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Positively Aware. 2003 Mar-Apr; 14(2):25.The Sparrow Ministries Hospice is an interdenominational Ministry of Help caring for "destitute terminally ill" adults and children with HIV/AIDS. They provide in-patient hospice accommodation, medical care, and psychological, social and spiritual support to 15 adults and 30 children. Their out-patient facility offers care to 45 adults and six children, including hospital visits, medication, food pantry, clothing, counseling and help with applications for disability grants. The Sparrow Hospice provides home-based care reaching up to 10 families a week. In addition, they provide home-based care courses, as well as counseling courses, in order to mobilize communities with effective HIV/AIDS knowledge. (excerpt)
Geneva, Switzerland, WHO, 1981. 76 p. (WHO Technical Report Series No. 657)This report on the effect of female sex hormones on fetal health and development aimed to evaluate research on the specific types of sex hormones and their uses, to determine their safety with respect to fetal development and infant health, and to recommend further research in these areas. Theoretically, sex hormones can affect any stage of fetal development. Sex hormones appear to act by promoting synthesis of messenger ribonucleic acid (mRNA) in target tissues, so that research should focus on the specific proteins formed under the direction of newly synthesized mRNA to elucidate potential morphological and physiological effects of exogenous hormones. Following are some research avenues: cytogenetic research, microscopic and macroscopic examination, observations on births and later life, animal teratology, and epidemiological studies. Epidemiological studies not only help elucidate causal associations but also provide public health data. Studies of sex hormones and fetal development and infant health must be free of bias and often suffer from problems of defining pregnancy outcome. Also sex steroids are frequently administered at the same time as other drugs, leading to confounding effects of drug interactions. In order to assess existing data, it is necessary to disaggregate the data from different reports and then to regroup them according to the indications for use, i.e., infertility, contraception, pregnancy testing, supportive therapy during pregnancy, contraception during pregnancy, contraception during breast feeding. Likewise data must be disaggregated according to different types of exposure, i.e., preconception or postconception. The bulk of this monograph is spent disaggregating study data based on the above-stated rationales. The following recommendations are made for indications for use of sex hormones: 1) they should not be used as pregnancy tests; 2) diethylstilbestrol should not be prescribed to a suspected pregnant woman; 3) benefits of progestin therapies must first be proven before they can be recommended for use in supporting pregnancy; 4) oral contraceptives given before pregnancy seem to have no effect on subsequent pregnancy; and during lactation combined therapy should not be given.
Geneva, World Health Organization, 1966. (Technical Report Series No. 334.) 21 p.A WHO Scientific Group on Immunological Aspects of Human Reproduction met in Geneva October 4-9, 1965. Topics of discussion included: 1) immunology of human gonadotropins; 2) sperm and seminal fluid; 3) blood group antigens and human reproduction; and 4) maternal-fetal immunological interactions. It was concluded that further investigations are required to study: 1) the correlation between physiocochemical, biological, and immunological criteria for the purity of antigens concerned in human reproduction; 2) the chemical structure of hormones concerned with reproduction, with special reference to the biologically active sites and the nature of antibodies against these active sites; 3) production of antibodies to the gonadotropins by the use of adjuvants and/or chemically modified gonadotropins; 4) modification of hormones from other species to render them active but non-antigenic in man; 5) the use of immunological methods for assisting in the detection of the time of ovulation: these could aid in the control of fertility and in the treatment of infertility; 6) the development of strains of animals of high immunological competence; 7) characterization of the male antigens responsible for various immunological phenomena in males; 8) characterization of male antigens responsible for inducing circulating antibodies and reducing the fertility of immunized females; 9) the nature and biological significance of the antagglutinins; 10) possible ways of interfering with the transmission of antibodies in man; and 11) the possible occurrence of specific antitrophoblastic antibodies in pre and postpartum. Other research needs are also outlined.
Estimating the rate of mother-to-child transmission of HIV. Report of a workshop on methodological issues, Ghent (Belgium), 17-20 February 1992.
AIDS. 1993 Aug; 7(8):1139-48.A meeting was held in 1992 in Ghent, Belgium, under the auspices of the European Economic Community AIDS Task Force in collaboration with the WHO Global program on AIDS and UNICEF. THe objective were: 1) to address methodological issues in the estimation of the rate of mother-to-child (MTCT) transmission of HIV-1, with special reference to developing countries, and 2) to present a critical evaluation of selected perinatal studies using a standardized methodological approach. The discussions and recommendations made during the workshop are summarized. In the previous 8 years, numerous studies had been conducted to estimate the rate of MTCT of HIV. Many of these had encountered problems in data collection and analysis, making it difficult to compare transmission rates between studies. 14 teams of investigators participated, representing studies from central (5) and eastern Africa (3), Europe (2), Haiti (1), and the US (3). A critical evaluation of the projects was carried out under 4 headings: 1) enrollment and follow-up procedures, 2) diagnostic criteria and case definitions, 3) measurement and comparison of MTCT rats, and 4) determinants of transmission. The different estimations of the rate of HIV MTCT reported ranged from 13-32% in industrialized countries and from 26-48% in developing countries. For the purpose of calculating the rate of HIV MTCT, it is important to establish whether a child who dies before 15 months is HIV-infected. 3 definitions were proposed for children who died before their infection status could be determined by serology. Factors identified as possible risk factors for HIV MTCT included impaired maternal clinical and immunological status, HIV-seroconversion during pregnancy, shortened duration of pregnancy, choriamnionitis, vaginal delivery, prolonged and/or complicated labor, and breast-feeding. Maternal age and parity did not appear to be associated with MTCT in most studies.
MINERVA GINECOLOGICA. 1991 Dec; 43(12):609-10.AIDS continues to pose a grave global problem because it is spreading in the general population by increasing heterosexual transmission and vertical transmission from seropositive mothers to fetuses. A minor rate of transmission has been observed from blood transfusion and blood products. On October 31, 1990 WHO data indicated that a total of 298,914 AIDS cases had been reported. In Africa there were 75,642 cases: 15,569 were in Uganda, 11,732 in Zaire, 9139 in Kenya, 7160 in Malawi, 3647 in the Ivory Coast, 3494 in Zambia, and 3134 in Zimbabwe, with the rest averaging less than 4% of the total African caseload. There were 180,663 cases in the Americas: 149,498 in the US, 11,070 in Brazil, 4941 in Mexico, 4427 in Canada, 2456 in Haiti, 1368 in the Dominican Republic, 870 in Venezuela, 743 in Honduras, 710 in Argentina, 648 in Trinidad an Tobago, 643 in Colombia, 507 in the Bahamas, and 203 in Panama, the rest being less than 200. Asia had only 790 cases: 290 in Japan, 116 in Israel, 48 in India, 45 in Thailand, 37 each in Turkey and the Philippines, 31 in Lebanon, and 27 in Hong Kong. Europe had 39,526 cases: 9718 in France and 6701 in Italy as of June 30, 1990, however, by December 31, 1990 there were 8227 cases reported of whom 4074 had died. There were 6210 in Spain, 5266 in the German Federal Republic, 3798 in England, 1462 in Switzerland, 1443 in the Netherlands, 999 in Romania, 764 in Belgium, 663 in Denmark, 481 in Portugal, 450 in Austria, 443 in Sweden, and 347 in Greece. Little attention has paid to notification in eastern Europe: 40 cases in the USSR, 43 in Poland, 23 in Czechoslovakia, 22 in the German Democratic Republic, 42 in Hungary which is contrasted to 999 cases in Romania. Oceania had 2293 cases: 2040 in Australia, 207 in New Zealand, 16 in French Polynesia, 14 in New Caledonia, 13 in New Guinea, 2 in Tonga, 1 in Fiji, and 1 in the Federated States of Micronesia.
ANTIBIOTICS AND CHEMOTHERAPY. 1991; 43:1-13.Delphi techniques used by the World Health Organization predict more than 6 million cases of AIDS and millions more to be infected with HIV by the year 2000. In the absence of quick solutions to the epidemic, one must prepare to work against and survive it. The modes of HIV transmission are constant and seen widely throughout the world. Transmission may occur through sexual intercourse and the receipt of donated semen; transfusion or surgically-related exposure to blood, blood products, or donated organs; and perinatally from an infected mother to child. There are, however, 3 patterns of transmission. Pattern I transmission is characterized by most cases occurring among homosexual or bisexual males and urban IV-drug users. Pattern II transmission is predominantly through heterosexual intercourse, while pattern III of only few reported cases is observed where HIV was introduced in the early to mid-1980s. Both homosexual and heterosexual transmission have been documented in the latter populations. Significant case underreporting exists in some countries. Investigators are therefore working to find incidence rates of both infection and AIDS cases to better estimate actual present and future needs in the fight against the epidemic. Surveillance data does reveal a rapidly rising and marked number of reported AIDS cases. The cumulative number reported to the World Health Organization increased over 15-fold over the past 4 years to reach 141,894 cases by March 1, 1989. Large, increasing numbers of cases are reported from North and Latin America, Oceania, Western Europe, and areas of central, eastern and southern Africa. 70% of all reported cases were from 42 countries in the Americas. 85% of these are within the United States. Increases in the proportion of IV-drug users who are infected with HIV are noteworthy especially in Western Europe and the U.S. The epidemic in Italy is also specifically discussed.
BULLETIN OF THE INTERNATIONAL UNION AGAINST TUBERCULOSIS AND LUNG DISEASE. 1990 Dec; 65(4):75.WHO estimates of pediatric AIDS cases are 400,000 by September 1990, not including 300,000 who have already died. WHO projects that 10 million or more infants and children will have HIV infections by 2000, in addition to 25-30 million adults. The primary mode of transmission in most countries is heterosexual contact, resulting in a rapidly increasing prevalence in women of childbearing age. WHO predicts that pediatric AIDS will be a major, and in some countries the predominant, cause of death in children in the 1990s. Even though child survival programs have made progress recently, by immunization and diarrhea control, the fruits of these efforts are expected to be reversed. The world's cumulative total of HIV infected women is about 3 million. In the U.S., 20,000 infants have been born to infected mothers. In contrast, in Eastern Europe, about 1000 children are infected, mostly from unscreened blood transfusions and unsterilized needles and syringes. The impact of childhood AIDS is expected to be an increase in child mortality by 50% in many developing countries. Serious social repercussions for children also stem from projected 10 million uninfected children orphaned by AIDS, mostly in sub-Saharan Africa. The only way to lessen this tragedy is for people to protect themselves by practicing safe sex and having sexually transmitted diseases treated.
ANNALS OF TROPICAL PAEDIATRICS. 1989 Mar; 9(1):1-5.A total of 177 children seen at 2 hospitals in Kampala are described who were strongly suspected of having acquired immunodeficiency syndrome (AIDS), either on clinical grounds or because they fulfilled WHO case- definition criteria for diagnosis of pediatric AIDS. Blood was taken from the 177 children and 154 of their mothers and tested for antibody to human immunodeficiency virus (HIV) by an enzyme-linked immunoassay (ELISA). Altogether, 119 (67%) children were seropositive, but only 85 (71%) fulfilled the WHO case-definition criteria, and they were significantly older than the 34 who did not fulfill the criteria. A further 58 children were seronegative but fulfilled the WHO criteria. Of the 119 seropositive children, only 3 had a history of previous blood transfusion, but 103 (98%) of 105 mothers were HIV seropositive: consequently, their children were considered to have been infected in utero or perinatally. 13 (26%) of 49 mothers of seronegative children were seropositive. 80% of HIV-infected children were under 2 years of age at diagnosis and 23% died within 3 months of diagnosis. None of the parents was known to be an intravenous drug user, a prostitute, or bisexual. The difficulty of accurate diagnosis of AIDS presents a major problem in Africa, as the WHO clinical case-definition criteria alone are clearly not adequate. (author's)
JOURNAL OF BIOSOCIAL SCIENCE. 1977; (Suppl 4):113-20.WHO (World Health Organization) is planning to undertake 3 different studies concerning lactation and contraception. These studies will attempt 1) to determine the effects, if any, of steroid contraceptives on lactation; 2) to identify and quantify any forms of steriods which may appear in the breast milk of mothers who use steroid contraceptives; and 3) to identify parameters which would help nursing mothers pinpoint ovulation onset. There is considerable controversy among scientists concerning the affects of steroid contraceptives on lactation. WHO proposes to undertake a prospective study assessing the effect of various typis of combined and progestogen only oral steroids as well as injectable preparation on lactation among matched control groups in a number of countries. An effort will be made to minimize an many extraneous variables as possible and to employ uniform procedures and methods in all the countries. In reference to the 2nd study, there is considerable controversy concerning the possible transfer of steroids to maternal breast milk and about the subsequent effect of these steroids on infants who ingest the milk. The WHO study will seek to determine if steroids or their metabolites are present in the breast milk of nursing mothers who take steroid contraceptives. In reference to the 3rd study, if reliable indicators of ovulation resumption among postpartum women can be identified, efforts will be made to develop test kits for home use by nursing mothers.
In: Raphael, D., ed. Breastfeeding and food policy in a hungry world. New York, Academic Press, 1979. p. 265-268USAID's Office of Nutrition supports research activity in infant weaning foods and breastfeeding at the Human Lactation Center. The project involves health and anthropological fieldwork that analyzes reasons for adverse trends in breastfeeding. Along with the U.S. Department of Agriculture, the Office of Nutrition supports efforts to develop low-cost nutritious food and intermediate technology for young children. A low-cost extrusion cooker for producing precooked childrens' food is being used in Central America, Tanzania, Sri Lanka, and the Philippines. Other research activities by the Office of Nutrition include evaluations of preschool feeding and the identification of time and technology constraints on low-income women. Breastfeeding data is also collected by the Office of Population. A combined "milk pill" and ovulation suppressant is being researched at Johns Hopkins University. The milk pill is designed to counteract the adverse effect of oral contraceptives on quantity of milk and duration of lactation.
In: Raphael, D., ed. Breastfeeding and food policy in a hungry world. New York, Academic Press, 1979. p. 277-285Pregnant Indian women and nursing mothers are often deficient in absorbable iron, folic acid, vitamin A, vitamin C, and calcium. These nutrients combined in an oil base with a protein fortificant could be marketed as a medicine. Project Poshak and the Kasa project are two maternal-child-health nutrition programs in which breastfeeding, solid food weaning and preschool child care were emphasized. Nontribal Hindu women have many dietary strictures during pregnancy which contribute to anemia and protein vitamin deficiency. Poshnak project influenced other projects, including national feeding programs, special nutrition programs, and take-home food and child care services. Traditional child rearing practises have outlasted modern agricultural production. The delayed introduction of supplements to the breastfeeding child and female child neglect continue despite availability of nutritional food.n unexpected result of both projects was that acceptance of birth control and family planning greatly increased.
Acta Paediatrica Scandinavica. 1978 September; 67(5):553-582.6 research articles plus an introduction constitute this review of present knowledge of lactation and its effects. The superiority of human milk as compared with milk of other origin for feeding newborns, term or preterm, was analyzed in terms of biological development related to digestive, metabolic, and excretory functions during fetal and postnatal life in the 1st article. WHO, concerned with the declining breast feeding rate in developing countries, has organized investigations in 9 different countries of different aspects of breast feeding and breast milk with the aim of formulating programs of intervention. Basic epidemiological data on 24,000 mother/child pairs have just been reported in a preliminary manner, emphasizing socioeconomic differences. The 3rd study investigated the nitrogen and protein components of human milk; the true protein content of human milk is .9% in both well-nourished and malnourished mothers. The next study reviewed lipid and trace element composition of human milk in relation to ethnic variables. Contaminants in human milk are characterized in the next review, with DDT and PCBs the most outstanding. The final article emphasizes new knowledge in human milk immunoglobulin, the most predominant of which is secretory IgA.