 weeks plus sd-NVP [regimen 3]. When gestational age was > or = 37 weeks, women received sd-NVP during labour [regimen 4]. Infants received sd-NVP plus ZDV and 3TC for 7 days or 30 days. Early diagnosis (6-10 weeks) was done, using b-DNA and subsequently RT-PCR. We determined early MTCT rate and associated risk factors using logistic regression. The 12-month HIV-free survival was assessed using Cox regression. Among 418 mothers, 335 (80%) received multidrug ARV regimens (1, 2, and 3) and MTCT rate with multidrug regimens was 6.6% [95%CI: 4.3-9.6] at 6 weeks, without any significant difference between regimens. Duration of mother's ARV regimen < 4 weeks [OR = 4.7, 95%CI: 1.3-17.6], mother's CD4 < 350 cells/mm(3) [OR = 6.4, 95%CI: 1.8-22.5] and low birth weight [OR = 4.0, 95%CI: 1.4-11.3] were associated with early MTCT. By 12 months, mixed feeding [HR = 8.7, 95%CI: 3.6-20.6], prematurity [HR = 2.3, 95%CI: 1.2-4.3] and low birth weight were associated with children's risk of progressing to infection or death. CONCLUSIONS Multidrug ARV regimens for PMTCT are feasible and effective in routine reference hospital. Early initiation of ARV during pregnancy and proper obstetrical care are essential to improve PMTCT.
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Affiliation(s)
- Patrice Tchendjou
- Laboratoire Epidémiologie, Centre Pasteur du Cameroun, Yaoundé, Cameroon.
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Ahoua L, Ayikoru H, Gnauck K, Odaru G, Odar E, Ondoa-Onama C, Pinoges L, Balkan S, Olson D, Pujades-Rodríguez M. Evaluation of a 5-year programme to prevent mother-to-child transmission of HIV infection in Northern Uganda. J Trop Pediatr 2010; 56:43-52. [PMID: 19602489 DOI: 10.1093/tropej/fmp054] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Prevention of mother-to-child transmission (PMTCT) is essential in HIV/AIDS control. We analysed 2000-05 data from mother-infant pairs in our PMTCT programme in rural Uganda, examining programme utilization and outcomes, HIV transmission rates and predictors of death or loss to follow-up (LFU). Out of 19,017 women, 1,037 (5.5%) attending antenatal care services tested HIV positive. Of these, 517 (50%) enrolled in the PMTCT programme and gave birth to 567 infants. Before tracing, 303 (53%) mother-infant pairs were LFU. Reasons for dropout were infant death and lack of understanding of importance of follow-up. Risk of death or LFU was higher among infants with no or incomplete intrapartum prophylaxis (OR = 1.90, 95% CI 1.07-3.36) and of weaning age <6 months (OR 2.55, 95% CI 1.42-4.58), and lower in infants with diagnosed acute illness (OR 0.30, 95% CI 0.16-0.55). Mother-to-child HIV cumulative transmission rate was 8.3%, and 15.5% when HIV-related deaths were considered. Improved tracking of HIV-exposed infants is needed in PMTCT programmes where access to early infant diagnosis is still limited.
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Abstract
New studies of breastfeeding have discovered or confirmed the benefits to mother and child. They reinforce an emphasis on exclusive breastfeeding - no other food or fluids - during the first 6 months. Studies include findings from across the world, in well-resourced and poorly resourced settings. They also emphasize longer duration of breastfeeding, into the second year of life, and gradual rather than abrupt weaning. For HIV-infected mothers, the dangers of non-exclusive feeding in the first half year of life have been well documented in recent publications. Other studies open up the possibilities for antiretroviral treatment to accompany breastfeeding, whether given to the mother, or child, or both. To be effective, implementation of any recommendations must consider individual, family, and community resources.
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Mothers' infant feeding experiences: constraints and supports for optimal feeding in an HIV-impacted urban community in South Africa. Public Health Nutr 2009; 12:1983-90. [PMID: 19323863 DOI: 10.1017/s1368980009005199] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To better understand the enabling and challenging factors impacting on infant feeding practices in communities with a high HIV prevalence. DESIGN Qualitative study, with data collected through in-depth interviews and observations of mothers, in addition to discussions with health-service providers. SETTING Urban settlement in the province of KwaZulu-Natal, South Africa. SUBJECTS Mothers recruited from an HIV clinic and from within the community. RESULTS Emerging from discussions with mothers on the acceptability of alternative feeding methods were the challenges they encountered in feeding their infants. Mothers readily identified feeding in the context of HIV infection as an issue of great concern, encompassing three central themes: (i) stigma and disclosure of HIV; (ii) confusion and coercion; and (iii) diarrhoea, sickness and free formula. It became evident that mothers rarely received quality infant feeding counselling and consequently mixed feeding, a widespread practice but one that is highly risky for HIV transmission, remained a common feeding practice. Exclusive breast-feeding (EBF) was best practised with support, following disclosure of HIV status. Availability of free formula did not guarantee exclusive formula feeding but instead led to inappropriate feeding practices. CONCLUSIONS In addition to providing accurate information, health-care workers must be empowered to counsel mothers effectively, addressing issues of disclosure and thereby facilitating mobilization of maternal support networks. These findings illustrate the challenges that exist in policy translation within the context of quality of training for health-care workers on optimizing maternal infant feeding practices, particularly in HIV-prevalent, resource-poor settings.
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Maheswaran H, Bland RM. Preventing mother-to-child transmission of HIV in resource-limited settings. Future Virol 2009. [DOI: 10.2217/17460794.4.2.165] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Mother-to-child transmission (MTCT) before, during and after delivery may result in the acquisition of HIV for 30–35% of infants of HIV-infected mothers. Peripartum HIV transmission can be reduced to under 5% in resource-limited settings using a feasible prophylactic antiretroviral regimen. Reducing postnatal transmission through breastfeeding, whilst maintaining child survival, is an urgent priority, given that breastfeeding causes one-third to one-half of all infant HIV infections. Recent evidence highlights the impact of breastfeeding duration and pattern, and hazards associated with the avoidance of breastfeeding in different settings. New international guidelines on HIV and infant feeding have been published. Despite knowledge of how to reduce MTCT of HIV in resource-poor settings, an unacceptably low proportion of women access prevention of MTCT services (PMTCT); follow-up of women and children is poor. To improve survival of mothers and children, health services need to be strengthened, with the integration of PMTCT into existing maternal and child health services.
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Affiliation(s)
- Hendramoorthy Maheswaran
- Africa Centre for Health & Population Studies, PO Box 198, Mtubatuba, Kwa-Zulu Natal, 3935, South Africa
| | - Ruth M Bland
- Africa Centre for Health & Population Studies, PO Box 198, Mtubatuba, Kwa-Zulu Natal, 3935, South Africa and, Division of Developmental Medicine, University of Glasgow Medical Faculty, Glasgow, UK
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Abstract
PURPOSE OF REVIEW In developing countries where replacement feeding is generally not feasible or safe, hundreds of thousands of infants acquire HIV infection during breastfeeding. Data from recently completed studies provide insight into the safety and hazards of different feeding approaches as well as the use of antiretroviral therapy to prevent postnatal transmission. RECENT FINDINGS Several studies confirm that the benefits of avoiding or shortening breastfeeding are offset by adverse outcomes in those infants who escape infection. Reductions in HIV transmission achieved with either formula feeding or early weaning are counterbalanced by increases in uninfected child mortality resulting in no net benefit for HIV-free survival. However, exclusive breastfeeding is associated with a significant decrease in HIV transmission risk. Antiretroviral treatment during breastfeeding to the mother or her infant appears to reduce the risk of postnatal transmission. Studies evaluating daily nevirapine to the breastfeeding infant suggest protection during the period of treatment. Similarly, infants born to breastfeeding women receiving antiretroviral therapy are at lower risk of acquiring HIV. SUMMARY While awaiting further studies defining optimal approaches to preventing HIV transmission during breastfeeding, promoting exclusive breastfeeding and assuring antiretroviral treatment for women with advanced HIV disease will likely prevent the majority of needless maternal and infant deaths.
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Fjeld E, Siziya S, Katepa-Bwalya M, Kankasa C, Moland KM, Tylleskär T. 'No sister, the breast alone is not enough for my baby' a qualitative assessment of potentials and barriers in the promotion of exclusive breastfeeding in southern Zambia. Int Breastfeed J 2008; 3:26. [PMID: 18986539 PMCID: PMC2614965 DOI: 10.1186/1746-4358-3-26] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Accepted: 11/05/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Appropriate feeding practices are of fundamental importance for the survival, growth, development and health of infants and young children. The aim of the present study was to collect baseline information on current infant and young child feeding practices, attitudes and knowledge in Mazabuka, Zambia, using a qualitative approach. METHODS The study was conducted in Mazabuka, 130 km south of Lusaka in Zambia in January and February in 2005. Nine focus group discussions with mothers and a total of 18 in-depth interviews with fathers, grandmothers, health staff and traditional birth attendants were performed in both rural and urban areas. RESULTS Breastfeeding was reported to be universal, the use of pre-lacteal feeds appeared to be low, colostrum was rarely discarded, and attitudes to and knowledge about exclusive breastfeeding were generally good. However, few practised exclusive breastfeeding. The barriers revealed were: (1) the perception of insufficient milk, (2) the fear of dying or becoming too sick to be able to breastfeed, (3) convention, (4) the perception of 'bad milk' and (5) lack of knowledge on the subject. The health staff and traditional birth attendants were the most important actors in transmitting knowledge about infant feeding to the mothers. Both categories appeared to have updated knowledge on child health and were well respected in the society. Fathers and grandmothers tended to be less knowledgeable on novel subjects such as exclusive breastfeeding and often showed a negative attitude towards it. At the same time they had considerable authority over mothers and children and infant feeding decisions. The rural population was in general less educated and more prone to conventional non-exclusive feeding practices. CONCLUSION The message that exclusive breastfeeding (EBF) is beneficial for child health had reached the health workers and was taught to mothers. However, conventions and expectations from family members in this Zambian community were important barriers in preventing the message of EBF from being translated into practice. The deep-rooted beliefs that prohibit EBF need to be addressed in projects and campaigns promoting EBF.
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Affiliation(s)
- Eli Fjeld
- Centre for International Health, University of Bergen, Norway.
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Breast milk as the "water that supports and preserves life"--socio-cultural constructions of breastfeeding and their implications for the prevention of mother to child transmission of HIV in sub-Saharan Africa. Health Policy 2008; 89:322-8. [PMID: 18676049 DOI: 10.1016/j.healthpol.2008.06.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2007] [Revised: 06/06/2008] [Accepted: 06/10/2008] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Complementary breastfeeding represents an important source of risk of HIV infection for infants born to HIV positive mothers. The World Health Organisation recommends that infants born to HIV positive mothers receive either replacement feeding or exclusive breastfeeding (EBF) followed by early weaning. Beyond the clinical and epidemiological debate, it remains unclear how acceptable and feasible the two options are for rural populations in sub-Saharan Africa. This qualitative study aims to fill this gap in knowledge by exploring both the socio-cultural construction and the practice of breastfeeding in the Nouna Health District, rural Burkina Faso. METHODS Information was collected through 32 individual interviews and 3 focus group discussions with women of all ages, and 6 interviews with local guérisseurs. RESULTS The findings highlight that breastfeeding is perceived as central to motherhood, but that women practice complementary, rather than exclusive, breastfeeding. The findings also indicate that women recognise both the nutritional value of breast milk and its potential to act as a source of disease transmission. CONCLUSIONS The findings suggest that given the socio-cultural importance attributed to breastfeeding and the prevailing poverty, it may be more acceptable and more feasible to promote EBF followed by early weaning than replacement feeding. A set of operational strategies are proposed to favour the prevention of mother to child transmission of HIV in the respect of the local socio-cultural setting.
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Varga C, Brookes H. Preventing Mother-to-Child HIV Transmission Among South African Adolescents. JOURNAL OF ADOLESCENT RESEARCH 2008. [DOI: 10.1177/0743558407310771] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although prevention of mother-to-child HIV transmission (PMTCT) programs are predicated on maternal behavior change, little is known about sociocultural factors affecting maternal—child care practices in this arena. The authors used narrative methods (key informant workshops, questionnaires, focus groups, and case study analysis) to explore how sociocultural context shapes adolescent mothers' ability to adhere to programmatic recommendations in rural and urban South Africa. The study aims were to understand the extent to which mothers' decisions are borne out in PMTCT-related practices and to identify contextual elements that affect the link between individual resolutions and action. The results revealed rural adolescents as less likely than urbanites to successfully implement most PMTCT-related practices. HIV stigma, family decision making, and cultural norms surrounding infant feeding hampered mothers' efforts to implement practices that would decrease the risk for infant infection. Barriers to behavior change were analyzed along four domains: history, culture, gender, and power. Methodological aspects and programmatic implications are discussed.
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Israel-Ballard K, Donovan R, Chantry C, Coutsoudis A, Sheppard H, Sibeko L, Abrams B. Flash-heat inactivation of HIV-1 in human milk: a potential method to reduce postnatal transmission in developing countries. J Acquir Immune Defic Syndr 2007; 45:318-23. [PMID: 17514015 DOI: 10.1097/qai.0b013e318074eeca] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Up to 40% of all mother-to-child transmission of HIV occurs by means of breast-feeding; yet, in developing countries, infant formula may not be a safe option. The World Health Organization recommends heat-treated breast milk as an infant-feeding alternative. We investigated the ability of a simple method, flash-heat, to inactivate HIV in breast milk from HIV-positive mothers. METHODS Ninety-eight breast milk samples, collected from 84 HIV-positive mothers in a periurban settlement in South Africa, were aliquoted to unheated control and flash-heating. Reverse transcriptase (RT) assays (lower detection limit of 400 HIV copies/mL) were performed to differentiate active versus inactivated cell-free HIV in unheated and flash-heated samples. RESULTS We found detectable HIV in breast milk samples from 31% (26 of 84) of mothers. After adjusting for covariates, multivariate logistic regression showed a statistically significant negative association between detectable virus in breast milk and maternal CD4+ T-lymphocyte count (P=0.045) and volume of breast milk expressed (P=0.01) and a positive association with use of multivitamins (P=0.03). All flash-heated samples showed undetectable levels of cell-free HIV-1 as detected by the RT assay (P<0.00001). CONCLUSIONS Flash-heat can inactivate HIV in naturally infected breast milk from HIV-positive women. Field studies are urgently needed to determine the feasibility of in-home flash-heating breast milk to improve infant health while reducing postnatal transmission of HIV in developing countries.
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Affiliation(s)
- Kiersten Israel-Ballard
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA 94720-7360, USA.
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Coovadia HM, Coutsoudis A. HIV, infant feeding, and survival: old wine in new bottles, but brimming with promise. AIDS 2007; 21:1837-40. [PMID: 17721090 DOI: 10.1097/qad.0b013e32826fb731] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Hoosen M Coovadia
- Nelson Mandela School of Medicine, University of Kwazulu/Natal, 719 Umbilo Road, Congella 4013, South Africa.
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Bland RM, Rollins NC, Coovadia HM, Coutsoudis A, Newell ML. Infant feeding counselling for HIV-infected and uninfected women: appropriateness of choice and practice. Bull World Health Organ 2007; 85:289-96. [PMID: 17546310 PMCID: PMC2636333 DOI: 10.2471/blt.06.032441] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Revised: 09/20/2006] [Accepted: 10/16/2006] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To examine infant feeding intentions of HIV-infected and uninfected women and the appropriateness of their choices according to their home resources; and to determine their adherence to their intentions in the first postnatal week. METHODS Feeding intentions of pregnant women were compared against four resources that facilitate replacement feeding: clean water, adequate fuel, access to a refrigerator and regular maternal income. First-week feeding practices were documented. FINDINGS The antenatal feeding intentions of 1253 HIV-infected women were: exclusive breastfeeding 73%; replacement feeding 9%; undecided 18%. Three percent had access to all four resources, of whom 23% chose replacement feeding. Of those choosing replacement feeding, 8% had access to all four resources. A clean water supply and regular maternal income were independently associated with intention to replacement feed (adjusted odds ratio (AOR) 1.94, 95% confidence interval (CI) 1.2-3.2; AOR 2.1, 95% CI: 1.2-3.5, respectively). Significantly more HIV-infected women intending to exclusively breastfeed, rather than replacement feed, adhered to their intention in week one (exclusive breastfeeding 78%; replacement feeding 42%; P<0.001). Of 1238 HIV-uninfected women, 82% intended to exclusively breastfeed; 2% to replacement feed; and 16% were undecided. Seventy-five percent who intended to exclusively breastfeed adhered to this intention postnatally, and only 11 infants (<1%) received no breast milk. The number of antenatal home visits significantly influenced adherence to feeding intention. CONCLUSION Most HIV-infected women did not have the resources for safe replacement feeding, instead choosing appropriately to exclusively breastfeed. Adherence to feeding intention among HIV-infected women was higher in those who chose to exclusively breastfeed than to replacement feed. With appropriate counselling and support, spillover of suboptimal feeding practices to HIV-negative women is minimal.
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Affiliation(s)
- R M Bland
- Africa Centre for Health and Population Studies, University of KwaZulu Natal, South Africa.
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Coovadia HM, Rollins NC, Bland RM, Little K, Coutsoudis A, Bennish ML, Newell ML. Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months of life: an intervention cohort study. Lancet 2007; 369:1107-16. [PMID: 17398310 DOI: 10.1016/s0140-6736(07)60283-9] [Citation(s) in RCA: 426] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Exclusive breastfeeding, though better than other forms of infant feeding and associated with improved child survival, is uncommon. We assessed the HIV-1 transmission risks and survival associated with exclusive breastfeeding and other types of infant feeding. METHODS 2722 HIV-infected and uninfected pregnant women attending antenatal clinics in KwaZulu Natal, South Africa (seven rural, one semiurban, and one urban), were enrolled into a non-randomised intervention cohort study. Infant feeding data were obtained every week from mothers, and blood samples from infants were taken monthly at clinics to establish HIV infection status. Kaplan-Meier analyses conditional on exclusive breastfeeding were used to estimate transmission risks at 6 weeks and 22 weeks of age, and Cox's proportional hazard was used to quantify associations with maternal and infant factors. FINDINGS 1132 of 1372 (83%) infants born to HIV-infected mothers initiated exclusive breastfeeding from birth. Of 1276 infants with complete feeding data, median duration of cumulative exclusive breastfeeding was 159 days (first quartile [Q1] to third quartile [Q3], 122-174 days). 14.1% (95% CI 12.0-16.4) of exclusively breastfed infants were infected with HIV-1 by age 6 weeks and 19.5% (17.0-22.4) by 6 months; risk was significantly associated with maternal CD4-cell counts below 200 cells per muL (adjusted hazard ratio [HR] 3.79; 2.35-6.12) and birthweight less than 2500 g (1.81, 1.07-3.06). Kaplan-Meier estimated risk of acquisition of infection at 6 months of age was 4.04% (2.29-5.76). Breastfed infants who also received solids were significantly more likely to acquire infection than were exclusively breastfed children (HR 10.87, 1.51-78.00, p=0.018), as were infants who at 12 weeks received both breastmilk and formula milk (1.82, 0.98-3.36, p=0.057). Cumulative 3-month mortality in exclusively breastfed infants was 6.1% (4.74-7.92) versus 15.1% (7.63-28.73) in infants given replacement feeds (HR 2.06, 1.00-4.27, p=0.051). INTERPRETATION The association between mixed breastfeeding and increased HIV transmission risk, together with evidence that exclusive breastfeeding can be successfully supported in HIV-infected women, warrant revision of the present UNICEF, WHO, and UNAIDS infant feeding guidelines.
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Affiliation(s)
- Hoosen M Coovadia
- Centre for HIV/AIDS Networking, University of KwaZulu-Natal, South Africa
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Papathakis PC, Van Loan MD, Rollins NC, Chantry CJ, Bennish ML, Brown KH. Body composition changes during lactation in HIV-infected and HIV-uninfected South African women. J Acquir Immune Defic Syndr 2007; 43:467-74. [PMID: 16980904 DOI: 10.1097/01.qai.0000243094.42276.92] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The nutritional consequences of HIV infection in lactating women are unknown. OBJECTIVE To measure the body composition of South African lactating women in relation to HIV status. METHODS Fat-free mass (FFM) and fat mass (FM) using bioimpedance spectrometry (BIS) and anthropometric measurements were obtained at 8 and 24 weeks postpartum in 92 HIV-infected (HIVpos) and 50 HIV-uninfected (HIVneg) lactating mothers. RESULTS At 8 weeks, HIVpos and HIVneg mothers were not significantly different in height (159.7 vs. 158.9 cm), weight (62.7 vs. 63.9 kg), body mass index (BMI; 24.6 vs. 25.3 kg/m), FFM (40.7 vs. 42.8 kg), or FM (21.6 vs. 22.0 kg), respectively. In HIVpos women, the median CD4 count was 621 (range: 101-1585) cells/muL; 95% had CD4 counts >200 cells/muL. Between 8 and 24 weeks, HIVpos mothers had a mean weight loss of 1.4 kg in contrast to a 0.4-kg weight gain in HIVneg mothers (P < 0.01). There were no significant group differences with regard to change in FFM (0.3 vs. 0.1 kg; P = 0.9) and FM (-1.5 vs. -0.3 kg; P = 0.2). CONCLUSION HIVpos South African breast-feeding mothers without severe immune suppression lost weight and subcutaneous fat between 8 and 24 weeks postpartum, whereas HIVneg mothers gained weight. FFM was maintained postpartum in HIVpos and HIVneg mothers.
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Affiliation(s)
- Peggy C Papathakis
- Africa Center for Health and Population Studies--KwaZulu-Natal Province, South Africa.
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Rea MF, dos Santos RG, Sanchez-Moreno CC. Quality of infant feeding counselling for HIV+ mothers in Brazil: challenges and achievements. Acta Paediatr 2007; 96:94-9. [PMID: 17187612 DOI: 10.1111/j.1651-2227.2007.00017.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM This project aimed to assess the information and counselling on infant feeding in HIV+ mothers. METHODS A cross-sectional study, based on 118 structured observations of mothers' visits to health professionals (5-8/professional)-in 15 purposively selected HIV/Aids healthcare units in Sao Paulo. RESULTS The general quality of communication and counselling skills was good: for example, professionals responded to all mothers' questions (98%); kept eye-to-eye contact (82%); encouraged the mother to talk (77.1%). However, the information provided to mothers aimed to help their choices concerning infant feeding was of very poor quality. No mother, for example, was informed about alternatives to formula feeding and the danger of mixed feeding. None was offered the option of using banked breast milk. Only around 20% of mothers were informed about the safe preparation of formula feeding. When counselled by a nutritionist (compared with a paediatrician) more mothers were informed about the correct way to prepare bottle-feeds. No mention was made of cup feeding. CONCLUSION Although health workers have good communication skills, the information provided to HIV+ mothers is insufficient. Recommending against breast-feeding and providing infant formula may not be enough to achieve safer infant-feeding practices.
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Affiliation(s)
- Marina Ferreira Rea
- Instituto de Saude, São Paulo, Rua Santo Antonio, 590 01314-000 - São Paulo, Brazil.
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Papathakis PC, Rollins NC, Chantry CJ, Bennish ML, Brown KH. Micronutrient status during lactation in HIV-infected and HIV-uninfected South African women during the first 6 mo after delivery. Am J Clin Nutr 2007; 85:182-92. [PMID: 17209195 DOI: 10.1093/ajcn/85.1.182] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Little information on the micronutrient status of HIV-infected (HIV-positive) breastfeeding women is available. OBJECTIVE The objective was to compare the protein and micronutrient status of South African breastfeeding women by HIV status. DESIGN Serum albumin, prealbumin, vitamin B-12, folate, retinol, alpha-tocopherol, hemoglobin, ferritin, and zinc concentrations were compared between 92 HIV-positive and 52 HIV-uninfected (HIV-negative) mothers 6, 14, and 24 wk after delivery. C-reactive protein and alpha1-acid glycoprotein were used as proxy indicators of an inflammatory process. RESULTS Mean albumin and prealbumin were significantly lower in HIV-positive mothers, and a higher proportion of HIV-positive mothers had low albumin concentrations (< 35 g/L). Less than 45% of the mothers were vitamin B-12 or folate sufficient. Significantly more HIV-positive (70.5%) than HIV-negative (46.2%) mothers had marginal vitamin B-12 status (P < 0.05), and mean folate concentrations were lower in HIV-positive mothers (P = 0.05). Mean serum retinol was significantly lower in HIV-positive mothers, even after control for the acute phase response. At 24 wk, 70% of both groups had an alpha-tocopherol deficiency (< 11.6 micromol/L), but no significant difference by HIV status was observed. More HIV-positive (33.3%) than HIV-negative (8.7%) mothers had anemia (P = 0.018), whereas 25% of all mothers had low serum ferritin concentrations. After the acute phase response was controlled for, zinc deficiency was more common in HIV-positive (45.0%) than in HIV-negative (25.0%) mothers (P = 0.05). CONCLUSIONS Deficiencies in vitamins B-12, folate, alpha-tocopherol, ferritin, and zinc are common in South African breastfeeding mothers. HIV-positive mothers had lower mean serum concentrations of albumin, prealbumin, folate, retinol, and hemoglobin than did HIV-negative mothers.
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Affiliation(s)
- Peggy C Papathakis
- Africa Centre for Health and Population Studies, Somekele, South Africa.
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Doull M, O'Connor A, Jacobsen MJ, Robinson V, Cook L, Nyamai-Kisia C, Tugwell P. Investigating the decision-making needs of HIV-positive women in Africa using the Ottawa Decision-Support Framework: Knowledge gaps and opportunities for intervention. PATIENT EDUCATION AND COUNSELING 2006; 63:279-91. [PMID: 16982168 DOI: 10.1016/j.pec.2006.06.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2006] [Revised: 06/22/2006] [Accepted: 06/29/2006] [Indexed: 05/11/2023]
Abstract
OBJECTIVE To examine HIV-positive women's decision making in the context of pregnancy and HIV/AIDS and to explore interventions that may enhance and develop women's decision-making capacity in the sub-Saharan African context. METHODS The Ottawa Decision-Support Framework was used to assemble evidence of women's decision-making needs. Several electronic databases were searched and an Internet search of the World Wide Web was conducted to search grey literature sources. An evidence-based approach to assessing benefits, harms and current practices was employed. RESULTS Several gaps in our knowledge about women's decision making in the context of pregnancy and HIV were identified. The availability of evidence varied for each decision; however, significant gaps included: evidence around testing for ones status, advanced directives for self and child, disclosure (specifically, the impact of), others perceptions of antiretroviral use and data on termination of pregnancies. CONCLUSION Decision making as a concept was generally not addressed in the MTCT literature. Evidence regarding the perceptions of women and others regarding the various decisions was often not available and subsequently an important aspect of MTCT interventions neglected. PRACTICE IMPLICATIONS Incorporating a multi-disciplinary decision-support framework may prove useful to promote women's autonomy and involvement in MTCT-related decision making.
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Affiliation(s)
- Marion Doull
- Centre for Global Health, Institute of Population Health, University of Ottawa, Ottawa, Canada.
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Coovadia H, Archary D. Prevention of transmission of HIV-1 from mothers to infants in Africa. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2006; 582:201-20. [PMID: 16802630 DOI: 10.1007/0-387-33026-7_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Affiliation(s)
- Hoosen Coovadia
- Centre for HIV and AIDS Networking, University of KwaZulu-Natal, Nelson R Mandela School of Medicine, Doris Duke Medical Research Institute, Congella, Durban, South Africa
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Igumbor J, Pengpid S, Obi L. Effect of exposure to clinic-based health education interventions on behavioural intention to prevent mother-to-child transmission of HIV infection. SAHARA J 2006; 3:394-402. [PMID: 17601021 PMCID: PMC11134001 DOI: 10.1080/17290376.2006.9724865] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
HIV and AIDS incidence among infants in South Africa is on the increase. The uptake of prevention of mother-to-child transmission (PMTCT) interventions is often said to be dependent on the beliefs and educational needs of those requiring PMTCT services. This study therefore sought to examine the effect of clinic-based health education interventions (HEI) on behavioural intention of PMTCT among 300 pregnant women from 4 primary health care clinics in Tshilidzini Hospital catchments area, South Africa. An interview schedule was used to obtain information regarding participants' demographic characteristics, level of exposure to clinic-based HEI, salient beliefs and behavioural intention on PMTCT. The major findings included that approximately 85% of the participants had heard of PMTCT. There was very little association between frequency of antenatal clinic (ANC) visits and level of exposure to PMTCT information. Condom use had the lowest set of salient belief scores. Control belief was the most common belief contributing to behavioural intention. Generally, the association between PMTCT salient beliefs and behavioural intention was weak. Clinic-based HEI had an impact on behavioural intention of HIV testing, normative belief of regular ANC visit and nevirapine use. The vital contribution of alternative PMTCT information sources such as the radio and television was observed. Enhancing initiatives that empower women, and a better coordination of the existing HEI through better implementation of health education strategy may strengthen the prevailing moderate PMTCT intention in the area investigated.
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Affiliation(s)
- Jude Igumbor
- School of Health Sciences, University of Venda, South Africa
| | - Supa Pengpid
- National School of Public Health, University of Limpopo, South Africa
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Piwoz EG, Ferguson YO, Bentley ME, Corneli AL, Moses A, Nkhoma J, Tohill BC, Mtimuni B, Ahmed Y, Jamieson DJ, van der Horst C, Kazembe P. Differences between international recommendations on breastfeeding in the presence of HIV and the attitudes and counselling messages of health workers in Lilongwe, Malawi. Int Breastfeed J 2006; 1:2. [PMID: 16722580 PMCID: PMC1436018 DOI: 10.1186/1746-4358-1-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2005] [Accepted: 03/09/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To prevent postnatal transmission of HIV in settings where safe alternatives to breastfeeding are unavailable, the World Health Organization (WHO) recommends exclusive breastfeeding followed by early, rapid cessation of breastfeeding. Only limited data are available on the attitudes of health workers toward this recommendation and the impact of these attitudes on infant feeding counselling messages given to mothers. METHODS As part of the Breastfeeding, Antiretroviral, and Nutrition (BAN) clinical trial, we carried out an in-depth qualitative study of the attitudes, beliefs, and counselling messages of 19 health workers in Lilongwe, Malawi. RESULTS Although none of the workers had received formal training, several reported having counseled HIV-positive mothers about infant feeding. Health workers with counselling experience believed that HIV-infected mothers should breastfeed exclusively, rather than infant formula feed, citing poverty as the primary reason. Because of high levels of malnutrition, all the workers had concerns about early cessation of breastfeeding. CONCLUSION Important differences were observed between the WHO recommendations and the attitudes and practices of the health workers. Understanding these differences is important for designing effective interventions.
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Affiliation(s)
- Ellen G Piwoz
- Academy for Educational Development, 1875 Connecticut Ave, NW, Washington, DC, 20009, USA
| | - Yvonne Owens Ferguson
- University of North Carolina at Chapel Hill, 1700 Airport Road, CB# 3368 Chapel Hill, North Carolina, 27514, USA
| | - Margaret E Bentley
- University of North Carolina at Chapel Hill, 1700 Airport Road, CB# 3368 Chapel Hill, North Carolina, 27514, USA
| | - Amy L Corneli
- University of North Carolina at Chapel Hill, 1700 Airport Road, CB# 3368 Chapel Hill, North Carolina, 27514, USA
| | - Agnes Moses
- UNC Project, Private Bag A-106, Lilongwe, Malawi
| | | | - Beth Carlton Tohill
- US Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Atlanta, Georgia, 30333, USA
| | | | - Yusuf Ahmed
- US Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Atlanta, Georgia, 30333, USA
| | - Denise J Jamieson
- US Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Atlanta, Georgia, 30333, USA
| | - Charles van der Horst
- University of North Carolina at Chapel Hill, 1700 Airport Road, CB# 3368 Chapel Hill, North Carolina, 27514, USA
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45
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Koulinska IN, Villamor E, Chaplin B, Msamanga G, Fawzi W, Renjifo B, Essex M. Transmission of cell-free and cell-associated HIV-1 through breast-feeding. J Acquir Immune Defic Syndr 2006; 41:93-9. [PMID: 16340480 DOI: 10.1097/01.qai.0000179424.19413.24] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Transmission through breast-feeding is an important cause of infant HIV-1 infections in developing countries; however, its mechanism remains largely unknown. We have explored the association between cell-free virus (CFV) and cell-associated virus (CAV) levels in breast milk (BM), as reflected by viral RNA and proviral DNA, respectively, and the risk of infant HIV-1 infection after 6 weeks postpartum. METHODS Sixty-one HIV-positive mothers who transmitted HIV-1 by BM were matched to 61 HIV-positive nontransmitting mothers based on their infant's age at sample collection. CFV and CAV were quantified in a single milk specimen per mother preceding the infant's first HIV-positive result. RESULTS After adjusting for maternal CD4 cell counts and disease stage, each 10-fold increase in CFV or CAV load was associated with an almost 3-fold increase in BM transmission. Whereas CAV load was predictive of transmission before and after 9 months postpartum, CFV was a significant predictor of transmission occurring only after 9 months. Phylogenetic analyses of the C2 to C5 env region showed that 85% of infants (11 of 13 infants) harboring viruses that clustered with CFV in their mother's milk were infected after 9 months postpartum. CONCLUSION A reduction in milk CAV and CFV loads might significantly decrease HIV-1 transmission by breast-feeding.
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Affiliation(s)
- Irene N Koulinska
- Harvard School of Public Health AIDS Initiative, Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA 02115, USA
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Israel-Ballard KA, Maternowska MC, Abrams BF, Morrison P, Chitibura L, Chipato T, Chirenje ZM, Padian NS, Chantry CJ. Acceptability of heat treating breast milk to prevent mother-to-child transmission of human immunodeficiency virus in Zimbabwe: a qualitative study. J Hum Lact 2006; 22:48-60. [PMID: 16467287 DOI: 10.1177/0890334405283621] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although heat treatment of human milk is an official infant-feeding recommendation for human immunodeficiency virus (HIV)-positive mothers in Zimbabwe, its implementation has not been adequately addressed, because knowledge about the safety of this method is rudimentary and its acceptability is poorly understood. To address this knowledge gap, the authors conducted focus group discussions among mothers, grandmothers, midwives, and husbands in various regions of Zimbabwe. Although the practice of heat treating expressed human milk was initially met with skepticism because of potential obstacles, including time constraints and social and cultural stigma, a pattern of opinion reversal emerged in all groups. By the end of each discussion, participants believed that, given its affordability and its potential to protect infants from HIV infection, heat-treated human milk may be a feasible infant-feeding option for HIV-positive mothers in Zimbabwe. These findings merit further investigation so that appropriate behavioral strategies can be designed.
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Affiliation(s)
- Kiersten A Israel-Ballard
- Division of Epidemiology, School of Public Health, University of California, Berkeley 94720-7360, USA
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47
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Canning D. The economics of HIV/AIDS in low-income countries: the case for prevention. THE JOURNAL OF ECONOMIC PERSPECTIVES : A JOURNAL OF THE AMERICAN ECONOMIC ASSOCIATION 2006; 20:121-42. [PMID: 17176527 DOI: 10.1257/jep.20.3.121] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
There are two approaches to reducing the burden of sickness and death associated with the human immunodeficiency virus (HIV), which leads to acquired immunodeficiency syndrome (AIDS): treatment and prevention. Despite large international aid flows for HIV/AIDS, the needs for prevention and treatment in low- and middle-income countries outstrip the resources available. Thus, it becomes necessary to set priorities. With limited resources, should the focus of efforts to combat HIV/AIDS be on prevention or treatment? I discuss the range of prevention and treatment alternatives and examine their cost effectiveness. I consider various arguments that have been raised against the use of cost-effectiveness analysis in setting public policy priorities for the response to HIV/AIDS in developing countries. I conclude that promoting AIDS treatment using antiretrovirals in resource-constrained countries comes at a huge cost in terms of avoidable deaths that could be prevented through interventions that would substantially lower the scale of the epidemic.
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Affiliation(s)
- David Canning
- Harvard School of Public Health, Harvard University, Boston, Massachusetts, USA.
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48
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Israel-Ballard K, Chantry C, Dewey K, Lönnerdal B, Sheppard H, Donovan R, Carlson J, Sage A, Abrams B. Viral, Nutritional, and Bacterial Safety of Flash-Heated and Pretoria-Pasteurized Breast Milk to Prevent Mother-to-Child Transmission of HIV in Resource-Poor Countries. J Acquir Immune Defic Syndr 2005; 40:175-81. [PMID: 16186735 DOI: 10.1097/01.qai.0000178929.15904.95] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Heat-treated breast milk of HIV-positive mothers has potential to reduce vertical transmission. This study compared the impact of flash-heating (FH) and Pretoria pasteurization (PP) on HIV, nutrients, and antimicrobial properties in human milk. METHODS Milk samples were spiked with 1 x 10 (8) copies/mL of clade C HIV-1 and treated with FH and PP. We measured HIV reverse transcriptase (RT) activity before and after heating (n = 5). Heat impact on vitamins A, B6, B12, and C; folate, riboflavin, thiamin, and antimicrobial proteins (lactoferrin and lysozyme) was assessed. Storage safety was evaluated by spiking with Escherichia coli or Staphylococcus aureus. RESULTS Both methods inactivated > or = 3 logs of HIV-1. FH resulted in undetectable RT activity. Neither method caused significant decrease in any vitamin, although reductions in vitamins C and E were noted. Heat decreased immunoreactive lactoferrin (P < 0.05) but not the proportions of lactoferrin and lysozyme surviving digestion. FH seems to retain more antibacterial activity. Both treatments eliminated spiked bacteria. CONCLUSIONS FH may be superior to PP in eliminating all viral activity; both methods retained nutrients and destroyed bacterial contamination. Heat-treated breast milk merits further study as a safe and practical infant feeding option for HIV-positive mothers in developing countries.
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Affiliation(s)
- Kiersten Israel-Ballard
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA.
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49
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Papathakis PC, Rollins NC, Brown KH, Bennish ML, Van Loan MD. Comparison of isotope dilution with bioimpedance spectroscopy and anthropometry for assessment of body composition in asymptomatic HIV-infected and HIV-uninfected breastfeeding mothers. Am J Clin Nutr 2005; 82:538-46. [PMID: 16155265 DOI: 10.1093/ajcn.82.3.538] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The effect of breastfeeding on the nutrition of HIV-infected (HIV+) mothers is unknown. Simple, valid methods are needed for body-composition assessment of HIV+ women. OBJECTIVE We compared the ability of bioimpedance spectroscopy (BIS) and anthropometry with that of isotope dilution (2H2O) to measure fat-free mass (FFM) and fat mass (FM) in HIV+ and HIV-uninfected (HIV-) breastfeeding South African mothers. DESIGN Total body water (TBW) content of 68 lactating mothers (20 HIV+, 48 HIV-) was measured 10 wk after delivery by using BIS and 2H2O to measure FFM and FM. Anthropometric measurements included body mass index (BMI; in kg/m2), midupper arm circumference (MUAC), and 4 skinfold thicknesses. RESULTS TBW, FFM, and FM measurements determined by BIS were correlated with 2H2O measurements in HIV+ (r = 0.664, 0.621, and 0.872, respectively; P < 0.01) and HIV- (r = 0.876, 0.868, and 0.932, respectively; P < 0.001) mothers. TBW measured by BIS was greater than that measured by the 2H2O method in both HIV+ (1.8 L) and HIV- (1.5 L) women; FM or FFM did not differ significantly by method. BMI, MUAC, and all skinfold-thickness measurements correlated strongly (r > 0.62, P < 0.001) with FM measured by 2H2O in both groups. BMI and MUAC correlated (r > 0.64, P < 0.001) with FFM in HIV- mothers but not in HIV+ mothers. CONCLUSIONS In HIV+ and HIV- breastfeeding mothers, BIS provides an estimate of body composition comparable to that obtained with the 2H2O method. BMI and MUAC are useful in predicting FM in both groups but are not valid measures of FFM in HIV+ mothers.
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Affiliation(s)
- Peggy C Papathakis
- Africa Centre for Health and Population Studies, Somekele, South Africa.
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50
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Papathakis PC, Rollins NC, Brown KH, Bennish ML, Van Loan MD. Comparison of isotope dilution with bioimpedance spectroscopy and anthropometry for assessment of body composition in asymptomatic HIV-infected and HIV-uninfected breastfeeding mothers. Am J Clin Nutr 2005. [DOI: 10.1093/ajcn/82.3.538] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Peggy C Papathakis
- From the Africa Centre for Health and Population Studies, Somekele, South Africa (PCP, NCR, and MLB); the Program in International Nutrition, University of California, Davis, Davis, CA (PCP, KHB, and MVL); the Department of Paediatrics, Nelson R Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa (NCR); the Division of Geographic Medicine and Infectious Diseases, Tufts-N
| | - Nigel C Rollins
- From the Africa Centre for Health and Population Studies, Somekele, South Africa (PCP, NCR, and MLB); the Program in International Nutrition, University of California, Davis, Davis, CA (PCP, KHB, and MVL); the Department of Paediatrics, Nelson R Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa (NCR); the Division of Geographic Medicine and Infectious Diseases, Tufts-N
| | - Kenneth H Brown
- From the Africa Centre for Health and Population Studies, Somekele, South Africa (PCP, NCR, and MLB); the Program in International Nutrition, University of California, Davis, Davis, CA (PCP, KHB, and MVL); the Department of Paediatrics, Nelson R Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa (NCR); the Division of Geographic Medicine and Infectious Diseases, Tufts-N
| | - Michael L Bennish
- From the Africa Centre for Health and Population Studies, Somekele, South Africa (PCP, NCR, and MLB); the Program in International Nutrition, University of California, Davis, Davis, CA (PCP, KHB, and MVL); the Department of Paediatrics, Nelson R Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa (NCR); the Division of Geographic Medicine and Infectious Diseases, Tufts-N
| | - Marta D Van Loan
- From the Africa Centre for Health and Population Studies, Somekele, South Africa (PCP, NCR, and MLB); the Program in International Nutrition, University of California, Davis, Davis, CA (PCP, KHB, and MVL); the Department of Paediatrics, Nelson R Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa (NCR); the Division of Geographic Medicine and Infectious Diseases, Tufts-N
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