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Title: Breastfeeding and obesity among Kuwaiti preschool children.
Author: Al-Qaoud N; Prakash P
Source: Medical Principles and Practice. 2009;18(2):111-7.
Abstract: OBJECTIVES: To determine if breastfeeding and its duration are associated with a reduced risk of obesity among Kuwaiti preschool children. SUBJECTS AND METHODS: The sample consisted of 2,291 (1,092 males and 1,199 females) preschool children (3-6 years of age) and their mothers. The data were collected from September 2003 to June 2004. Height and weight measurements were used for defining weight status while other data were collected by questionnaire. RESULTS: There was no significant association of breastfeeding or its duration with either overweight or obesity among preschool children after adjusting for effects of the confounders. The child's gender, age and birth weight were the significant factors influencing current weight. Girls were at 32% higher risk of becoming obese than boys. Children aged 4-5 years were at nearly 3 times higher risk of overweight and obesity than children of less than 4 years. Children with higher birth weight (>or=4 kg) had double the risk of obesity than those of normal birth weight (>or=2.5 to <4.0 kg). Maternal obesity was a strong predictor of obesity in the children. A child with an obese mother had nearly 2 times higher risk of being overweight (BMI between the 85th the 95th percentiles) and 3 times of being obese (BMI >or=95th percentile) compared to a child born to a mother with a normal body weight. CONCLUSION: Breastfeeding and its duration are not associated with obesity status. However, there is a positive association between child and maternal obesity.
Language: English
Keywords:
KUWAIT | RESEARCH REPORT | PREVALENCE | CHILDREN | BREASTFEEDING | OBESITY | BODY WEIGHT | CHILD HEALTH | Middle East | Developed Countries | Measurement | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Infant Nutrition | Nutrition | Health | Physiology | Biology
Document Number: 341031

Peer Reviewed

Title: Seroreversion in children born to HIV-positive and AIDS mothers from Central West Brazil.
Author: Alcantara KC; Pereira GA; Albuquerque M; Stefani MM
Source: Transactions of the Royal Society of Tropical Medicine and Hygiene. 2009 Jun;103(6):620-6.
Abstract: The spread of HIV-1 infection among women of childbearing age has led to increasing numbers of children at risk of vertical transmission. This study aimed to assess child outcomes among HIV-positive (n=19) and AIDS (n=22) mothers from Central West Brazil. CD4(+) T-cell counts (FACScount, BD) and viral loads (HIV-1 RT-PCR, Amplicor HIV-1 Monitor Roche) were assessed at delivery and during the first 6 months of life. Heteroduplex mobility assay identified env and gag HIV-1 subtypes. Frequencies and medians were calculated. HIV-positive and AIDS mothers did not differ with regard to age, antiretroviral prophylaxis, parity and viral load. AIDS mothers had lower CD4(+) T-cell counts. One vertical transmission and a neonatal death were observed. Gestational age, gender and oral zidovudine prophylaxis were similar regardless of maternal clinical status. Infants born to AIDS mothers had lower birthweight and shorter time to seroreversion. Eight infants were lost to follow-up, and two were breastfed due to delayed maternal diagnosis. HIV-1 B(env)/B(gag) subtype were 75.6%; discordant B(env)/F(gag) were 12.2%. Exposed uninfected infants born to AIDS mothers with lower CD4(+) T-cell counts seroreverted earlier than infants born to asymptomatic HIV-positive mothers. It is possible that maternal immunological status may impact on the time to seroreversion.
Language: English
Keywords:
BRAZIL | RESEARCH REPORT | MOTHERS | PERSONS LIVING WITH HIV/AIDS | MOTHER-TO-CHILD TRANSMISSION | BREASTFEEDING | LABORATORY PROCEDURES | AIDS | HIV INFECTIONS | South America, Eastern | South America | Latin America | Americas | Developing Countries | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Viral Diseases | Diseases | Transmission | Infections | Infant Nutrition | Nutrition | Health | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care
Document Number: 342742

Peer Reviewed

Title: Pregnancy and optimal care of HIV-infected patients.
Author: Anderson BL; Cu-Uvin S
Source: Clinical Infectious Diseases. 2009 Feb 15;48(4):449-55.
Abstract: Human immunodeficiency virus (HIV) infection during pregnancy is a condition that requires multidisciplinary care. Care must be rendered that is appropriate for both the mother and the fetus. Prevention of mother-to-child transmission of HIV is of paramount concern. To prevent transmission, universal testing for HIV infection in pregnant women is ideal. In the United States and other developed countries, great strides have been made toward decreasing the risk of HIV transmission to infants to <2% with use of a combination of highly active antiretroviral therapy during the antepartum period and during labor and delivery, scheduled cesarean section when appropriate, avoidance of breast-feeding, and 6 weeks of zidovudine prophylaxis for infants. The continuation of antiretroviral therapy after delivery depends on the needs of the mother with regard to treatment of her own health. In resource-limited countries, where simplified and shortened courses of antiretroviral regimens have been used, reduction in mother-to-child transmission has also been shown, although not as effectively as that with highly active antiretroviral therapy. In these settings, exclusive breast-feeding for 6 months is recommended to reduce the risk of postnatal transmission.
Language: English
Keywords:
UNITED STATES OF AMERICA | DEVELOPING COUNTRIES | RECOMMENDATIONS | PREGNANT WOMEN | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | HIV TESTING | ANTIRETROVIRAL DRUGS | ADMINISTRATION AND DOSAGE | DRUG RESISTANCE | ANTIRETROVIRAL THERAPY | RISK FACTORS | CESAREAN SECTION | BREASTFEEDING | Developed Countries | North America | Americas | Population Characteristics | Demographic Factors | Population | Disease Transmission Control | Prevention and Control | Diseases | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Treatment | Drugs | HIV | HIV Infections | Viral Diseases | Obstetrical Surgery | Surgery | Infant Nutrition | Nutrition
Document Number: 342644

Peer Reviewed

Title: Growth faltering due to breastfeeding cessation in uninfected children born to HIV-infected mothers in Zambia.
Author: Arpadi S; Fawzy A; Aldrovandi GM; Kankasa C; Sinkala M; Mwiya M; Thea DM; Kuhn L
Source: American Journal of Clinical Nutrition. 2009 Aug;90(2):344-53.
Abstract: BACKGROUND: The effect of breastfeeding on growth in HIV-exposed infants is not well described. OBJECTIVE: The objective was to evaluate the effect of early breastfeeding cessation on growth. DESIGN: In a trial conducted in Lusaka, Zambia, HIV-infected mothers were randomly assigned to exclusive breastfeeding for 4 mo followed by rapid weaning to replacement foods or exclusive breastfeeding for 6 mo followed by introduction of complementary foods and continued breastfeeding for a duration of the mother's choice. Weight-for-age z score (WAZ), length-for-age z score (LAZ), and weight-for-length z score (WLZ) and the self-reported breastfeeding practices of 593 HIV-uninfected singletons were analyzed. Generalized estimating equations were used to adjust for confounders. RESULTS: WAZ scores declined precipitously between 4.5 and 15 mo. The decline was slower in the breastfed infants. At 9, 12, and 15 mo, mean WAZs were, respectively, -0.74, -0.92, and -1.06 in infants who were reportedly breastfed and were -1.07, -1.20, and -1.31 in the weaned infants (P = 0.003, 0.007, and 0.02, respectively). No differences were observed past 15 mo. Breastfeeding practice was not associated with LAZ, which declined from -0.98 to -2.24 from 1 to 24 mo. After adjustment for birth weight, maternal viral load, body mass index, education, season, and marital and socioeconomic status, not breastfeeding was associated with a 0.28 decline in WAZ between 4.5 and 15 mo (P < 0.0001). During the rainy season, not breastfeeding was associated with a larger WAZ decline (0.33) than during the dry season (0.22; P for interaction = 0.02). CONCLUSIONS: Early growth is compromised in uninfected children born to HIV-infected Zambian mothers. Continued breastfeeding partially mitigates this effect through 15 mo. Nutritional interventions to complement breastfeeding after 6 mo are urgently needed. This trial was registered at clinicaltrials.gov as NCT00310726.
Language: English
Keywords:
ZAMBIA | RESEARCH REPORT | EVALUATION | INFANT | MOTHERS | PERSONS LIVING WITH HIV/AIDS | BREASTFEEDING | CHILD DEVELOPMENT | IMPACT | NEEDS | MATERNAL NUTRITION | NUTRITION PROGRAMS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | HIV Infections | Viral Diseases | Diseases | Infant Nutrition | Nutrition | Health | Biology | Communication | Economic Factors | Primary Health Care | Health Services | Delivery of Health Care
Document Number: 342426

Title: Effectiveness of an intervention to improve breastfeeding knowledge and attitudes among fifth-grade children in Brazil.
Author: Bottaro SM; Giugliani ER
Source: Journal of Human Lactation. 2009 Aug;25(3):325-32.
Abstract: This cluster-randomized trial evaluated the effectiveness and residual effect of an educational intervention to improve breastfeeding knowledge and attitudes among fifth grade children of both sexes in Brazil. Schools were considered clusters and analysis of variance was used to compare an intervention group (n = 298) and a control group (n = 253) regarding knowledge, perceptions, and beliefs about breastfeeding before and after the intervention, measured through a standardized 25-item, multiple-choice questionnaire. The scores in the intervention group improved significantly, with the effect lasting at least 3 months. The intervention had greater impact on girls and on students between 9 and 11 years of age when compared with boys and students between 12 and 17 years old and also between students from public schools. Results suggest that pro-breastfeeding interventions in schools improve breastfeeding knowledge and attitudes.
Language: English
Keywords:
BRAZIL | RESEARCH REPORT | INTERVENTIONS | CHILDREN | PRIMARY SCHOOLS | STUDENTS | BREASTFEEDING | KNOWLEDGE | ATTITUDES | PROGRAM EFFECTIVENESS | South America, Eastern | South America | Latin America | Americas | Developing Countries | Programs | Organization and Administration | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Schools | Education | Infant Nutrition | Nutrition | Health | Sociocultural Factors | Psychological Factors | Behavior | Program Evaluation
Document Number: 342903

Title: Reliability of reported breastfeeding duration among reproductive-aged women from Mexico.
Author: Cupul-Uicab LA; Gladen BC; Hernandez-Avila M; Longnecker MP
Source: Maternal and Child Nutrition. 2009 Apr;5(2):125-37.
Abstract: Breastfed children have lower risk of infectious diseases, post-neonatal mortality and chronic diseases later in life. Because epidemiologic studies usually rely on reported history of previous breastfeeding, data on the accuracy and precision of recalled histories allow improved interpretation of the epidemiologic findings. We evaluated the reliability of two reported breastfeeding durations in 567 reproductive-aged women from Mexico using information obtained from nearly identical sets of questions applied at different times after weaning. We compared differences between reports, and examined the intraclass correlation coefficient (ICC) for any and for exclusive breastfeeding (EBF). Logistic regression was used to evaluate the determinants of poor recall (difference between reports of >20%). The reliability of duration of any breastfeeding was high (ICC 0.94). Overall, differences between reports of duration were usually <1 month, and for 385/567, the difference was < or =0.5 months. Predictors of poorer recall were having > or =4 children, and time between reports of >2 months. The only predictor of better recall was greater age of the baby at weaning. The reliability of EBF duration was lower (ICC 0.49). In this population with a relatively long duration of breastfeeding, reliability of any breastfeeding duration was high. Age, education and previous breastfeeding were not important predictors of recall, in contrast to findings in earlier studies. Consistent with previous reports, however, parity and length of recall were associated with poorer recall of duration of any breastfeeding. Future studies that use reported breastfeeding duration may want to consider the effect of these variables on recall.
Language: English
Keywords:
MEXICO | RESEARCH REPORT | SAMPLING STUDIES | MEASUREMENT | MOTHERS | BREASTFEEDING | BREASTFEEDING, EXCLUSIVE | TIME FACTORS | RELIABILITY | SOCIOECONOMIC STATUS | North America | Americas | Developing Countries | Studies | Research Methodology | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Infant Nutrition | Nutrition | Health | Population Dynamics | Demographic Factors | Population | Socioeconomic Factors | Economic Factors
Document Number: 341786

10.
Peer Reviewed

Title: Trends in infant nutrition in Saudi Arabia: compliance with WHO recommendations.
Author: El Mouzan MI; Al Omar AA; Al Salloum AA; Al Herbish AS; Qurachi MM
Source: Annals of Saudi Medicine. 2009 Jan-Feb;29(1):20-3.
Abstract: BACKGROUND AND OBJECTIVE: The WHO recommends exclusive breastfeeding in the first 6 months of life. Our objective was to evaluate trends in infant nutrition in Saudi Arabia and the degree of compliance with WHO recommendations. SUBJECTS AND METHODS: A nationwide nutritional survey of a sample of Saudi households was selected by the multistage probability sampling procedure. A validated questionnaire was administered to mothers of children less than 3 years of age. RESULTS: Of 5339 children in the sample, 4889 received breast milk at birth indicating a prevalence of initiation of 91.6%. Initiation of breastfeeding was delayed beyond 6 hours after birth in 28.1% of the infants. Bottle feeding was introduced by 1 month of age to 2174/4260 (51.4%) and to 3831/4260 (90%) by 6 months of age. The majority of infants 3870/4787 (80.8%) were introduced to "solid foods" between 4 to 6 months of age and whole milk feedings were given to 40% of children younger than 12 months of age. CONCLUSIONS: The current practice of feeding of Saudi infants is very far from compliance with even the most conservative WHO recommendations of exclusive breastfeeding for 4 to 6 months. The high prevalence of breastfeeding initiation at birth indicates the willingness of Saudi mothers to breastfeed. However, early introduction of complementary feedings reduced the period of exclusive breastfeeding. Research in infant nutrition should be a public health priority to improve the rate of breastfeeding and to minimize other inappropriate practices.
Language: English
Keywords:
SAUDI ARABIA | RESEARCH REPORT | NUTRITION SURVEYS | INFANT | HOUSEHOLDS | INFANT NUTRITION | WHO | STANDARDS | BREASTFEEDING, EXCLUSIVE | PREVALENCE | TIME FACTORS | SUPPLEMENTARY FEEDING | AGE FACTORS | BREASTFEEDING | Middle East | Developing Countries | Nutrition | Health | Youth | Population Characteristics | Demographic Factors | Population | Family and Household | Sociocultural Factors | UN | International Agencies | Organizations | Political Factors | Research Methodology | Measurement | Population Dynamics
Document Number: 331138

11.

Peer Reviewed

Title: Infant feeding among HIV-positive mothers and the general population mothers: comparison of two cross-sectional surveys in Eastern Uganda.
Author: Fadnes LT; Engebretsen IM; Wamani H; Semiyaga NB; Tylleskar T; Tumwine JK
Source: BMC Public Health. 2009;9:124.
Abstract: BACKGROUND: Infant feeding recommendations for HIV-positive mothers differ from recommendations to mothers of unknown HIV-status. The aim of this study was to compare feeding practices, including breastfeeding, between infants and young children of HIV-positive mothers and infants of mothers in the general population of Uganda. METHODS: This study compares two cross-sectional surveys conducted in the end of 2003 and the beginning of 2005 in Eastern Uganda using analogous questionnaires. The first survey consisted of 727 randomly selected general-population mother-infant pairs with unknown HIV status. The second included 235 HIV-positive mothers affiliated to The Aids Support Organisation, TASO. In this article we compare early feeding practices, breastfeeding duration, feeding patterns with dietary information and socio-economic differences in the two groups of mothers. RESULTS: Pre-lacteal feeding was given to 150 (64%) infants of the HIV-positive mothers and 414 (57%) infants of general-population mothers. Exclusive breastfeeding of infants under the age of 6 months was more common in the general population than among the HIV-positive mothers (186 [45%] vs. 9 [24%] respectively according to 24-hour recall). Mixed feeding was the most common practice in both groups of mothers. Solid foods were introduced to more than half of the infants under 6 months old among the HIV-positive mothers and a quarter of the infants in the general population. Among the HIV-positive mothers with infants below 12 months of age, 24 of 90 (27%) had stopped breastfeeding, in contrast to 9 of 727 (1%) in the general population. The HIV-positive mothers were poorer and had less education than the general-population mothers. CONCLUSION: In many respects, HIV-positive mothers fed their infants less favourably than mothers in the general population, with potentially detrimental effects on both the child's nutrition and the risk of HIV transmission. Mixed feeding and pre-lacteal feeding were widespread. Breastfeeding duration was shorter among HIV-positive mothers. Higher educational level and being socio-economically better off were associated with more beneficial infant feeding practices.
Language: English
Keywords:
UGANDA | RESEARCH REPORT | COMPARATIVE STUDIES | MOTHERS | PERSONS LIVING WITH HIV/AIDS | INFANT NUTRITION | BREASTFEEDING | SOCIOECONOMIC STATUS | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | HIV Infections | Viral Diseases | Diseases | Nutrition | Health | Socioeconomic Factors | Economic Factors | Disease Transmission Control | Prevention and Control
Document Number: 341408

12.

Title: Need to optimise infant feeding counselling: a cross-sectional survey among HIV-positive mothers in Eastern Uganda.
Author: Fadnes LT; Engebretsen IM; Wamani H; Wangisi J; Tumwine JK; Tylleskar T
Source: BMC Pediatrics. 2009;9:2.
Abstract: BACKGROUND: The choice of infant feeding method is important for HIV-positive mothers in order to optimise the chance of survival of their infants and to minimise the risk of HIV transmission. The aim of this study was to investigate feeding practices, including breastfeeding, in the context of PMTCT for infants and children under two years of age born to HIV-positive mothers in Uganda. METHODS: In collaboration with The Aids Support Organisation Mbale, we conducted a cross-sectional survey involving 235 HIV-positive mothers in Uganda. Infant feeding practices, reasons for stopping breastfeeding, and breast health problems were studied. Breastfeeding duration was analysed using the Kaplan-Meier method based on retrospective recall. RESULTS: Breastfeeding was initiated by most of the mothers, but 20 of them (8.5%) opted exclusively for replacement feeding. Pre-lacteal feeding was given to 150 (64%) infants and 65 (28%) practised exclusive breastfeeding during the first three days. One-fifth of the infants less than 6 months old were exclusively breastfed, the majority being complementary fed including breast milk. The median duration of breastfeeding was 12 months (95% confidence interval [CI] 11.5 to 12.5). Adjusted Cox regression analysis indicated that a mother's education, socio-economic status, participation in the PMTCT-program and her positive attitude to breastfeeding exclusively, were all associated with a reduction in breastfeeding duration. Median duration was 3 months (95% CI 0-10.2) among the most educated mothers, and 18 months (95% CI 15.0-21.0) among uneducated mothers. Participation in the PMTCT program and being socio-economically better-off were also associated with earlier cessation of breastfeeding (9 months [95% CI 7.2-10.8] vs. 14 months [95% CI 10.8-17.2] and 8 months [95% CI 5.9-10.1] vs. 17 months [95% CI 15.2-18.8], respectively). The main reasons for stopping breastfeeding were reported as: advice from health workers, maternal illness, and the HIV-positive status of the mother. CONCLUSION: Exclusive breastfeeding was uncommon. Exclusive replacement feeding was practised by few HIV-positive mothers. Well-educated mothers, mothers who were socio-economically better-off and PMTCT-attendees had the shortest durations of breastfeeding. Further efforts are needed to optimise infant feeding counselling and to increase the feasibility of the recommendations.
Language: English
Keywords:
UGANDA | RESEARCH REPORT | KAP SURVEYS | CROSS SECTIONAL ANALYSIS | MOTHERS | PERSONS LIVING WITH HIV/AIDS | WOMEN IN DEVELOPMENT | INFANT | HIV PREVENTION | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | INFANT NUTRITION | BREASTFEEDING | SUPPLEMENTARY FEEDING | BREASTFEEDING, EXCLUSIVE | TIME FACTORS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | HIV Infections | Viral Diseases | Diseases | Economic Development | Economic Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Disease Transmission Control | Prevention and Control | Nutrition | Health | Population Dynamics
Document Number: 341171

13.
Peer Reviewed

Title: Influence of wasting and stunting at the onset of the rainy season on subsequent malaria morbidity among rural preschool children in Senegal.
Author: Fillol F; Cournil A; Boulanger D; Cisse B; Sokhna C; Targett G; Trape JF; Simondon F; Greenwood B; Simondon KB
Source: American Journal of Tropical Medicine and Hygiene. 2009 Feb;80(2):202-8.
Abstract: In sub-Saharan Africa, malaria and malnutrition are major causes of morbidity and mortality in children less than five years of age. To explore the impact of malnutrition on subsequent susceptibility to malaria, a cohort of 874 rural preschool children in Senegal was followed-up during one malaria transmission season from July through December. Data on nutritional status and Plasmodium falciparum parasitemia were collected at baseline. Malaria morbidity was monitored through weekly home visits. Wasted children (weight-for-height z-score < -2) were at lower risk of having at least one subsequent clinical malaria attack (odds ratio = 0.33; 95% confidence interval = 0.13-0.81, P = 0.02), whereas stunting (height-for-age z-score < -2) or being underweight (weight-for-age z-score < -2) was not associated with clinical malaria. Although non-biological explanations such as overprotection of wasted children by their mothers should be considered, immunomodulation according to nutritional status could explain the lower risk of malaria attack among wasted children.
Language: English
Keywords:
IRAN | RESEARCH REPORT | KAP SURVEYS | WOMEN IN DEVELOPMENT | MOTHERS | CHILD CARE | KNOWLEDGE | ATTITUDES | BREASTFEEDING | DEMOGRAPHIC FACTORS | TIME FACTORS | BREASTFEEDING, EXCLUSIVE | SUPPLEMENTARY FEEDING | EDUCATIONAL STATUS | Middle East | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Economic Development | Economic Factors | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Child Rearing | Behavior | Psychological Factors | Infant Nutrition | Nutrition | Health | Population | Population Dynamics | Socioeconomic Status | Socioeconomic Factors
Document Number: 330300

14.

Peer Reviewed

Title: The HIV-exposed, uninfected African child.
Author: Filteau S
Source: Tropical Medicine and International Health. 2009 Mar;14(3):276-87.
Abstract: The increasing success of prevention of mother-to-child HIV transmission programmes means that in Africa, very large numbers of HIV-exposed, uninfected (HIV-EU) children are being born. Any health problems that these children may have will thus be of enormous public health importance, but to date have been largely neglected. There is some evidence that HIV-EU African children are at increased risk of mortality, morbidity and slower early growth than their HIV-unexposed counterparts. A likely major cause of this impaired health is less exposure to breast milk as mothers are either less able to breastfeed or stop breastfeeding early to protect their infant from HIV infection. Other contributing factors are parental illness or death resulting in reduced care of the children, increased exposure to other infections and possibly exposure to antiretroviral drugs. A broad approach for psychosocial support of HIV-affected families is needed to improve health of HIV-EU children. High quality programmatic research is needed to determine how to deliver such care.
Language: English
Keywords:
AFRICA | CRITIQUE | LITERATURE REVIEW | EVALUATION | CHILDREN | PERSONS LIVING WITH HIV/AIDS | ORPHANS AND VULNERABLE CHILDREN | BREASTFEEDING | TIME FACTORS | CHILD HEALTH | GROWTH | DEFICIENCY DISEASES | CHILD MORTALITY | ANTIRETROVIRAL DRUGS | INFECTIONS | Developing Countries | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Family and Household | Sociocultural Factors | Infant Nutrition | Nutrition | Health | Population Dynamics | Child Development | Biology | Nutrition Disorders | Mortality | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care
Document Number: 330961

15.

Peer Reviewed

Title: Role of breastfeeding cessation in mediating the relationship between maternal HIV disease stage and increased child mortality among HIV-exposed uninfected children.
Author: Fox MP; Brooks DR; Kuhn L; Aldrovandi G; Sinkala M; Kankasa C; Horsburgh R; Thea DM
Source: International Journal of Epidemiology. 2009 Apr;38(2):569-76.
Abstract: BACKGROUND: Maternal CD4 count predicts child mortality in HIV-uninfected children born to HIV-infected women. METHODS: To explore the mediating role of breastfeeding cessation in this relationship, we compared marginal structural models of maternal CD4 count on child death with and without adjustment for breastfeeding. RESULTS: In crude analyses, children of mothers with CD4<200 during pregnancy were 3.2 times more likely to die by 18 months (CI 1.3-8.1) as children whose mothers had CD4>500. Earlier breastfeeding cessation was also associated with low CD4 (HR 1.8; CI 1.2-2.7). After adjusting for breastfeeding and low birth weight using a marginal structural model, the low CD4 count-child mortality association through 18 months was reduced 17%. The change was overestimated using a traditional Cox proportional hazards model (35% reduction in HR from 3.4 to 2.5). CONCLUSIONS: Our analysis suggests that only a small part of the effect of low vs high CD4 count on child mortality through 18 months is mediated through breastfeeding cessation. Our results must be taken into account when deciding whether or not to recommend breastfeeding for infants of HIV-infected mothers.
Language: English
Keywords:
AFRICA | RESEARCH REPORT | DATA ANALYSIS | CHILDREN | CHILD MORTALITY | BREASTFEEDING | INFANT MORTALITY | HIV | RESEARCH METHODOLOGY | Developing Countries | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Mortality | Population Dynamics | Infant Nutrition | Nutrition | Health | HIV Infections | Viral Diseases | Diseases
Document Number: 341015

16.

Title: Breastfeeding and breast cancer risk in India: a multicenter case-control study.
Author: Gajalakshmi V; Mathew A; Brennan P; Rajan B; Kanimozhi VC; Mathews A; Mathew BS; Boffetta P
Source: International Journal of Cancer. 2009 Aug 1;125(3):662-5.
Abstract: Breast cancer incidence is low in India compared with high-income countries, but it has increased in recent decades, particularly among urban women. The reasons for this pattern are not known although they are likely related to reproductive and lifestyle factors. Here, we report the results of a large case-control study on the association between breastfeeding and breast cancer risk. The study was conducted in 2 areas in South India during 2002-2005 and included 1,866 cases and 1,873 controls. Detailed information regarding menstruation, reproduction, breastfeeding and physical activity was collected through in-person interview. Odds ratios (OR) and 95% confidence intervals (CI) were estimated by unconditional logistic regression models. Breastfeeding for long duration was common in the study population. Lifetime duration of breastfeeding was inversely associated with breast cancer risk among premenopausal women (p-value of linear trend, 0.02). No such protective effect was observed in postmenopausal women, among whom a protective effect of parity was suggested. A reduction of breast cancer risk with prolonged breastfeeding was shown among premenopausal women. Health campaign focusing on breastfeeding behavior by appropriately educating women would contribute to reduce breast cancer burden.
Language: English
Keywords:
INDIA | RESEARCH REPORT | CONTROL GROUPS | WOMEN | BREAST CANCER | RISK FACTORS | BREASTFEEDING | TIME FACTORS | MENOPAUSE | PARITY | Asia, Southern | Asia | Developing Countries | Research Methodology | Demographic Factors | Population | Cancer | Neoplasms | Diseases | Health | Infant Nutrition | Nutrition | Population Dynamics | Reproduction | Fertility Measurements | Fertility
Document Number: 342166

17.

Title: Barriers to best outcomes in breastfeeding for Maori: mothers' perceptions, whanau perceptions, and services.
Author: Glover M; Waldon J; Manaena-Biddle H; Holdaway M; Cunningham C
Source: Journal of Human Lactation. 2009 Aug;25(3):307-16.
Abstract: This research explores the perceptions of New Zealand Maori women and their whanau (customary Maori extended family) toward barriers to achieving best outcomes in infant feeding: exclusively breastfed infants at 6 months. Interviews are undertaken with 59 Maori women who have given birth in the previous 3 years and 27 whanau members. Although mothers and whanau members feel positively toward breastfeeding and generally expect to breastfeed exclusively, these expectations are unmet in many cases because of lack of support when establishing breastfeeding; lack of support when life circumstances change; lack of timely, culturally relevant, and comprehensible information; confusion about smoking while breastfeeding; uncertainty about the safety of bed-sharing, and perceived lack of acceptability of breastfeeding in public. The relatively high rates of tobacco use by Maori create a tension for breastfeeding mothers, cited by some as a reason for ending breastfeeding prematurely.
Language: English
Keywords:
NEW ZEALAND | RESEARCH REPORT | MOTHERS | INFANT | BREASTFEEDING | TOBACCO USE | SAFETY | Oceania | Developed Countries | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Infant Nutrition | Nutrition | Health | Behavior | Public Health
Document Number: 342916

18.
Peer Reviewed

Title: Operational effectiveness of guidelines on complete breast-feeding cessation to reduce mother-to-child transmission of HIV: results from a prospective observational cohort study at routine prevention of mother-to-child transmission sites, South Africa.
Author: Goga AE; Van Wyk B; Doherty T; Colvin M; Jackson DJ; Chopra M
Author: Good Start Study Group
Source: Journal of Acquired Immune Deficiency Syndromes. 2009 Apr 15;50(5):521-8.
Abstract: OBJECTIVE: Until 2006, HIV-positive women who chose to exclusively breast-feed were advised to completely stop breast-feeding by 6 months. We investigated operational feasibility and predictors of complete breast-feeding cessation (CBC). DESIGN: A prospective observational cohort study at 3 routine prevention of mother-to-child transmission sites, South Africa. METHODS: Data on "complete breast-feeding cessation at 24 weeks" and "not breast-feeding (NBF) for 4 days before the last follow-up visit at or before 24 weeks" were gathered during home visits (3, 5, 7, 9, 12, 16, 20, and 24 weeks). The main subgroup of interest for this analysis was women practicing exclusive breast-feeding/predominant breast-feeding at 3 weeks. Univariate analysis, logistic regression, Kaplan-Meier Survival analysis, and Cox regression were performed. RESULTS: Eighty-eight women (43.6%) reported CBC. "Health staff suggesting formula use: [OR(a) 4.39 (1.76-10.97)] and "infant hospitalization" [OR(a) 3.27 (1.37-7.79)] were the only significant predictors of CBC. The probability of NBF at 5, 7, 9, 12, 16, 20, and 24 weeks was 2.8% [95% confidence interval (CI) 1.8% to 3.8%], 4.3% (3.0% to 5.6%), 5.9% (4.4% to 7.4%, 9.8% (7.9% to 11.7%), 16.1 (13.8% to 18.4%), 23.1% (20.5% to 25.7%), and 37.6% (34.6% to 40.6%), respectively. Infant HIV status [hazard ratio 5.5 95% CI 2.4 to 12.5] was the only predictor of infant death. NBF was not protective against 9-month infant HIV or death in univariate and multivariable analysis. CONCLUSIONS: At programmatic level, CBC by 24 weeks is uncommon, and success seems unrelated to predetermined social, economic, and environmental (acceptable, feasible, affordable, sustainable, and safe AFASS) criteria. Thus at this level, activities that encourage CBC (amongst women meeting AFASS criteria) need to be identified and tested.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | STANDARDS | MOTHERS | BREASTFEEDING | BREASTFEEDING, EXCLUSIVE | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | MOTHER-TO-CHILD TRANSMISSION | WEANING | HIV PREVENTION | PROGRAM EFFECTIVENESS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Infant Nutrition | Nutrition | Health | Disease Transmission Control | Prevention and Control | Diseases | Transmission | Infections | HIV Infections | Viral Diseases | Program Evaluation | Programs | Organization and Administration
Document Number: 341054

19.

Title: Letter to the editor of AIDS based on a recent paper by Rollins et al. 'there is no evidence for any specific age at which HIV-positive mothers in Africa should be advised to stop breastfeeding' [letter]
Author: Greiner T
Source: AIDS. 2009 Feb 20;23(4):547-8.
Abstract: The authors attempted to convince sample mothers that they should stop breastfeeding at 6 months, implying that all had access to nutritious foods for their infants. The assumption that doing so would lead to increased rates of HIV-free survival seems to be justified by their data. However, if poorer mothers are the ones who opt to breastfeed longer, wemust be very careful in assuming that their infants will have the same outcomes as those who opt to breastfeed for shorter periods. This is especially true in South Africa where fears of stigma may be less of a factor explaining the continuation of breastfeeding beyond 6 months than poverty, at least compared with other African countries. Thus, WHO no longer recommends attempting to convince all HIV� mothers to stop breastfeeding at 6months: 'At 6months, if replacement feeding is still not acceptable, feasible, affordable, sustainable and safe, continuation of breastfeeding with additional complementary foods is recommended, while the mother and baby continue to be regularly assessed (http://whqlibdoc. who.int/publications/2007/9789241595964_eng.pdf). Finally, while both the article and editorial mention, respectively, that HAART treatment of eligible mothers and antiretroviral therapy (ART) prophylaxis are likely to reduce postnatal HIV transmission, the former is now increasingly available in Africa, making generalization from this study even more difficult. (excerpt)
Language: English
Keywords:
AFRICA | CRITIQUE | CLINICAL RESEARCH | MOTHERS | PERSONS LIVING WITH HIV/AIDS | WOMEN IN DEVELOPMENT | BREASTFEEDING | TIME FACTORS | HIV PREVENTION | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | BREASTFEEDING, EXCLUSIVE | RISK ASSESSMENT | COUNSELING | SOCIOECONOMIC STATUS | POVERTY | Developing Countries | Research Methodology | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | HIV Infections | Viral Diseases | Diseases | Economic Development | Economic Factors | Infant Nutrition | Nutrition | Health | Population Dynamics | Demographic Factors | Population | Disease Transmission Control | Prevention and Control | Evaluation | Clinic Activities | Program Activities | Programs | Organization and Administration | Socioeconomic Factors
Document Number: 341158

20.

Title: Reconsidering childhood undernutrition: can birth spacing make a difference? An analysis of the 2002-2003 El Salvador National Family Health Survey.
Author: Gribble JN; Murray NJ; Menotti EP
Source: Maternal and Child Nutrition. 2009 Jan;5(1):49-63.
Abstract: It is well understood that undernutrition underpins much of child morbidity and mortality in less developed countries, but the causes of undernutrition are complex and interrelated, requiring a multipronged approach for intervention. This paper uses a subsample of 3853 children under age 5 from the most recent family health survey in El Salvador to examine the relationship between birth spacing and childhood undernutrition (stunting and underweight). While recent research and guidance suggest that birth spacing of three to five years contributes to lower levels of infant and childhood mortality, little attention has been given to the possibility that short birth intervals have longer-term effects on childhood nutrition status. The analysis controls for clustering effects arising from siblings being included in the subsample, as well as variables that are associated with household resources, household structure, reproductive history and outcomes, and household social environment. The results of the multiple regression analyses find that in comparison to intervals of 36-59 months, birth intervals of less than 24 months and intervals of 24-35 months significantly increase the odds of stunting (<24 months Odds Ratio (OR) = 1.52; 95% confidence interval (CI): 1.21-1.92; 25-36 months OR = 1.30; 95% CI: 1.05-1.64). Other factors related to stunting and underweight include standard of living index quintile, child's age, mother's education, low birthweight, use of prenatal care, and region of the country where the child lives. Policy and program implications include more effective use of health services and outreach programs to counsel mothers on family planning, breastfeeding, and well child care.
Language: English
Keywords:
EL SALVADOR | RESEARCH REPORT | ANTHROPOMETRY | CHILDREN | CHILD HEALTH | CHILD DEVELOPMENT | CHILD NUTRITION | BIRTH SPACING | BIRTH INTERVALS | LOW BIRTH WEIGHT | FAMILY PLANNING | BREASTFEEDING | NEEDS | PROGRAM EVALUATION | Developing Countries | Central America | Latin America | Americas | Measurement | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Health | Biology | Nutrition | Fertility Measurements | Fertility | Population Dynamics | Birth Weight | Body Weight | Physiology | Infant Nutrition | Economic Factors | Programs | Organization and Administration
Document Number: 329593

21.

Peer Reviewed

Title: The obstetric face and challenge of HIV/AIDS.
Author: Guidozzi F; Black V
Source: Clinical Obstetrics and Gynecology. 2009 Jun;52(2):270-84.
Abstract: The human immunodeficiency virus (HIV) pandemic is one of the most serious health crises facing the world. Of the estimated 33.2 million people living with HIV worldwide, 22.5 million (68%) live in Sub-Saharan Africa, where women of childbearing age are most severely affected. Children primarily acquire HIV infection through mother-to-child transmission. Despite recent encouraging success, low-income countries have not been able to effectively curtail transmission of HIV to the infant during or after pregnancy, resulting in about 90% of the estimated 420,000 newly infected children per annum occurring in Sub-Saharan Africa.
Language: English
Keywords:
DEVELOPING COUNTRIES | CRITIQUE | RECOMMENDATIONS | HIV INFECTIONS | AIDS | EPIDEMICS | OBSTETRICS | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | BREASTFEEDING | HIV TESTING | ANTIRETROVIRAL THERAPY | ANTIRETROVIRAL DRUGS | ADMINISTRATION AND DOSAGE | DRUG RESISTANCE | Viral Diseases | Diseases | Medicine | Health Services | Delivery of Health Care | Health | Disease Transmission Control | Prevention and Control | Infant Nutrition | Nutrition | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | HIV | Treatment | Drugs
Document Number: 342173

22.

Title: Breast cancer in young women and its impact on reproductive function.
Author: Hickey M; Peate M; Saunders CM; Friedlander M
Source: Human Reproduction Update. 2009 May-Jun;15(3):323-39.
Abstract: BACKGROUND: Breast cancer is the most common cancer in women in developed countries, and 12% of breast cancer occurs in women 20-34 years. Survival from breast cancer has significantly improved, and the potential late effects of treatment and the impact on quality of life have become increasingly important. Young women constitute a minority of breast cancer patients, but commonly have distinct concerns and issues compared with older women, including queries regarding fertility, contraception and pregnancy. Further, they are more likely than older women to have questions regarding potential side effects of therapy and risk of relapse or a new primary. In addition, many will have symptoms associated with treatment and they present a management challenge. Reproductive medicine specialists and gynaecologists commonly see these women either shortly after initial diagnosis or following adjuvant therapy and should be aware of current management of breast cancer, the options for women at increased genetic risk, the prognosis of patients with early stage breast cancer and how adjuvant systemic treatments may impact reproductive function. METHODS: No systematic literature search was done. The review focuses on the current management of breast cancer in young women and the impact of treatment on reproductive function and subsequent management. With reference to key studies and meta-analyses, we highlight controversies and current unanswered questions regarding patient management. RESULTS: Chemotherapy for breast cancer is likely to negatively impact on reproductive function. A number of interventions are available which may increase the likelihood of future successful pregnancy, but the relative safety of these interventions is not well established. For those who do conceive following breast cancer, there is no good evidence that pregnancy is detrimental to survival. We review current treatment; effects on reproductive function; preservation of fertility; contraception; pregnancy; breastfeeding and management of menopausal symptoms following breast cancer. CONCLUSION: This paper provides an update on the management of breast cancer in young women and is targeted at reproductive medicine specialists and gynaecologists.
Language: English
Keywords:
AUSTRALIA | RESEARCH REPORT | BREAST CANCER | SURGERY | DRUGS | GENETICS | FERTILITY | CONTRACEPTION | PREGNANCY | BREASTFEEDING | MENOPAUSE | AGE FACTORS | TAMOXIFEN | Oceania | Developed Countries | Cancer | Neoplasms | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Biology | Population Dynamics | Demographic Factors | Population | Family Planning | Reproduction | Infant Nutrition | Nutrition | Population Characteristics | Fertility Agents | Reproductive Control Agents
Document Number: 341960

23.

Title: 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.
Author: Hofmann J; De Allegri M; Sarker M; Sanon M; Bohler T
Source: Health Policy. 2009 Mar;89(3):322-8.
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 guerisseurs. 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.
Language: English
Keywords:
BURKINA FASO | RESEARCH REPORT | QUALITATIVE RESEARCH | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | HIV PREVENTION | BREASTFEEDING | HUMAN MILK | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Disease Transmission Control | Prevention and Control | Diseases | HIV Infections | Viral Diseases | Infant Nutrition | Nutrition | Health | Lactation | Maternal Physiology | Physiology | Biology
Document Number: 341367

25.

Title: An update on HIV and infant feeding issues in developed and developing countries.
Author: Jackson DJ; Goga AE; Doherty T; Chopra M
Source: Journal of Obstetric, Gynecologic, and Neonatal Nursing. 2009 Mar-Apr;38(2):219-29.
Abstract: The field of mother to child transmission of human-immunodeficiency virus is rapidly evolving. In the United States, prevention focuses on implementation of universal human-immunodeficiency virus testing to assure compliance with recommended treatment regimens and infant-feeding strategies. In most cases, this is the avoidance of all breastfeeding. In developing countries, avoidance of breastfeeding places infants at higher risk of morbidity and mortality. Current World Health Organization recommendations require individualized counseling to determine the best feeding method for each woman.
Language: English
Keywords:
GLOBAL | RECOMMENDATIONS | INFANT NUTRITION | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | BREASTFEEDING | RISK FACTORS | CHILD SURVIVAL | ANTIRETROVIRAL THERAPY | BREASTFEEDING, EXCLUSIVE | SUPPLEMENTARY FEEDING | COUNSELING | INTERVENTIONS | Nutrition | Health | Disease Transmission Control | Prevention and Control | Diseases | Survivorship | Length of Life | Mortality | Population Dynamics | Demographic Factors | Population | HIV | HIV Infections | Viral Diseases | Clinic Activities | Program Activities | Programs | Organization and Administration
Document Number: 341948

26.

Peer Reviewed

Title: Breastfeeding knowledge and practices amongst mothers in a rural population of North India: a community-based study.
Author: Kishore MS; Kumar P; Aggarwal AK
Source: Journal of Tropical Pediatrics. 2009 Jun;55(3):183-8.
Abstract: BACKGROUND: National family health survey-3 of India has revealed startling lower exclusive breastfeeding (EBF) rates (16.9%) in the state of Haryana compared with national data (46%). The barriers to breastfeeding in this population are not clearly known. Therefore, a study was conducted in a rural population of the state to study their breastfeeding practices, knowledge regarding usefulness of breastfeeding and factors influencing the breastfeeding practices. METHODS: In six villages of Panchkula district of Haryana, all the mothers of infants between 0-6 months were interviewed using a pretested semi-structured questionnaire. Time at initiation of breastfeeding, duration of EBF and their understanding about the usefulness of breastfeeding were assessed. Position of the baby during breastfeeding and attachment of the baby's mouth to the breast were assessed by direct observation while feeding. Breastfeeding knowledge of the mother was evaluated. RESULTS: Out of the 77 mothers, 30% and 10% exclusively breastfed their infants till 4 and 6 months of age, respectively. There was 'good attachment' in 42% mother-infant pairs and infants were held in 'correct position' by 60% mothers. Thirty-nine percent of the mothers had 'satisfactory' breastfeeding knowledge. On multivariate logistic regression analysis, lack of breastfeeding counseling was significantly associated with decreased rates of EBF at 4 months and 6 months (p-value 0.01 and 0.002, respectively) and 'full' breastfeeding (FBF) at 6 months of age (p-value 0.002). CONCLUSIONS: EBF/FBF practices and breastfeeding knowledge are suboptimal among the rural North Indian mothers. Breastfeeding counseling with emphasis on correct technique can improve the EBF/FBF rates.
Language: English
Keywords:
INDIA | RESEARCH REPORT | SAMPLING STUDIES | RURAL POPULATION | MOTHERS | BREASTFEEDING | BREASTFEEDING, EXCLUSIVE | TIME FACTORS | KNOWLEDGE | OBSTACLES | LITERACY | COUNSELING | Asia, Southern | Asia | Developing Countries | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Infant Nutrition | Nutrition | Health | Population Dynamics | Organization and Administration | Educational Status | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Clinic Activities | Program Activities | Programs
Document Number: 341968

27.
Title: [Contraceptive methods used by women in the period before and after giving birth] Praxe v pouzivani kontracepcnich metod u zen v obdobi pred porodem a po porodu.
Author: Krepelka P; Hanacek J; Hrdlicka D
Source: Ceska Gynekologie. 2009 Jun;74(3):211-8.
Abstract: GOAL OF THE STUDY: To provide information on the knowledge and practices involving the use of the contraceptive methods employed by women of a fertile age, especially in the period of lactation. DESIGN: A cross-section, descriptive study. Setting: Institute for the Care of Mother and Child, Prague; Department of Gynaecology and Obstetrics at the Institute of Postgraduate Education in Healthcare, Prague; Cegedim Strategic Data CZ s.r.o., Prague. METHODOLOGY: The method involved a written questionnaire in a structured form. The investigation was undertaken in two phases; the first round took place directly after giving birth, while the second took place 6 months after giving birth. The group consisted of 4535 women who gave birth at the Institute for the Care of Mother and Child in the period between 15. 11. 2006 - 15. 11. 2007. RESULTS: 2540 women (56.0%) answered the questions in the first round; 85% of them were in the 26-35 age group, 44.3% were secondary school graduates and 36.7% were university graduates. 61.3% were first-time mothers, 32.3% were second-time mothers and 5.4% were third-time mothers. Contraception used before current gravidity: (n=2540) oral hormonal contraception 59.7%, a condom 11.1%, intrauterine contraception 1.0% and 20.6% of the women used no contraceptive method. The users of oral hormonal contraception (n=1517) were most frequently prescribed (12.8% of the women) a preparation containing 20 microg ethinylestradiol and 150 eLg desogestrel (Mercilon). The contraception used during the course of lactation after a birth in the group of mothers of more than one child (n=982): oral hormonal contraception 19.6%, a condom 17.1%, intrauterine contraception 1.3%, no contraceptive method 54.5%. Breastfeeding users of oral hormonal contraception (n=192) were most frequently prescribed (20.3% of women) a preparation containing 500 microg lynestrenol (Exluton) and a preparation containing 75 microg desogestrel (Cerazette) (16.1% of women). The contraceptive methods planned by women after birth (n=2540): oral hormonal contraceptive 36.5%, a condom 18.8%, intrauterine contraception 18.8%, no method 20.1%. 1440 women (56.7%) answered the questions in the second round; 83.5% of them were in the 26-35 age group, 45.0% were secondary school graduates and 37.0% were university graduates. 64.4% were first-time mothers, 30.6% were second time mothers and 4.2% were third-time mothers. 74.6% of women were still breastfeeding 6 months after giving birth. Contraception used by breastfeeding women (n=1074): oral hormone contraception 27.6%, a condom 21.8%, an intrauterine system with levonorgestrel 2.8%, intrauterine contraception 2.4%, no method 39.5%. Contraception used by non-breastfeeding women (n=366): oral hormonal contraception 42.1%, a condom 15.0%, an intrauterine system with levonorgestrel 2.7%, intrauterine contraception 2.7%, no method 31.4%. In both groups of women, the users of oral hormonal contraception were most frequently prescribed a preparation containing 75 pg desogestrel (Cerazette); this accounted for 99.3% of the breastfeeding women and 18.8% of those not breastfeeding. 40.0% of breastfeeding and 48.4% of non-breastfeeding women are planning to use hormonal contraception in the coming period. The self-evaluation of the knowledge of contraception methods (n=2540): 61.6% of women evaluated their knowledge as good, but 77.6% of women did not know a suitable hormonal contraceptive for the period of lactation. According to 80.7% of the women, their main source of expert information in the area of family planning is their gynaecologist. CONCLUSION: The prevalence of breastfeeding women 6 months after giving birth is high in the monitored group. Oral hormonal contraceptives are the most frequently used contraceptive method in general, including during the lactation period when women prefer a preparation containing 75 microg desogestrel regardless of whether or not they are breastfeeding. The women's knowledge of suitable methods of contraception during the period of lactation is unsatisfactory and represents a challenge for healthcare providers to improve the amount of information available to women in this area
Language: Czech
Keywords:
EUROPE | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | PREVALENCE | WOMEN | CONTRACEPTIVE USAGE | CONTRACEPTIVE METHODS | ORAL CONTRACEPTIVES | BREASTFEEDING | KNOWLEDGE | INFORMATION | COUNSELING | Developed Countries | Research Methodology | Measurement | Demographic Factors | Population | Contraception | Family Planning | Infant Nutrition | Nutrition | Health | Sociocultural Factors | Clinic Activities | Program Activities | Programs | Organization and Administration
Document Number: 342298

28.

Title: Breastfeeding and AIDS in the developing world.
Author: Kuhn L; Reitz C; Abrams EJ
Source: Current Opinion In Pediatrics. 2009 Feb;21(1):83-93.
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.
Language: English
Keywords:
DEVELOPING COUNTRIES | RESEARCH REPORT | MOTHERS | MOTHER-TO-CHILD TRANSMISSION | HIV INFECTIONS | BREASTFEEDING | ANTIRETROVIRAL THERAPY | HIV TRANSMISSION | HIV | AIDS | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Transmission | Infections | Diseases | Viral Diseases | Infant Nutrition | Nutrition | Health
Document Number: 341551

29.

Title: Persistence of nevirapine in breast milk and plasma of mothers and their children after single-dose administration.
Author: Kunz A; Frank M; Mugenyi K; Kabasinguzi R; Weidenhammer A; Kurowski M; Kloft C; Harms G
Source: Journal of Antimicrobial Chemotherapy. 2009 Jan;63(1):170-7.
Abstract: OBJECTIVES: Nevirapine is widely used in the developing world for the prevention of mother-to-child transmission (PMTCT) of HIV. A single mutation in the HIV genome is sufficient to lead to significant nevirapine resistance. Persistence of low-level drug concentrations in body compartments can foster resistance formation. In this study, concentration-time courses of nevirapine after single-dose administration were analysed over an extended post-partum period. PATIENTS AND METHODS: Breast milk and plasma samples of 62 HIV-positive Ugandan mother-child pairs who had received single-dose nevirapine were collected at delivery and 1, 2 and 6 weeks post-partum. Nevirapine concentrations were quantified by LC/tandem-mass-spectrometry using a quantification limit of 15 ng/mL, and a population pharmacokinetic (PK) analysis was performed. RESULTS: Concentration-time profiles in breast milk, maternal plasma and child plasma showed similar shapes. At week 1, median nevirapine concentrations were 164 ng/mL in maternal plasma, 114 ng/mL in breast milk and 183 ng/mL in child plasma. The population PK model predicted nevirapine concentrations>10 ng/mL (IC50 for nevirapine) for 13 days in breast milk, 14 days in maternal plasma and 18 days in child plasma in 80% of the samples. CONCLUSIONS: Nevirapine concentrations were present for 2-3 weeks in the three compartments. The concentrations are probably sufficiently high to protect most breastfed children from HIV transmission during the first 2 weeks. The long presence of slowly decreasing levels of nevirapine is likely to induce resistance formation. Post-natal addition of antiretrovirals for 1 week only, as recommended in the current PMTCT guidelines, will not suffice to avoid nevirapine resistance formation.
Language: English
Keywords:
GERMANY | RESEARCH REPORT | MOTHERS | INFANT | POSTPARTUM | PERSONS LIVING WITH HIV/AIDS | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | DRUGS | BREASTFEEDING | HUMAN MILK | ADMINISTRATION AND DOSAGE | TREATMENT | Europe, Central | Europe | Developed Countries | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Puerperium | Reproduction | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Disease Transmission Control | Prevention and Control | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Infant Nutrition | Nutrition | Lactation | Maternal Physiology | Physiology | Biology
Document Number: 329752

30.

Title: Knowledge about breastfeeding among a group of primary care physicians and residents in Puerto Rico.
Author: Leavitt G; Martinez S; Ortiz N; Garcia L
Source: Journal of Community Health. 2009 Feb;34(1):1-5.
Abstract: Physicians have an essential role in promoting, protecting, and supporting breastfeeding as the ideal method of infant feeding. They are in an important position to promote breastfeeding but report difficulty in advising mothers with lactation problems. The purpose of this study is to assess knowledge about breastfeeding among primary care physicians and residents and identify potential barriers to its promotion. One hundred seventy-seven residents and physicians answered an anonymous questionnaire. The participants recognized breastfeeding benefits but 26% did not encourage exclusive breastfeeding. Mastitis, breast abscess, and the use of medications by the mother were considered contraindications to breastfeeding. Temporary breastfeeding discontinuation and bilirubin levels measurement were the preferred recommendations for the jaundiced infant. Most physicians received training in breastfeeding benefits although they report fair knowledge in myths, techniques, and contraindications. Physicians demonstrated to recognize breastfeeding benefits, but formal education is needed to eliminate barriers to breastfeeding promotion and support.
Language: English
Keywords:
PUERTO RICO | RESEARCH REPORT | PHYSICIANS | KNOWLEDGE | PRIMARY HEALTH CARE | HEALTH FACILITIES | BREASTFEEDING | HEALTH EDUCATION | MATERNAL HEALTH | Caribbean | Americas | Developed Countries | Health Personnel | Delivery of Health Care | Health | Sociocultural Factors | Health Services | Infant Nutrition | Nutrition | Education
Document Number: 330862


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