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Title: Spatial analysis of logistics indicator data for health commodities.
Author: John Snow [JSI]. DELIVER
Source: Arlington, Virginia, JSI, DELIVER, 2009 Jul. 6 p.
Abstract: The USAID | DELIVER PROJECT has developed robust monitoring and evaluation tools to quantitatively and qualitatively assess the performance of logistics systems for essential health commodities. The purpose of this paper is to explore how analysis of stock indicators by location provides added value to these data sets, through a relatively minor investment in GPS devices and GIS software. Beginning with visual examination of logistics indicator data within a geographic context and progressing to network analysis, each of the spatial analysis methods presented in this paper presents its own set of strengths and weaknesses, yet they all excel in providing insights into the logistics system that might not otherwise be understood or even observed by simply looking at tabular data of stock levels for different facilities in the health system. Since a logistics system is inherently a geographically heterogeneous entity, using cartographic and spatial analysis tools may prove to be a crucial asset in assisting managers to identify key questions related to the performance of the logistics system and focus on potential causes and solutions. Moving forward, it will be useful to build off of the descriptive strengths of the spatial analysis methods described herein and begin building more robust statistical models that measure correlation between different components of the logistics system and commodity availability, while still accounting for the geographical variability of the data. (Excerpts)
Language: English
Keywords:
ZAMBIA | PARAGUAY | SUMMARY REPORT | PILOT PROJECTS | DATA COLLECTION | DATA ANALYSIS | USAID | LOGISTICS | GEOGRAPHY | INFORMATION RETRIEVAL SYSTEMS | DISTANCE | STREETS AND ROADS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | South America, Central | South America | Latin America | Americas | Studies | Research Methodology | Government Agencies | Organizations | Political Factors | Sociocultural Factors | Management | Organization and Administration | Social Sciences | Science | Data Storage and Retrieval | Information Processing | Information | Geographic Factors | Population | Transportation | Economic Factors
Document Number: 331660

Title: Building support for orphans and vulnerable children.
Author: Population Council
Source: Momentum. 2009 Jun;:[1] p.
Abstract: We provide solid scientific evidence about programs targeting orphans and vulnerable children to help governments and communities provide better care for these children in need. The Council�s studies apply innovative research techniques to address complex issues about providing care and services to children affected by HIV. The Council�s evaluation of the RAPIDS intervention has highlighted the effectiveness of program activities and valuable lessons for program managers and providers. A mid-term evaluation in 2007 showed important progress, such as more help with school books, uniform fees, and transportation and improvements in school attendance among vulnerable children. Results from the 2009 data collection promise to provide further guidance to program managers on how to ensure the greatest impact with available resources. (Excerpts)
Language: English
Keywords:
ZAMBIA | SUMMARY REPORT | ORPHANS AND VULNERABLE CHILDREN | PERSONS LIVING WITH HIV/AIDS | PROGRAM ACTIVITIES | MANAGEMENT | INFORMATION | FINANCIAL ACTIVITIES | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Family and Household | Sociocultural Factors | HIV Infections | Viral Diseases | Diseases | Programs | Organization and Administration | Economic Factors
Document Number: 331493

Title: Helping mothers keep their babies safe from HIV.
Author: Population Council
Source: Momentum. 2009 Jun;:[1] p.
Abstract: The Population Council's evaluation of m2m provided solid evidence that the program was helping women use services to prevent transmission of HIV to their children. An innovative program, mothers2mothers (m2m), was created in South Africa to support HIV-positive pregnant women. The program trains and employs HIV-positive mothers who have used services to prevent mother-to-child transmission of HIV. These "mentor mothers" organize health talks and conduct regular support groups for their peers. They also reach out to the community to help women follow feeding practices that are best for their baby. They promote safer sex and family planning, and encourage mothers to return for HIV treatment and to bring their baby to the clinic for HIV testing. Women who participated in m2m were more likely to talk about their HIV status with friends and family members, to receive drugs to reduce the chance that their baby would be infected with HIV, and to follow recommended infant feeding practices. Following the evaluation, the program has expanded to hundreds of other locations in South Africa and beyond to Lesotho, Zambia, Kenya, Rwanda, Malawi, and Swaziland -- providing hope and care to HIV-positive mothers across Africa.
Language: English
Keywords:
SOUTH AFRICA | SUMMARY REPORT | WOMEN | PERSONS LIVING WITH HIV/AIDS | INFANT NUTRITION | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | PARTICIPATION | STIGMA | SOCIAL DISCRIMINATION | UTILIZATION OF HEALTH CARE | COUNSELING | TREATMENT | NEEDS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Nutrition | Health | Disease Transmission Control | Prevention and Control | Social Behavior | Behavior | Social Problems | Sociocultural Factors | Health Services | Delivery of Health Care | Clinic Activities | Program Activities | Programs | Organization and Administration | Medical Procedures | Medicine | Economic Factors
Document Number: 331490

10.

Title: Increasing HIV testing for at-risk children.
Author: Population Council
Source: Momentum. 2009 Jun;:[1] p.
Abstract: The Caregiver Project is helping HIV-positive children access life-saving medical treatment and providing an outreach model that can be replicated across Africa. The project trains grandmothers (called �grannies") to serve as peer supporters for elderly caregivers. The grannies provide information about pediatric HIV testing and treatment to elderly caregivers who come to Social Security Agency sites to get grants for social services for children and the elderly. Grannies offer caregivers referral cards that list the locations of pediatric testing services and encourage them to take the children to be tested. The Caregiver Project is targeting an important gateway to accessing these children, the elderly caregivers, and motivating caregivers to seek care through age-appropriate resources. (Excerpts)
Language: English
Keywords:
SOUTH AFRICA | SUMMARY REPORT | ORPHANS AND VULNERABLE CHILDREN | PERSONS LIVING WITH HIV/AIDS | CARE AND SUPPORT | PROMOTION | HIV TESTING | TREATMENT | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Family and Household | Sociocultural Factors | HIV Infections | Viral Diseases | Diseases | Health Services | Delivery of Health Care | Health | Marketing | Economic Factors | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine
Document Number: 331491

11.

Title: Advice columns in South African print publications.
Author: Soul City Institute for Health and Development Communication
Source: [Houghton, South Africa], Soul City Institute for Health and Development Communication, [2009]. 17 p.
Abstract: This paper reports on a study about letters to and responses from advice columnists in 13 South African publications over a three-month period. Approximately 40 percent of letters to the columnists asked for advice about multiple concurrent partnerships, but less than half of the answers included information related to HIV and the increased risk of infection that accompanies such relationships. Instead, the columnists chose to focus on emotional or moral issues of concurrent partnerships. The paper highlights this missed opportunity to address HIV-prevention issues.
Language: English
Keywords:
SOUTH AFRICA | SUMMARY REPORT | RESPONDENTS | PRINTED MEDIA | HIV INFECTIONS | AIDS | KNOWLEDGE | COUNSELING | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Surveys | Sampling Studies | Studies | Research Methodology | Mass Media | Communication | Viral Diseases | Diseases | Sociocultural Factors | Clinic Activities | Program Activities | Programs | Organization and Administration
Document Number: 331820

12.

Peer Reviewed

Title: HIV infection and tuberculosis in South Africa: an urgent need to escalate the public health response.
Author: Abdool Karim SS; Churchyard GJ; Abdool Karim Q; Lawn SD
Source: Lancet. 2009 Sep 12;374(9693):921-33.
Abstract: One of the greatest challenges facing post-apartheid South Africa is the control of the concomitant HIV and tuberculosis epidemics. HIV continues to spread relentlessly, and tuberculosis has been declared a national emergency. In 2007, South Africa, with 0.7% of the world's population, had 17% of the global burden of HIV infection, and one of the world's worst tuberculosis epidemics, compounded by rising drug resistance and HIV co-infection. Until recently, the South African Government's response to these diseases has been marked by denial, lack of political will, and poor implementation of policies and programmes. Nonetheless, there have been notable achievements in disease management, including substantial improvements in access to condoms, expansion of tuberculosis control efforts, and scale-up of free antiretroviral therapy (ART). Care for acutely ill AIDS patients and long-term provision of ART are two issues that dominate medical practice and the health-care system. Decisive action is needed to implement evidence-based priorities for the control of the HIV and tuberculosis epidemics. By use of the framework of the Strategic Plans for South Africa for tuberculosis and HIV/AIDS, we provide prioritised four-step approaches for tuberculosis control, HIV prevention, and HIV treatment. Strong leadership, political will, social mobilisation, adequate human and financial resources, and sustainable development of health-care services are needed for successful implementation of these approaches.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | CLIENTS | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | TUBERCULOSIS | ANTIRETROVIRAL THERAPY | DRUG RESISTANCE | HEALTH SERVICES | DELIVERY OF HEALTH CARE | MANAGEMENT | TREATMENT | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Program Activities | Programs | Organization and Administration | Viral Diseases | Diseases | Infections | HIV | Medical Procedures | Medicine | Health
Document Number: 342870

13.

Title: Prevention of invasive pneumococcal disease in HIV-infected children: expanding the toolbox [editorial]
Author: Abzug MJ; Pelton SI
Source: Journal of Infectious Diseases. 2009 Apr 15;199(8):1109-11.
Abstract: Invasive pneumococcal disease (IPD) remains a threat to HIV-infected children, adolescents, and adults in both developed and emerging nations. In the pre-highly active antiretroviral therapy (HAART) era, Mao et al. identified a cumulative incidence of 6.1 cases per 100 patient-years through age 7 years among HIV-infected children in Massachusetts, a rate 100-300-fold that seen in HIV-uninfected immunocompetent children in the United States. Similarly, Westwood et al. reported an IPD rate of 13 cases per 100 patient-years in Capetown, South Africa, a large proportion of which were lower respiratory tract infections. With widespread use of HAART in the United States, the rate of pneumococcal bacteremia declined by 80%, to 1.9 cases per 100 patient-years; this residual rate still remained at least 10-fold greater than that among HIV-uninfected children, and children who suffered an episode of pneumococcal bacteremia were more likely to die during follow-up than were HIV-infected children without an episode. These data identify the need to protect HIV-infected children from infection with Streptococcus pneumoniae, even in populations treated with HAART. (excerpt)
Language: English
Keywords:
UNITED STATES OF AMERICA | MASSACHUSETTS | SOUTH AFRICA | SUMMARY REPORT | CLINICAL TRIALS | PERSONS LIVING WITH HIV/AIDS | CHILDREN | ADULTS | ADOLESCENTS | ANTIRETROVIRAL THERAPY | DISEASE PREVENTION | VACCINES | Developed Countries | North America | Americas | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Clinical Research | Research Methodology | HIV Infections | Viral Diseases | Diseases | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | HIV | Prevention and Control | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 341354

14.

Peer Reviewed

Title: Unmet need for contraception among HIV-positive women in Lesotho and implications for mother-to-child transmission.
Author: Adair T
Source: Journal of Biosocial Science. 2009 Mar;41(2):269-78.
Abstract: In Lesotho, the risk of mother-to-child-transmission (MTCT) of HIV is substantial; women of childbearing age have a high HIV prevalence rate (26.4%), low knowledge of HIV status and a total fertility rate of 3.5 births per woman. An effective means of preventing MTCT is to reduce unwanted fertility. This paper examines the unmet need for contraception to limit and space births among HIV-positive women in Lesotho aged 15-49 years, using the 2004 Lesotho Demographic and Health Survey. HIV-positive women have their need for contraception unmet in almost one-third of cases, and multivariate analysis reveals this unmet need is most likely amongst the poor and amongst those not approving of family planning. Urgent action is needed to lower the level of unmet need and reduce MTCT. A constructive strategy is to improve access to family planning for all women in Lesotho, irrespective of HIV status, and, more specifically, integrate family planning with MTCT prevention and voluntary counselling and testing services.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | KAP SURVEYS | DEMOGRAPHIC AND HEALTH SURVEYS | MULTIVARIATE ANALYSIS | URBAN POPULATION | WOMEN IN DEVELOPMENT | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | KNOWLEDGE | CONTRACEPTION | NEEDS ASSESSMENT | BIRTH SPACING | POVERTY | ATTITUDES | PROGRAM ACCESSIBILITY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Surveys | Sampling Studies | Studies | Research Methodology | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Data Analysis | Population Characteristics | Economic Development | Economic Factors | Disease Transmission Control | Prevention and Control | Diseases | Sociocultural Factors | Family Planning | Evaluation | Socioeconomic Factors | Psychological Factors | Behavior | Program Evaluation | Programs | Organization and Administration
Document Number: 331114

15.

Peer Reviewed

Title: PMTCT, HAART, and childbearing in Mozambique: an institutional perspective.
Author: Agadjanian V; Hayford SR
Source: AIDS and Behavior. 2009 Jun;13(Suppl 1):S103-S112.
Abstract: Maternal and Child Health (MCH) units, where VCT/PMTCT/HAART have been integrated with traditional services, play a critical role in the connection between the massive HAART rollout and reproductive behavior. In this article, we use data from semi-structured interviews with MCH workers and ethnographic observations carried out in southern Mozambique to explore this role from the institutional perspective. We find that, along with logistical and workload problems, the de facto segregation of PMTCT/HAART clients within the �integrated� MCH system and the simplistic and uncompromising message discouraging further fertility and stressing condom-based contraception may pose serious challenges to a successful formulation and implementation of reproductive goals among seropositive clients. Although the recency of PMTCT/HAART services may partly explain these challenges, we argue that they are due largely to cultural miscommunication between providers and clients. We show how the cultural gap between the two is bridged by community activists and peer interactions among clients.
Language: English
Keywords:
MOZAMBIQUE | RESEARCH REPORT | HEALTH PERSONNEL | SUPPORT GROUPS | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | ANTIRETROVIRAL THERAPY | VOLUNTARY COUNSELING AND TESTING | MATERNAL-CHILD HEALTH SERVICES | INTEGRATED PROGRAMS | HEALTH SERVICES ADMINISTRATION | INTERVIEWS | FERTILITY PREFERENCES | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Delivery of Health Care | Health | Social Networks | Friends and Relatives | Family and Household | Sociocultural Factors | Disease Transmission Control | Prevention and Control | Diseases | HIV | HIV Infections | Viral Diseases | HIV Testing | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Primary Health Care | Programs | Organization and Administration | Management | Data Collection | Research Methodology | Fertility | Population Dynamics | Demographic Factors | Population
Document Number: 341906

16.

Peer Reviewed

Title: Structural barriers and human rights related to HIV prevention and treatment in Zimbabwe.
Author: Amon JJ; Kasambala T
Source: Global Public Health. 2009 Mar 26;:1-17.
Abstract: There has long been recognition that individual risk factors can only partially explain vulnerability to HIV infection, and that a broader range of socioeconomic, cultural and political factors must be taken into account. More recently this understanding has been applied to addressing obstacles to accessing HIV treatment. Yet, while structural interventions aimed at contextual factors related to HIV prevention and treatment have been shown to be effective, they have not been widely implemented. Using the situation of Zimbabwe as an example, we will present an illustration of how contextual barriers can be understood in human rights terms, and how using a human rights analysis can specifically help define 'structural-rights' interventions and compel their implementation.
Language: English
Keywords:
ZIMBABWE | CRITIQUE | EVALUATION | PERSONS LIVING WITH HIV/AIDS | POLICYMAKERS | HUMAN RIGHTS | HIV PREVENTION | AIDS PREVENTION | SOCIOECONOMIC FACTORS | CULTURE | POLITICAL FACTORS | INTERVENTIONS | SOCIAL PROBLEMS | HEALTH POLICY | SOCIAL POLICY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | HIV Infections | Viral Diseases | Diseases | Administrative Personnel | Organization and Administration | Sociocultural Factors | AIDS | Economic Factors | Programs | Policy
Document Number: 341476

17.

Title: The use of home-based therapy with ready-to-use therapeutic food to treat malnutrition in a rural area during a food crisis.
Author: Amthor RE; Cole SM; Manary MJ
Source: Journal of the American Dietetic Association. 2009 Mar;109(3):464-7.
Abstract: When the international community declared a famine in Malawi in January of 2006, emergency food aid reached only populations with pre-existing health care services. To treat the widespread childhood malnutrition in Machinga district, a rural area lacking health care facilities, in February 2006 five outpatient therapeutic programs were implemented that utilized home-based therapy and ready-to-use therapeutic food. Children with severe malnutrition, defined as the presence of edema and/or a weight-for-height less than 70% of the reference standard, were enrolled in the program. Two senior clinical nurses trained village health aides in each of the five communities. Children visited the health aides biweekly. During the visits, health aides collected demographic and anthropometric information and distributed a 2-week supply of ready-to-use therapeutic food, providing 175 kcal/kg/d. Treatment continued for 8 weeks; children were discharged before 8 weeks if they reached a weight-for-height more than 100% of the reference standard, or required admission to the hospital due to systemic infection or recurrence of edema. Of the 826 children enrolled, 775 (93.7%) recovered, 13 (1.8%) remained malnourished, 30 (3.6%) defaulted, and 8 (0.9%) died. Mean weight gained was 2.7+/-3.7 g/kg/d, height gained 0.3+/-0.9 mm/d, and mid-upper arm circumference gained 0.2+/-0.3 mm/d. Home-based therapy with ready-to-use therapeutic food administered by village health aides is an effective approach to treating malnutrition during food crises in areas lacking health services.
Language: English
Keywords:
DEVELOPING COUNTRIES | MALAWI | RESEARCH REPORT | RURAL AREAS | COMMUNITY | CHILDREN | FAMINE | FOOD SECURITY | NUTRITION DISORDERS | ANTHROPOMETRY | BODY WEIGHT | BODY HEIGHT | MALNUTRITION | HOME CARE | TREATMENT | Africa, Southern | Africa, Sub Saharan | Africa | Geographic Factors | Population | Residence Characteristics | Population Distribution | Youth | Age Factors | Population Characteristics | Demographic Factors | Food Supply | Natural Resources | Environment | Diseases | Measurement | Research Methodology | Physiology | Biology | Care and Support | Health Services | Delivery of Health Care | Health | Medical Procedures | Medicine
Document Number: 330803

18.

Peer Reviewed

Title: Knowledge of HIV status, sexual risk behaviors and contraceptive need among people living with HIV in Kenya and Malawi.
Author: Anand A; Shiraishi RW; Bunnell RE; Jacobs K; Solehdin N; Abdul-Quader AS; Marum LH; Muttunga JN; Kamoto K; Aberle-Grasse JM; Diaz T
Source: AIDS. 2009 Jun 17;
Abstract: BACKGROUND:: Several studies support the need for effective interventions to reduce HIV transmission risk behaviors among people living with HIV/AIDS (PLWHAs). DESIGN:: Cross-sectional nationally representative demographic health survey of Kenya (2003) and Malawi (2004-2005) that included HIV testing for consenting adults. METHODS:: We analyzed demographic health survey data for awareness of HIV status and sexual behaviors of PLWHAs (Kenya: 412; Malawi: 664). The analysis was adjusted (weighted) for the design of the survey and the results are nationally representative. FINDINGS:: Eighty-four percent of PLWHAs in Kenya and 86% in Malawi had sex in the past 12 months and in each country, 10% reported using condoms at last intercourse. Among sexually active PLWHAs, 86% in Kenya and 96% in Malawi reported their spouse or cohabiting partner as their most recent partner. In multivariate logistic regression models, married or cohabiting PLWHAs were significantly more likely to be sexually active and less likely to use condoms. Over 80% of PLWHAs were unaware of their HIV status. Of HIV-infected women, nearly three-quarters did not want more children either within the next 2 years or ever, but 32% in Kenya and 20% in Malawi were using contraception. INTERPRETATION:: In 2003-2005, majority of PLWHAs in Kenya and Malawi were unaware of their HIV status and were sexually active, especially married or cohabiting PLWHAs. Of HIV-infected women not wanting more children, few used contraception. HIV testing should be expanded, prevention programs should target married or cohabiting couples and family planning services should be integrated with HIV services.
Language: English
Keywords:
KENYA | MALAWI | RESEARCH REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | PERSONS LIVING WITH HIV/AIDS | AWARENESS | SEX BEHAVIOR | CONDOM USE | CONTRACEPTION | NEEDS | FERTILITY PREFERENCES | HIV/FP INTEGRATION | HIV TESTING | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Africa, Southern | Demographic Surveys | Population Dynamics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Knowledge | Sociocultural Factors | Behavior | Risk Reduction Behavior | Family Planning | Economic Factors | Fertility | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 341748

19.

Peer Reviewed

Title: Sexual risk behaviour of the first cohort undergoing screening for enrollment into Phase I/II HIV vaccine trials in South Africa.
Author: Andersson KM; Van Niekerk RM; Niccolai LM; Mlungwana ON; Holdsworth IM; Bogoshi M; McIntyre JA; Gray GE; Vardas E
Source: International Journal of STD and AIDS. 2009 Feb;20(2):95-101.
Abstract: We assessed risk behaviour in a heterosexual cohort undergoing prescreening for the first Phase I/II HIV vaccine trials in Soweto. We developed a survey and collected self-reported data from HIV-negative potential volunteers. Of 488 participants, most were single and approximately half were from households with incomes below the poverty level. Males reported higher rates of heavy alcohol use (P < 0.001), marijuana use (P < 0.001) and other recreational drug use (P < 0.01). Males reported more sex partners than females in the previous six months (P < 0.001), as well as more casual/anonymous partners (P < 0.001) and one-night stands (P < 0.001). Multivariate analyses revealed substance use and male gender predicted higher risk behaviours, including <100% condom use with known/suspected HIV-positive partners, having casual/anonymous partners and having more than two partners. For this population, male volunteers may need increased risk-reduction counselling during Phase I/II trials and additional recruitment methods may be necessary to identify high-risk female volunteers for Phase III efficacy trials.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | KAP SURVEYS | CLINICAL TRIALS | MULTIVARIATE ANALYSIS | HETEROSEXUALS | SEXUAL PARTNERS | SEX BEHAVIOR | RISK BEHAVIOR | VACCINES | ALCOHOL USE AND ABUSE | SCREENING | POVERTY | DRUG USE AND ABUSE | SEX FACTORS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Surveys | Sampling Studies | Studies | Research Methodology | Clinical Research | Data Analysis | Behavior | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Examinations and Diagnoses | Socioeconomic Factors | Economic Factors | Population Characteristics | Demographic Factors | Population
Document Number: 331093

20.

Peer Reviewed

Title: Comparison of HIV type 1 sequences from plasma, cell-free breast milk, and cell-associated breast milk viral populations in treated and untreated women in Mozambique.
Author: Andreotti M; Galluzzo CM; Guidotti G; Germano P; Altan AD; Pirillo MF; Marazzi MC; Vella S; Palombi L; Giuliano M
Source: AIDS Research and Human Retroviruses. 2009 Jul;25(7):707-11.
Abstract: We analyzed the sequences of the HIV viral populations obtained from plasma, cell-free breast milk, and breast milk cells of HAART-treated (23) and untreated (30) HIV-infected women to obtain information about the origin of the breast milk virus. Sequence analyses of viruses were performed using the TruGene HIV-1 assay. Direct sequences of the reverse transcriptase (RT) and protease (PR) genes were analyzed using the Phylip 3.68 suite of sequence analysis program and pairwise evolutionary distances were calculated with the Kimura two parameter model for estimation of distances. We found that the genetic distances between the plasma and the cell-free breast milk viruses and between the cell-free and cell-associated breast milk viruses for RT were higher in HAART-receiving women than in untreated women, suggesting viral evolution under selective drug pressure in breast milk. Our data support the hypothesis of the presence of an actively replicating viral population in the breast milk compartment, distinct from that present in plasma.
Language: English
Keywords:
MOZAMBIQUE | RESEARCH REPORT | COMPARATIVE STUDIES | WOMEN | HUMAN MILK | HIV | HIV TESTING | LABORATORY PROCEDURES | TREATMENT | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Demographic Factors | Population | Lactation | Maternal Physiology | Physiology | Biology | HIV Infections | Viral Diseases | Diseases | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 342889

21.

Peer Reviewed

Title: Overestimating HIV infection: The construction and accuracy of subjective probabilities of HIV infection in rural Malawi.
Author: Anglewicz P; Kohler HP
Source: Demographic Research. 2009;20(6):65-96.
Abstract: In the absence of HIV testing, how do rural Malawians assess their HIV status? In this paper, we use a unique dataset that includes respondents' HIV status as well as their subjective likelihood of HIV infection. These data show that many rural Malawians overestimate their likelihood of current HIV infection. The discrepancy between actual and perceived status raises an important question: Why are so many wrong? We begin by identifying determinants of self-assessed HIV status, and then compare these assessments with HIV biomarker results. Finally, we ask what characteristics of individuals are associated with errors in self-assessments.
Language: English
Keywords:
MALAWI | RESEARCH REPORT | RURAL AREAS | RESPONDENTS | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | ESTIMATION TECHNIQUES | PROBABILITY | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Geographic Factors | Population | Surveys | Sampling Studies | Studies | Research Methodology | Viral Diseases | Diseases | Statistical Studies
Document Number: 342533

22.
Peer Reviewed

Title: HIV testing rates and outcomes in a South African community, 2001-2006: implications for expanded screening policies.
Author: April MD; Walensky RP; Chang Y; Pitt J; Freedberg KA; Losina E; Paltiel AD; Wood R
Source: Journal of Acquired Immune Deficiency Syndromes. 2009 Jul 1;51(3):310-6.
Abstract: BACKGROUND: Revised World Health Organization recommendations seek to increase HIV testing. We assessed the need for expanded testing in South Africa by examining current testing and treatment trends among a high prevalence population. METHODS: We determined the numbers of adults receiving HIV testing and antiretroviral treatment (ART) during 2001-2006 using testing registers linked to patient records from 2 health care facilities believed responsible for virtually all HIV services available to the population. We evaluated annual population testing rates using census population counts; proportions of clients testing seropositive (yield); CD4 counts and World Health Organization stage at diagnosis; and ART initiation rates. RESULTS: HIV testing rates rose from 4% in 2001 to 20% in 2006 (P < 0.001) and were highest among pregnant females receiving provider-initiated testing. Yield for first-time testers decreased from 47% in 2001 to 28% in 2006; annual incidence of seroconversion among initially HIV-negative retesters was 1.9%. Median CD4 counts and World Health Organization stage distributions for newly diagnosed clients remained stable. HIV-infected clients receiving ART within 6 months of eligibility increased from 0% in 2001 to 68% in 2006 (P < 0.001). CONCLUSIONS: Population testing and ART initiation rates rose dramatically during 2001-2006. Yet, yield remained high, and HIV-infected persons continued to receive late diagnoses. These findings highlight the continuing need for expanded testing and linkage to care.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | DATA LINKAGE | STATISTICAL STUDIES | HIV TESTING | ANTIRETROVIRAL THERAPY | VOLUNTARY COUNSELING AND TESTING | SCREENING | HEALTH POLICY | CENSUS | HIV INFECTIONS | PREVALENCE | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Data Collection | Research Methodology | Studies | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV | Viral Diseases | Diseases | Policy | Political Factors | Sociocultural Factors | Population Statistics | Measurement
Document Number: 342149

23.

Title: PRISM tools for assessing, monitoring, and evaluating RHIS performance.
Author: Aqil A; Lippeveld T
Source: Chapel Hill, North Carolina, University of North Carolina at Chapel Hill, Carolina Population Center [CPC], MEASURE Evaluation, 2009 Mar. [32] p. (MS-09-34USAID Cooperative Agreement No. GPO-A-00-03-00003-00)
Abstract: PRISM Framework and its tools applications have expanded since 2004. Now it has been applied in Pakistan, Uganda, South Africa, Mexico, Paraguay, Honduras, Haiti, China and Cote d'Ivore for assessment and evaluation. It has been applied in diverse countries of Africa, Asia, Latin America and Carribean continents. While these applications showed the strengths and appropriateness of PRISM Framework and its tools in identifying strengths and weaknesses of the routine information systems, they brought some challenges to attention. First, to make a distinction between RHIS performance indicators -accuracy, timeliness and completeness, from their counterpart processes. Second, to keep minimum variables in various tools for triangulation of information to avoid respondent's burden of filling the details. Third, better measurement of use of information. Thus, there was a need to revise the PRISM tools. Uganda PRISM evaluation in 2007 for testing its reliability and validity also helped to make the revisions. PRISM tools version 3.0 meets old and new challenges in assessing, monitoring and evaluation of RHIS.
Language: English
Keywords:
PAKISTAN | MEXICO | HONDURAS | HAITI | CHINA | PARAGUAY | SOUTH AFRICA | UGANDA | SUMMARY REPORT | EVALUATION | INFORMATION PROCESSING | DATA COLLECTION | MANAGEMENT | PROGRAM ACTIVITIES | Developing Countries | Asia, Southern | Asia | North America | Americas | Central America | Latin America | Caribbean | Asia, Eastern | South America, Central | South America | Africa, Southern | Africa, Sub Saharan | Africa | Africa, Eastern | Information | Research Methodology | Organization and Administration | Programs
Document Number: 339994

24.

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

25.

26.

Title: Undernutrition malnutrition in infants in developing countries [letter]
Author: Ashorn P; Phuka JC; Maleta K; Thakwalakwa C; Cheung YB; Briend A; Manary MJ
Source: Archives of Pediatrics and Adolescent Medicine. 2009 Feb;163(2):186.
Abstract: We commend Dr Humphrey on an insightful and well-written editorial on infant underweight malnutrition and thank her for her interest in our study on this topic. In our trial, provision of fortified spread, a novel lipid-based nutrient supplement, to Malawian infants was associated with a markedly reduced incidence of severe stunting between 6 and 18 months of age. Yet, there was a large decrease in mean height-for-age, indicating that even the infants given supplementation often failed to maintain normal growth during this critical age. Dr Humphrey proposes 2 explanations for how this might be linked to insufficient dietary intakes: breast-milk displacement and increased energy and nutrient needs due to high rates of disease. Whereas the former has been documented in other settings, we found little evidence supporting this theory in our study area. Diarrhea, malaria, and respiratory infections, on the other hand, are common and associated with infant stunting in this population. Malaria incidence has recently declined, apparently owing to the frequent use of bed nets, but other childhood infections may well have contributed to the growth faltering of our study participants. Besides events after birth, we would like to emphasize the importance of antenatal factors for linear growth failure in many low-income countries. Due to a high proportion of preterm births and the frequency of intrauterine growth retardation, Malawian children are already shorter than expected at birth. In the present trial, mean length-for-age was below a -1 z score by age 6 months.1 In such conditions, it is difficult to prevent growth faltering solely with postnatal interventions; instead, these interventions need to be complemented with others that address antenatal problems, such as maternal undernutrition and infections. On the other hand, when fetal conditions are less distressing and stunting has not started by 6 months of age, an isolated nutrition intervention may prove sufficient. This was illustrated in a recent trial in Ghana, where infants who were given a lipid-based nutrient supplement that was not very different from the one we used in Malawi lost no length-for-age between 6 and 12 months of age. (full-text)
Language: English
Keywords:
MALAWI | CRITIQUE | INFANT | MALNUTRITION | CALORIC INTAKE | SUPPLEMENTARY FEEDING | INTRAUTERINE GROWTH RETARDATION | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Nutrition Disorders | Diseases | Nutrition | Health | Infant Nutrition | Congenital Abnormalities | Neonatal Diseases and Abnormalities
Document Number: 330227

27.

28.

Title: Philani program: a case study of an integrative approach of empowerment and social and economic development.
Author: Austin SA; Mbewu N
Source: Social Work In Public Health. 2009 Jan-Apr;24(1-2):148-60.
Abstract: This article reports a case study of a South African nongovernmental organization's role in implementing maternal and child health care services for families in Khayelitsha, an informal township in the Western Cape. The township is an extremely poor community with high unemployment and many other social indicators of high need. The case study explores how services were enhanced to respond to the service needs of children and families. The role of economic development as a means of empowering the mothers is examined within the context of nongovernmental organization services. The implications of developing services that integrate social and economic development are discussed as a model for social work practice in the United States.
Language: English
Keywords:
SOUTH AFRICA | SUMMARY REPORT | CASE STUDIES | NONGOVERNMENTAL ORGANIZATIONS | MATERNAL-CHILD HEALTH SERVICES | NEEDS | POVERTY | ECONOMIC DEVELOPMENT | SOCIAL DEVELOPMENT | WOMEN'S EMPOWERMENT | INTEGRATED PROGRAMS | SOCIAL POLICY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Organizations | Political Factors | Sociocultural Factors | Primary Health Care | Health Services | Delivery of Health Care | Health | Economic Factors | Socioeconomic Factors | Women's Status | Programs | Organization and Administration | Policy
Document Number: 341952

29.

Peer Reviewed

Title: Effect of male circumcision on the prevalence of high-risk human papillomavirus in young men: results of a randomized controlled trial conducted in orange farm, South Africa.
Author: Auvert B; Sobngwi-Tambekou J; Cutler E; Nieuwoudt M; Lissouba P; Puren A; Taljaard D
Source: Journal of Infectious Diseases. 2009 Jan 1;199(1):14-9.
Abstract: The authors used data from a male circumcision (MC) trial conducted in Orange Farm, South Africa among men aged 18-24 years to investigate the association between male circumcision (MC) and the prevalence of high-risk human papillomavirus (HR-HPV) among young men. Urethral swab samples were collected during a period of 262 consecutive days from participants in the intervention (circumcised) and control (uncircumcised) groups who were reporting for a scheduled follow-up visit. Swab samples were analyzed using polymerase chain reaction. HR-HPV prevalence rate ratios were assessed using univariate and multivariate log Poisson regression. In an intention-to-treat analysis, the prevalence of HR-HPV among the intervention group was 14.8% (94/637) and in the control group was 22.3% (140/627). Controlling for propensity score and confounders (ethnic group, age, education, sexual behavior [including condom use], marital status, and human immunodeficiency virus status) had no effect on the results. This is the first randomized controlled trial to show a reduction in the prevalence of urethral HR-HPV infection after MC. This finding explains why women with circumcised partners are at a lower risk of cervical cancer than other women.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | CLINICAL TRIALS | EPIDEMIOLOGIC METHODS | YOUTH | MULTIVARIATE ANALYSIS | MEN | MALE CIRCUMCISION | HPV | PREVALENCE | RISK FACTORS | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Clinical Research | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Data Analysis | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Viral Diseases | Diseases | Measurement | Biology
Document Number: 328586

30.

Peer Reviewed

Title: Neonatal near miss: a measure of the quality of obstetric care.
Author: Avenant T
Source: Best Practice and Research. Clinical Obstetrics and Gynaecology. 2009 Jun;23(3):369-374.
Abstract: Thirty-seven percent of under-five deaths occur in the neonatal period. Identifying and correcting factors that contribute to neonatal and maternal care are of the utmost importance. Evaluation of severe acute maternal morbidity, also known as �near miss�, is used to improve obstetric practice. Neonatal near miss in conjunction with neonatal mortality can be used in a similar fashion to identify deficiencies in care. No accepted definition of neonatal near miss currently exists. None of the neonatal morbidity scoring systems is applicable or appropriate for this purpose. Organ system based criteria are objective and allow for identifying severe morbidities and identifying primary causes. This system can be of use in a variety of settings to identify health system problems and to institute remedial action where necessary.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | PREGNANCY | MATERNAL MORTALITY | PERINATAL MORTALITY | MORBIDITY | QUALITY OF HEALTH CARE | MATERNAL-CHILD HEALTH SERVICES | MEASUREMENT | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Reproduction | Mortality | Population Dynamics | Demographic Factors | Population | Diseases | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Primary Health Care | Health Services | Delivery of Health Care | Health | Research Methodology
Document Number: 341303


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