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Differences between international recommendations on breastfeeding in the presence of HIV and the attitudes and counselling messages of health workers in Lilongwe, Malawi.
International Breastfeeding Journal. 2006 Mar 9; 1(1):2.To prevent postnatal transmission of HIV in settings where safe alternatives to breastfeeding are unavailable, the World Health Organization (WHO) recommends exclusive breastfeeding followed by early, rapid cessation of breastfeeding. Only limited data are available on the attitudes of health workers toward this recommendation and the impact of these attitudes on infant feeding counselling messages given to mothers. As part of the Breastfeeding, Antiretroviral, and Nutrition (BAN) clinical trial, we carried out an in-depth qualitative study of the attitudes, beliefs, and counselling messages of 19 health workers in Lilongwe, Malawi. Although none of the workers had received formal training, several reported having counseled HIV-positive mothers about infant feeding. Health workers with counselling experience believed that HIV-infected mothers should breastfeed exclusively, rather than infant formula feed, citing poverty as the primary reason. Because of high levels of malnutrition, all the workershad concerns about early cessation of breastfeeding. Important differences were observed between the WHO recommendations and the attitudes and practices of the health workers. Understanding these differences is important for designing effective interventions. (author's)
Testing the effectiveness of integrating community-based approaches for encouraging abandonment of female genital cutting into CARE's reproductive health programs in Ethiopia and Kenya.
Washington, D.C., Population Council, Frontiers in Reproductive Health, 2004 Dec.  p. (USAID Cooperative Agreement No. HRN-A-00-98-00012-00; USAID Cooperative Agreement No. HRN-A-00-98-00023-00)Between 2000 and 2002, CARE International, with technical support from the Frontiers in Reproductive Health Program of the Population Council, implemented an operations research (OR) project among the Afar people of Ethiopia and Somali refugees in Daadab camps in Kenya. The OR project aimed to assess the effectiveness of community-based female genital cutting (FGC) strategies in increasing the knowledge of harmful FGC effects and positive FGC related attitudes and intended behaviour among the intervention communities. Both communities are predominantly of Islamic faith and practice infibulation, the most severe form of FGC. In both Ethiopia and Kenya, CARE integrated FGC interventions into existing community-based reproductive and primary health care information and service delivery activities. The study in Ethiopia was designed to test the effectiveness of education activities using behaviour change communication (BCC) approaches and advocacy activities by religious and other key leaders in the intervention site. No interventions occurred in the control sites. In Kenya, both the intervention and comparison sites had education/BCC activities. The intervention site had advocacy activities in addition to education/BCC activities. The OR study assessed the effectiveness of BCC and advocacy activities versus no interventions in Ethiopia, while in Kenya the comparison was between BCC strategies alone and the combination of BCC and advocacy activities. (excerpt)
[People's perception of diseases: an exploratory study of popular beliefs, attitudes and practices regarding immunizable diseases]
Dhaka, Bangladesh, Worldview International Foundation, 1987 Nov.  p.Researchers interviewed 57 mothers and 27 heads of family in predominantly rural areas about 135km from the capital city of Dhaka, Bangladesh to learn about their perception of diseases. They also talked with 3 traditional healers and 8 influential people in the different locales, e.g., teachers and imams. They learned that each vaccine preventable disease has at least 1 local name rooted in popular beliefs, e.g., all local names for poliomyelitis are associated with an ominous wind. Generally, the local people believe that witches or evil spirits cause all the vaccine preventable diseases. These entities prefer attacking babies, but also are known to afflict women. A preventive measure practiced includes pregnant women never leaving the house in the evening, at noon, or at midnight since these are the times when they are most exposed to evil spirits. There exist 2 traditional healers--fakirs and kabiraj. Fakirs use mystic words with religious chants and perform various healing rituals. The kabiraj sometimes use healing rituals, but also prescribe indigenous medicines. This research provides some useful insights into WHO's Expanded Programme on Immunization in developing communication strategies which build on what people already know. For example, since the local people believe that evil spirits or witches attack the newborn immediately after birth may provide an incentive for early immunization. Since preventing illness and death in newborns is a goal of both modern and traditional medicine, it is likely that the local people are not so concerned with the real cause of illness and will accept any practice that keeps their infant healthy and that fits into their beliefs and perceptions.
Network. 2001; 21(2):13.In many settings, domestic violence is accepted by both women and men, and will only be reduced as basic human rights are recognized. Since many health care workers do not have the time, training, resources, or support to help victims of domestic violence, the WHO recommends several ways that they may be able to perform their duties at a minimum. The provider's first priority should be to evaluate the woman's safety in terms of risk of recurrence of violence, adverse reproductive health outcomes, or death through homicide or suicide. They should also keep in mind the credo "do no harm." This includes not blaming a woman for the domestic violence she has suffered. In general, a provider who wishes to take the first step of trying to identify victims of domestic violence should have a specific goal either to give better care, counseling, or refer the victim to the appropriate services. One source of guidance on integrating gender-based violence into sexual and reproductive health is the International Planned Parenthood Federation/Western Hemisphere newsletter. In the winter 2001 and summer 2000 newsletters, it describes how to create a protocol for implementing screening and services for victims of domestic violence and tells how to create a referral network and begin implementing client screening and staff training, respectively.
Interview schedule for Knowledge, Attitudes, Beliefs and Practices on AIDS. Phase I: African countries. A. Household form. B. Community characteristics. C. Individual questionnaire.
[Unpublished] 1989 Feb. 28 p.The household interview form has spaces in which to designate a household's location and track interviewer visits with notation of visit results. Basic information can be recorded about the people over age 10 years who usually live in the household or who slept in the household on the preceding night. Data are then taken on the community characteristics form on the type of locality, travel time to the nearest large town, and facilities available in the community. The individual questionnaire is for people aged 15-64 years who slept in the household on the preceding night and is comprised of the following sections: identification; individual characteristics; awareness of AIDS; knowledge on AIDS; sources of information; beliefs, attitudes, and behavior; knowledge of and attitudes toward condoms; sexual practices; injection practices; locus of control; IV drug use; and drinking habits.
Some lessons from the World Health Organization Global Programme on AIDS (WHO / GPA) sexual behavior surveys and knowledge, attitudes, beliefs, and practices (KABP) surveys.
In: AIDS in the world II: global dimensions, social roots, and responses. The Global AIDS Policy Coalition, edited by Jonathan M. Mann and Daniel J.M. Tarantola. New York, New York, Oxford University Press, 1996. 140-5.Sexual behavior surveys were conducted during 1980-94 among the general population of specific population groups in 67 countries. 15 of the sexual behavior and knowledge, attitude, behavior, and practices (KABP) surveys conducted during 1989-90 in developing countries were reviewed and summarized by the World Health Organization's Global Program on AIDS. While not all of publishable quality, the studies nonetheless shed light upon HIV/AIDS KABP. For example, while there was considerable awareness of HIV/AIDS during the late 1980s, incorrect beliefs on the modes of HIV transmission were quite prevalent. The large majority of women and 66% of men claimed to be faithful to one regular sex partner, although there was considerable variability among sites. 0-11% of men reported having five or more extramarital sex partners within the preceding 12 months, 20-50% of whom reported not feeling at risk of contracting HIV. The survey data failed to support the assumption that towns and cities are more conducive than rural areas to nonregular sexual relationships. Large variations were identified in the levels of condom awareness and use.
In: Sexual behaviour and AIDS in the developing world, edited by John Cleland and Benoit Ferry. London, England, Taylor and Francis, 1995. 124-56. (Social Aspects of AIDS)Primitive forms of the condom were used to prevent pregnancy more than 3000 years ago. The widespread use of condoms to prevent sexually transmitted diseases (STD), especially syphilis, however, over the past two centuries has made condoms highly controversial. In many countries since the beginning of the AIDS pandemic, condoms have come to connote illicit sex. Their widespread use as a contraceptive has therefore been impeded by the historical association with STD prevention. This chapter summarizes survey findings on the awareness, use, and attitudes toward condoms. It is divided into the following sections: awareness of condoms and access to supplies, condom use, and perceived attributes of the condom. The implications of survey findings are discussed.
In: Sexual behaviour and AIDS in the developing world, edited by John Cleland and Benoit Ferry. London, England, Taylor and Francis, 1995. 43-74. (Social Aspects of AIDS)Data derived from surveys conducted in 1989 and 1990 on the levels of awareness of HIV and AIDS, the accuracy of specific areas of knowledge regarding transmission routes, the perceived severity of the condition, views on the appropriate ways in which to care for people who are HIV-seropositive, and attitudes toward testing are presented. There was some variation between study populations with regard to the proportions of people who had heard of AIDS, with a trend toward lower figures in francophone central and west Africa. Within populations, the groups less likely to have heard of AIDS were women, those with lower levels of education, those in rural areas, and those with lower media exposure. Generally, levels of accuracy concerning actual routes of HIV transmission were high. Accuracy levels regarding transmission through casual routes, however, tended to be very poor. The implications of these findings are discussed.
AIDS SURVEILLANCE REPORT. 1995 Jan; (4):3, 5-6.More than forty studies were reviewed in 1995 on the knowledge, attitudes, beliefs, and practices of individuals with respect to HIV/AIDS in American Samoa, Cambodia, China, Cook Islands, Fiji, French Polynesia, Guam, Hong Kong, Japan, Lao People's Democratic Republic, Malaysia, Palau, Papua New Guinea, Philippines, Republic of Korea, Samoa, Singapore, Solomon Islands, Tonga, Vanuatu, and Vietnam. In all but one of the twenty studies which inquired, more than 80% of respondents had heard of AIDS. In a number of countries, correct knowledge about the sexual transmission of HIV/AIDS was found to be at least 80%. A similar level of knowledge was found about needle transmission of HIV/AIDS, although comparatively lower levels of knowledge about HIV transmission via sexual intercourse, needle use/reuse, and maternal-child exchange was, however, identified in Cambodia, Fiji, Malaysia, Solomon Islands, and the high-risk populations of Vietnam and French Polynesia. Relatively high levels of incorrect answers were observed for the incorrect modes of HIV transmission. Moreover, 20% of respondents in each of the eight studies are in favor of exiling or isolating HIV-infected persons; in two countries, support for isolation or exile was 60% or greater. Overall, risk behaviors appear to exist at levels which will support an HIV epidemic in the countries studied. Levels of other sexually transmitted diseases and reported levels of extramarital and premarital sex, especially among males, support this conclusion. Commercial sex appears to occur at a substantial level in most of the societies studied, while condom use in casual and commercial sexual encounters seems to be the exception rather than the rule.
Social Science and Medicine. 1993 Jul; 37(1):97-103.Dehydration from diarrheal disease is the leading cause of infant and child mortality in many developing countries. World Health Organization (WHO) policy recommends oral rehydration solution (ORS) for its treatment and prevention. In concordance with this recommendation, many community-based oral rehydration therapy programs have been implemented since the late 1960s, making ORS widely available and affordable. The solution, however, has not been incorporated universally where needed into people's health-seeking practices. A study was conducted on the household management of childhood diarrhea in a poor, urban neighborhood of Managua, Nicaragua, over the period February 1987 - April, 1988. Results are based upon data collected from interviews with 8 key informants and 109 mothers, and 44 reported cases of diarrhea. Despite the provision of ORS by state health facilities, pharmacies, and informal drug vendors, and health education efforts to change mothers' beliefs and practices, the appropriate use of ORS was not common in the household management of diarrhea. Mothers knew about dehydration and diarrhea, but their explanatory models and actual practice reflected heavy reliance upon self-prescribed pharmaceuticals and home remedies; ORS use was associated with clinic attendance. These findings underscore the existing obstacles to changing people's explanatory models for illness and illness management. To best effect positive, healthy change, the context in which treatment options are assessed and used must be understood.
Epidemiological studies on measles in Karachi, Pakistan -- mothers' knowledge, attitude and beliefs about measles and measles vaccine.
ACTA PAEDIATRICA JAPONICA. 1992 Jun; 34(3):290-4.In Pakistan, the Accelerated Health Program has greatly improved the immunization coverage rates, and local area monitoring revealed a marked decrease of measles between 1974 and 1984. In October 1988, 287 randomly selected mothers living in Karachi who took their children to the Civil Hospital or to the Abbasi Shahid Civil Hospital were interviewed by means of a questionnaire about their knowledge of the clinical manifestations of measles, their own children's history of morbidity and mortality, and any history of immunizations, and attitude and beliefs about measles and measles vaccine. In 1989 and 1990, in a community-based survey visits were conducted in Neelam Colony, Karachi, with a population of about 3000, and infantile mortality rate of 153/1000 births, and an immunization acceptance rate up to 1 year of age of about 35%. More than half of the women mentioned serious complications of measles, including diarrhea and malnutrition. Of 1076 children whose parents gave usable answers, only a few had repeated episodes of measles. The age of contraction of measles varied widely from 4 months to 12 years with high prevalence: 89% of them contracted it before 6 years of age, primarily between 9 and 18 months of age. The vaccine efficacy rate was 72%. The severity of the illness and complications were well known and immunizations were appreciated. In traditional families, grandparents had made the decision about immunization, but many mothers were starting to assume that responsibility. The vaccine acceptance rate had increased sharply in recent years, as a result of local health educators' activities in clinics providing regular health checks and especially owing to TV programs. The importance of promotion of primary heath care by collaboration of motivated mothers and community health workers is emphasized.
INTERNATIONAL JOURNAL OF HEALTH SERVICES. 1991; 21(3):505-10.This article asks the reader to carefully consider the personal implications of AIDS were either he or close friends and relatives afflicted with the syndrome. We are urged to acknowledge the limited capabilities of personal and social response to the epidemic, and recognize the associated degree of social inequity and knowledge deficiency which exists. Summaries of 3 articles are discussed as highly integrated in their common call for global solidarity in the fight against HIV infections and AIDS. Pros and cons of Cuba's evolving response to AIDS are considered, paying attention to the country's recent abandonment of health policy which isolated those infected with HIV, in favor of renewed social integration of these individuals. Brazil's inadequate, untimely, and erred response to AIDS is then strongly criticized in the 2nd article summary. Finally, the 3rd article by Dr. Jonathan Mann, former head of the World Health Organization's Global program on AIDS, on AIDS prevention in the 1990s is discussed. Covering behavioral change and the critical role of political factors in AIDS prevention, Mann asserts the need to apply current concepts and strategies, while developing new ones, and to reassess values and concepts guiding work in the field. AIDS and its associated crises threaten the survival of humanity. It is not just a disease to be solved by information, but is intimately linked to issues of sexuality, health, and human behavior which are in turn shaped by social, political, economic, and cultural factors. Strong, concerted political resolve is essential in developing, implementing, and sustaining an action agenda against AIDS set by people with AIDS and those at risk of infection. Vision, resources, and leadership are called for in this war closely linked to the struggle for worldwide social justice.
SCIENCE. 1991 Oct 25; 254:511-2.The 1st Director of the World Health Organization's (WHO) Global Program on AIDS (GPA) abruptly resigned March, 1990. Jonathan Mann led the GPA in an innovative, aggressive, and comparatively non-bureaucratic style since its inception in 1986, building a staff of nearly 200 under an eventual 1990 budget of $90 million. Mann's non-conformist style and ever-growing budget, however, ran counter to the bureaucratic forces in WHO, causing him to leave for a position at Harvard University. A 12-year WHO veteran, Michael H. Merson succeeded Mann, and has since managed the GPA in a more conventional, bureaucratic manner. Senior staff have resigned, and the budget will drop to only $75 million for 1992. Staff replacements are used to the bureaucratic structure and demands of WHO, but lack experience in the field of AIDS. This paper discusses the markedly different management styles and approaches of Merson and Mann, with concern voiced over the future of the GPA. Critics are uncertain of GPA's present direction, and whether or not it is a necessary, positive change in the fight against the AIDS pandemic. As AIDS appears with less frequency and centrality i the world's media, the GPA is needed now even more than just a few years ago to inform the world of the dangers of AIDS. Merson is expected to promote relatively simple treatment options for AIDS, with some emphasis upon technological fixes like the condom. With cuts to the behavioral research budget, however, it is almost certain that inadequate steps will be taken to effect behavioral change for the prevention and control of HIV infection.
HEALTH FOR THE MILLIONS. 1991 Aug; 17(4):20-3.Until recently, the only sustained AIDS activity in India has been alarmist media attention complemented by occasional messages calling for comfort and dignity. Public perception of the AIDS epidemic in India has been effectively shaped by mass media. Press reports have, however, bolstered awareness of the problem among literate elements of urban populations. In the absence of sustained guidance in the campaign against AIDS, responsibility has fallen to voluntary health activists who have become catalysts for community awareness and participation. This voluntary initiative, in effect, seems to be the only immediate avenue for constructive public action, and signals the gradual development of an AIDS network in India. Proceedings from a seminar in Ahmedabad are discussed, and include plans for an information and education program targeting sex workers, health and communication programs for 150 commercial blood donors and their agents, surveillance and awareness programs for safer blood and blood products, and dialogue with the business community and trade unions. Despite the lack of coordination among volunteers and activists, every major city in India now has an AIDS group. A controversial bill on AIDS has ben circulating through government ministries and committees since mid-1989, a national AIDS committee exists with the Secretary of Health as its director, and a 3-year medium-term national plan exists for the reduction of AIDS and HIV infection and morbidity. UNICEF programs target mothers and children for AIDS awareness, and blood testing facilities are expected to be expanded. The article considers the present chaos effectively productive in forcing the Indian population to face up to previously taboo issued of sexuality, sex education, and sexually transmitted disease.
CURRENT SCIENCE. 1990 Jul 25; 59(13-14):710-3.The Government of India (GOI) founded the National Diarrhoea Management Programme in 1985 to address a leading public health problem which kills >1.5 million children every year. GOI and UNICEF based the program on 3 assumptions: rural Indian mothers do not perceive diarrhea as a serious problem; they do not give food and fluids to their child during diarrhea; and they do not refer their ill child to a medical practitioner. It has since conducted various studies to look at current knowledge, attitudes, and practices of mothers towards diarrhea. Research revealed that indeed mothers did not consider diarrhea a problem until after 4-5 loose stools. Further they did not believe diarrhea could cause death. They only took action when the child with diarrhea did not improve. On the other hand, research showed that 98% of the mothers continued to breast feed or give their child fluids during a diarrhea episode. Nevertheless 70% only gave their child <100 ml or fluid at a time, <3 times/day. Most also fed their child, but usually in smaller quantities. 1 study indicated that most mothers (65%) consulted a medical practitioner, usually a private practitioner, during the most recent diarrhea episode. The medical practitioner was not necessarily a qualified physician and usually prescribed antidiarrheals, even though he knew of ORS. GOI and market research agencies have considered the results of these studies to design advertising and education campaigns that would persuade and convince caretakers and medical practitioners to treat diarrhea in children with oral rehydration solution (ORS) or a sugar salt solution. Moreover the program has restructured its plan to include reinforcing the use of well known home available fluids and foods and promoting the ORS packet as the 1st response to the 1st response to the 1st loose stool.
London, England, International Planned Parenthood Federation [IPPF], 1989. 68 p.The International Planned Parenthood Federation (IPPF) surveyed male involvement projects in 7 Family Planning Associations (FPAs) as a preliminary step for program development. Male involvement was defined as organizational activities aimed at men, with the objective of improving family planning practice of either sex. The 1987-1988 survey, which consisted of interviews of FPA staffers in Ghana and Nigeria, Cyprus, Thailand, 4 Caribbean islands, Mexico, Egypt and Nepal, sought to identify FPA activities directed at men; to examine their relative effectiveness, especially against other priorities of the FPAs; and to develop criteria for future male projects. The study concluded that male involvement activities make up a greater part of FPA programs than generally believed: programs included male-targeted community-based contraceptive distribution (CBD), community centers, education in the workplace, contraceptive social marketing (CSM), youth centers, vasectomy clinics, family life education, distribution of educational materials and promotional events. Male groups proved relatively easy to reach for educational work but the effectiveness of the education was uneven and evaluation largely nonexistent. The debate between encouraging CSM programs by independent marketing organizations or continuing more expensive smaller-scale CBD will need to be resolved. The study recommended greater attention to curriculum design; information, education and communication projects; adolescent counselling and contraceptive services; CSM to promote condom use; education and service delivery to the workplace; and in each of these areas, effective and continuous evaluation. An annex provides detailed country reports with the data for the survey.