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Barriers to implementing WHO's exclusive breastfeeding policy for women living with HIV in sub-Saharan Africa: an exploration of ideas, interests and institutions.
International Journal of Health Planning and Management. 2013 Jul-Sep; 28(3):257-68.The vertical transmission of HIV occurs when an HIV-positive woman passes the virus to her baby during pregnancy, delivery or breastfeeding. The World Health Organization's (WHO) Guidelines on HIV and infant feeding 2010 recommends exclusive breastfeeding for HIV-positive mothers in resource-limited settings. Although evidence shows that following this strategy will dramatically reduce vertical transmission of HIV, full implementation of the WHO Guidelines has been severely limited in sub-Saharan Africa. This paper provides an analysis of the role of ideas, interests and institutions in establishing barriers to the effective implementation of these guidelines by reviewing efforts to implement prevention of vertical transmission programs in various sub-Saharan countries. Findings suggest that WHO Guidelines on preventing vertical transmission of HIV through exclusive breastfeeding in resource-limited settings are not being translated into action by governments and front-line workers because of a variety of structural and ideological barriers. Identifying and understanding the role played by ideas, interests and institutions is essential to overcoming barriers to guideline implementation. Copyright (c) 2012 John Wiley & Sons, Ltd.
Geneva, Switzerland, United Nations High Commissioner for Refugees [UNHCR], 2008 Apr. 20 p.This Guidance on Infant feeding and HIV aims to assist UNHCR, its implementing and operational partners, and governments on policies and decision- making strategies on infant feeding and HIV in refugees and displaced populations. Its purpose is to provide an overview of the current technical and programmatic consensus on infant feeding and HIV, and give guidance to facilitate elective implementation of HIV and infant feeding programmes in refugee and displaced situations, in emergency contexts, and as an integral element of coordinated approach to public health, HIV and nutrition programming. The goal of this guidance is to provide tools to prevent malnutrition, improve the nutritional status of infants and young children, to reduce the transmission of HIV infection from mother to child after delivery, and to increase HIV-free survival of infants.
Promotion of WHO feeding recommendations: A model evaluating the effects on HIV-free survival in African children.
Journal of Human Lactation. 2008 May; 24(2):140-149.In Africa, HIV and feeding practices deeply affect child mortality. To prevent mother-to-child transmission, the World Health Organization recommends exclusive breastfeeding for 6 months and replacement feeding when acceptable, feasible, affordable, and sustainable. Determining the proportion and number of children saved with exclusive breastfeeding and replacement feeding is essential to design and implement crucial nationwide policies. Using data on 31 sub-Saharan countries and a decision tree for risk assessment, the authors estimated the number of children's lives potentially saved according to 6 scenarios that combine exclusive breastfeeding for 6 months or replacement feeding with 3 promotion strategies. Among all HIV-negative children born to HIV-positive mothers who die in sub-Saharan Africa per year, 52 315 (9.6%) would be saved yearly with exclusive breastfeeding versus 21 638 (4.0%) with replacement feeding. Promotion support would double these numbers (110 625 vs 45 330; ie, 20.3% vs 8.3%), and with additional prenatal group education, 132 633 versus 54 192 lives would be saved (24.3% vs 9.9%). Wherever replacement feeding is not possible, exclusive breastfeeding with promotion support and prenatal group education would save 1 of 4 exposed children. (author's)
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)
Feeding of nonbreastfed children from 6 to 24 months of age: Conclusions of an informal meeting on infant young child feeding organized by the World Organization, Geneva, March 8-10, 2004.
Food and Nutrition Bulletin. 2004; 25(4):403-406.According to current United Nations recommendations, infants should be exclusively breastfed for the first six months of life and thereafter should receive appropriate complementary feeding with continued breastfeeding up to two years or beyond. However, there are a number of infants who will not enjoy the benefits of breastfeeding in the early months of life or for whom breastfeeding will stop before the recommended period of two years or beyond. A group that calls for particular attention consists of the infants of mothers who are known to be HIV positive. To reduce the risk of HIV transmission, it is recommended that when it is acceptable, feasible, affordable, sustainable, and safe, these mothers give replacement feeding from birth. Otherwise, they should breastfeed exclusively and stop as soon as alternative feeding options become feasible. Another group includes those infants whose mothers have died, or who for some reason do not breastfeed. (excerpt)
New York, New York, UNICEF, 1999 Aug.  p.If every baby were exclusively breastfed from birth, an estimated 1.5 million lives would be saved each year. And not just saved, but enhanced, because breastmilk is the perfect food for a baby's first six months of life - no manufactured product can equal it. Virtually all children benefit from breastfeeding, regardless of where they live. Breastmilk has all the nutrients babies need to stay healthy and grow. It protects them from diarrhoea and acute respiratory infections - two leading causes of infant death. It stimulates their immune systems and response to vaccinations. It contains hundreds of health-enhancing antibodies and enzymes. It requires no mixing, sterilization or equipment. And it is always the right temperature. Children who are breastfed have lower rates of childhood cancers, including leukaemia and lymphoma. They are less susceptible to pneumonia, asthma, allergies, childhood diabetes, gastrointestinal illnesses and infections that can damage their hearing. Studies suggest that breastfeeding is good for neurological development. And breastfeeding offers a benefit that cannot be measured: a natural opportunity to communicate love at the very beginning of a child's life. Breastfeeding provides hours of closeness and nurturing every day, laying the foundation for a caring and trusting relationship between mother and child. (excerpt)