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Your search found 24 Results

  1. 1
    393677
    Peer Reviewed

    I beg you...breastfeed the baby, things changed: infant feeding experiences among Ugandan mothers living with HIV in the context of evolving guidelines to prevent postnatal transmission.

    Dunkley E; Ashaba S; Burns B; O'Neil K; Sanyu N; Akatukwasa C; Kastner J; Berry NS; Psaros C; Matthews LT; Kaida A

    BMC Public Health. 2018 Jan 29; 18(1):188.

    BACKGROUND: For women living with HIV (WLWH) in low- and middle-income countries, World Health Organization (WHO) infant feeding guidelines now recommend exclusive breastfeeding until six months followed by mixed feeding until 24 months, alongside lifelong maternal antiretroviral therapy (ART). These recommendations represent the sixth major revision to WHO infant feeding guidelines since 1992. We explored how WLWH in rural Uganda make infant feeding decisions in light of evolving recommendations. METHODS: We conducted semi-structured interviews with 20 postpartum Ugandan WLWH accessing ART, who reported pregnancy < 2 years prior to recruitment. Interviews were conducted between February-August 2014 with babies born between March 2012-October 2013, over which time, the regional HIV treatment clinic recommended lifelong ART for all pregnant and breastfeeding women (Option B+). Content analysis was used to identify major themes. Infant feeding experiences was an emergent theme. NVivo 10 software was used to organize analyses. RESULTS: Among 20 women, median age was 33 years [IQR: 28-35], number of livebirths was 3 [IQR: 2-5], years on ART was 2.3 [IQR: 1.5-5.1], and 95% were virally suppressed. Data revealed that women valued opportunities to reduce postnatal transmission. However, women made infant feeding choices that differed from recommendations due to: (1) perception of conflicting recommendations regarding infant feeding; (2) fear of prolonged infant HIV exposure through breastfeeding; and (3) social and structural constraints shaping infant feeding decision-making. CONCLUSIONS: WLWH face layered challenges navigating evolving infant feeding recommendations. Further research is needed to examine guidance and decision-making on infant feeding choices to improve postpartum experiences and outcomes. Improved communication about changes to recommendations is needed for WLWH, their partners, community members, and healthcare providers.
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  2. 2
    340407

    Guideline: Updates on HIV and infant feeding. The duration of breastfeeding and support from health services to improve feeding practices among mothers living with HIV.

    World Health Organization [WHO]; UNICEF

    Geneva, Switzerland, WHO, 2016. [68] p.

    The objective of this guideline is to improve the HIV-free survival of HIV-exposed infants by providing guidance on appropriate infant feeding practices and use of ARV drugs for mothers living with HIV and by updating WHO-related tools and training materials. The guideline is intended mainly for countries with high HIV prevalence and settings in which diarrhoea, pneumonia and undernutrition are common causes of infant and child mortality. However, it may also be relevant to settings with a low prevalence of HIV depending on the background rates and causes of infant and child mortality. This guideline aims to help Member States and their partners in their efforts to make informed decisions on the appropriate nutrition actions to achieve the Sustainable Development Goals, the global targets set in the comprehensive implementation plan on maternal, infant and young child nutrition, the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030) and the Global Health Sector Strategy on Sexually Transmitted Infections 2016-2021. The target audience for this guideline includes: (1) national policy-makers in health ministries; (2) programme managers working in child health, essential drugs and health worker training; (3) health-care providers, researchers and clinicians providing services to pregnant women and mothers living with HIV at various levels of health care; and (4) development partners providing financial and/or technical support for child health programmes, including those in conflict and emergency settings. (Excerpt)
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  3. 3
    382783
    Peer Reviewed

    Individualizing the WHO HIV and infant feeding guidelines: optimal breastfeeding duration to maximize infant HIV-free survival.

    Ciaranello AL; Leroy V; Rusibamayila A; Freedberg KA; Shapiro R; Engelsmann B; Lockman S; Kelly KA; Dabis F; Walensky RP

    AIDS. 2014 Jul; 28 Suppl 3:S287-99.

    OBJECTIVES: To determine how infant feeding recommendations can maximize HIV-free survival (HFS) among HIV-exposed, uninfected African infants, balancing risks of breast milk-associated HIV infection with setting-specific risks of illness and death associated with replacement feeding. DESIGN: Validated mathematical model of HIV-exposed, uninfected infants, with published data from Africa. METHODS: We projected 24-month HFS using combinations of: maternal CD4, antiretroviral drug availability, and relative risk of mortality among replacement-fed compared to breastfed infants ('RR-RF', range 1.0-6.0). For each combination, we identified the 'optimal' breastfeeding duration (0-24 months) maximizing HFS. We compared HFS under an 'individualized' approach, based on the above parameters, to the WHO 'public health approach' (12 months breastfeeding for all HIV-infected women). RESULTS: Projected HFS was 65-93%. When the value of RR-RF is 1.0, replacement feeding from birth maximized HFS. At a commonly reported RR-RF value (2.0), optimal breastfeeding duration was 3-12 months, depending on maternal CD4 and antiretroviral drug availability. As the value of RR-RF increased, optimal breastfeeding duration increased. Compared to the public health approach, an individualized approach improved absolute HFS by less than 1% if RR-RF value was 2.0-4.0, by 3% if RR-RF value was 1.0 or 6.0, and by greater amounts if access to antiretroviral drugs was limited. CONCLUSION: Tailoring breastfeeding duration to maternal CD4, antiretroviral drug availability, and local replacement feeding safety can optimize HFS among HIV-exposed infants. An individualized approach leads to moderate gains in HFS, but only when mortality risks from replacement feeding are very low or very high, or antiretroviral drug availability is limited. The WHO public health approach is beneficial in most resource-limited settings.
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  4. 4
    362421
    Peer Reviewed

    Time for new recommendations on cotrimoxazole prophylaxis for HIV-exposed infants in developing countries?

    Coutsoudis A; Coovadia HM; Kindra G

    Bulletin of the World Health Organization. 2010 Dec 1; 88(12):949-50.

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  5. 5
    361855
    Peer Reviewed

    How evidence based are public health policies for prevention of mother to child transmission of HIV?

    Van de Perre P; Tylleskar T; Delfraissy JF; Nagot N

    BMJ. 2013; 346:f3763.

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  6. 6
    313929
    Peer Reviewed

    Evidence behind the WHO guidelines: Hospital care for children: What are the risks of HIV transmission through breastfeeding?

    Bulteel N; Henderson P

    Journal of Tropical Pediatrics. 2007 Oct; 53(5):298-302.

    The World Health Organization (WHO) has produced guidelines for the management of common illnesses in hospitals with limited resources. This series reviews the scientific evidence behind WHO's recommendations. This review addresses the question: What are the risks of HIV transmission through breastfeeding? The WHO Pocketbook of Hospital Care for Children estimates the additional risk of mother-to-child transmission (MTCT) of HIV through breastfeeding without interventions to be 5-20%. This risk varies depending on duration and method of breastfeeding, and also because of differences in population characteristics, such as maternal and CD4+ cell counts and RNA viral load. (excerpt)
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  7. 7
    303018

    HIV and infant feeding. A policy statement developed collaboratively by UNAIDS, UNICEF and WHO.

    Joint United Nations Programme on HIV / AIDS [UNAIDS]; UNICEF; World Health Organization [WHO]

    [Geneva, Switzerland], UNAIDS, [2005]. [5] p.

    The number of infants born with HIV infection is growing every day. The AIDS pandemic represents a tragic setback in the progress made on child welfare and survival. Given the vital importance of breast milk and breast-feeding for child health, the increasing prevalence of HIV infection around the world, and the evidence of a risk of HIV transmission through breast-feeding, it is now crucial that policies be developed on HIV infection and infant feeding. The following statement provides policy-makers with a number of key elements for the formulation of such policies. (excerpt)
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  8. 8
    303283

    WHO - UNAIDS - UNICEF Technical Consultation on HIV and Infant Feeding: Implementation of Guidelines. Report of a meeting -- Geneva, 20-22 April 1998.

    World Health Organization [WHO]; Joint United Nations Programme on HIV / AIDS [UNAIDS]; UNICEF

    Geneva, Switzerland, UNAIDS, 1998. [38] p.

    The Guidelines and Guide recognise that: HIV infection can be transmitted through breastfeeding. Appropriate alternatives to breastfeeding should be available and affordable in adequate amounts for women whom testing has shown to be HIV-positive. Breastfeeding is the ideal way to feed the majority of infants. Efforts to protect, promote and support breastfeeding by women who are HIV-negative or of unknown HIV status need to be strengthened; HIV-positive mothers should be enabled to make fully informed decisions about the best way to feed their infants in their particular circumstances. Whatever they decide, they should receive educational, psychosocial and material support to carry out their decision as safely as possible, including access to adequate alternatives to breastfeeding if they so choose; To make fully informed decisions about infant feeding, as well as about other aspects of HIV, mother-to-child transmission (MTCT) and reproductive life, women need to know and accept their HIV status. There is thus an urgent need to increase access to voluntary and confidential counselling and HIV testing (VCT), and to promote its use by women and when possible their partners, before making alternatives to breastfeeding available; An essential priority is primary prevention of HIV infection. Education for all adults of reproductive age, particularly for pregnant and lactating women and their sexual partners, and for young people, needs to be strengthened; Women who are HIV positive need to understand the particular importance of avoiding infection during pregnancy and lactation. (excerpt)
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  9. 9
    282155

    Evaluation of United Nations-supported pilot projects for the prevention of mother-to-child transmission of HIV. Overview of findings.

    Rutenberg N; Baek C; Kalibala S; Rosen J

    New York, New York, UNICEF, 2003. 47 p. (HIV / AIDS Working Paper)

    This overview report presents key findings from an evaluation of UN- supported pilot PMTCT projects in eleven countries, including: Botswana, Burundi, Cote d'Ivoire, Honduras, India, Kenya, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe. Key findings discuss: feasibility and coverage; factors contributing to programme coverage; programme challenges; scaling-up; the special case of low prevalence countries; and recommendations. Recommendations include: To increase coverage and improve infant feeding counseling: supplement clinic staff with lay counselors; introduce rapid HIV tests so women can receive same day counseling, HIV testing, and test results; improve the quality of HIV and infant feeding counseling by providing job aids and active supervision; offer support to PMTCT providers including material support and peer psychosocial support; partner with community groups to offer community education and outreach; and expand the vision of PMTCT to encompass an active role for fathers and male partners. To strengthen postnatal support and follow up of HIV- infected women and their infant to assist them with infant feeding, getting care for themselves and their families, and to evaluate the program: establish national infant feeding guidelines; establish postnatal follow-up protocols; forge partnerships between the PMTCT program and NGO care and support groups; Enhance referral links between PMTCT programs and HIV care; New measurement tools and systems should be developed. To scale up PMTCT programs the findings suggest: expand to new sites but enlarge the scope of activities within existing sites to reach more women; and provide a comprehensive package of HIV prevention and care. The pilot experience has shown that introducing PMTCT programs into antenatal care in a wide variety of settings is feasible and acceptable to a significant proportion of antenatal care clients who have a demand for HIV information, counseling, and testing. As they go to scale, PMTCT programs have much to learn from the pilot phase, during which they successfully reached hundreds of thousands of clients. (author's)
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  10. 10
    192349

    Strategic approaches to the prevention of HIV infection in infants. Report of a WHO meeting. Morges, Switzerland, 20-22 March 2002.

    World Health Organization [WHO]. Department of HIV / AIDS

    Geneva, Switzerland, WHO, Department of HIV / AIDS, 2003. 22 p.

    To further guide its contribution to global efforts to reach the UNGASS goal, WHO organized a meeting from 20 to 22 March 2002 with the following specific objectives: to review the likely contribution of current strategic approaches to preventing HIV infection in infants and young children in different epidemiological situations and settings for service delivery; to provide guidance to WHO on priority areas of work for preventing HIV infection in infants within the frame of its mandate, strategic directions and core functions. Annexes 1 and 2 outline the meeting agenda and list of participants. The first day, participants reviewed programme experiences related to preventing HIV infection in infants and young children and discussed how the strategy of the United Nations agencies in this area could be refined and strengthened. Some historical background on the development and implementation of intervention to prevent the mother-to-child transmission of HIV was briefly reviewed. Through plenary presentations, group work and plenary discussions, the elements of a comprehensive strategic approach were defined. During the second day of the meeting, participants focused their attention on the specific role of WHO in global efforts to achieve the UNGASS goal. (excerpt)
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  11. 11
    279053

    Brief guide on tuberculosis control for primary health care providers for countries in the WHO European Region with a high and intermediate burden of tuberculosis.

    Ahamed N; Yurasova Y; Zaleskis R; Grzemska M; Reichman LB

    Copenhagen, Denmark, World Health Organization [WHO], Regional Office for Europe, 2004. [71] p.

    Tuberculosis is an increasingly serious problem in the WHO European region, particularly in the countries of eastern Europe, the Baltic States, and the Commonwealth of Independent States (CIS). Primary health care providers can play an important role in tuberculosis control through early detection of the disease, referral for treatment, and involvement in directly observed treatment. This guide has been written with the aim of developing the knowledge, awareness and skills of primary health care providers regarding tuberculosis and its prevention and control. The guide is not intended as a complete source of information on tuberculosis, but rather a summary of general principles regarding prevention, detection and treatment. The guide does not reflect specific national guidelines on TB control, and is intended to be used in conjunction with the appropriate national regulations. A reference card containing key information is included with this guide. (author's)
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  12. 12
    195128

    Breastfeeding: foundation for a healthy future.

    UNICEF

    New York, New York, UNICEF, 1999 Aug. [15] 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)
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  13. 13
    274800

    Hepatitis B and breastfeeding.

    World Health Organization [WHO]. Global Programme for Vaccines and Immunization; World Health Organization [WHO]. Division of Child Health and Development; World Health Organization [WHO]. Division of Reproductive Health (Technical Support)

    Geneva, Switzerland, WHO, Division of Child Health and Development, 1996 Nov. [4] p. (Update No. 22)

    The question of whether breastfeeding plays a significant role in the transmission of hepatitis B has been asked for many years. It is important given the critical role of breastfeeding and the fact that about 5% of mothers worldwide are chronic hepatitis B virus (HBV) carriers. Examination of relevant studies indicates that there is no evidence that breastfeeding poses any additional risk to infants of HBV carrier mothers. The use of hepatitis B vaccine in infant immunization programmes, recommended by WHO and now implemented in 80 countries, is a further development that will eventually eliminate risk of transmission. This document discusses the issues relevant to breastfeeding and HBV transmission, and provides guidance from a WHO perspective. (excerpt)
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  14. 14
    273362

    Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants: guidelines on care, treatment and support for women living with HIV / AIDS and their children in resource-constrained settings.

    World Health Organization [WHO]

    Geneva, Switzerland, WHO, 2004. v, 49 p.

    Mother-to-child transmission (MTCT) is the most important source of HIV infection in children. In 2001, the United Nations General Assembly Special Session on HIV/AIDS committed countries to reduce the proportion of infants infected with HIV by 20% by 2005 and by 50% by 2010. Achieving this urgently requires an increase in access to integrated and comprehensive programmes to prevent HIV infection in infants and young children. Such programmes consist of interventions focusing on primary prevention of HIV infection among women and their partners; prevention of unintended pregnancies among HIV-infected women; prevention of HIV transmission from HIV-infected women to their children; and the provision of treatment, care and support for women living with HIV/AIDS, their children and families. WHO convened a Technical Consultation on Antiretroviral Drugs and the Prevention of Mother-to-child Transmission of HIV Infection in Resource-limited Settings in Geneva, Switzerland on 5–6 February 2004. Scientists, policymakers, programme managers and community representatives reviewed the most recent experience with programmes and evidence on the safety and efficacy of various antiretroviral (ARV) regimens for preventing HIV infection in infants. This information was reviewed in the context of the rapid expansion of ARV treatment in resource-constrained settings using standardized and simplified drug regimens. Prior to the Technical Consultation, a draft set of recommendations had been issued for public comment. (excerpt)
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  15. 15
    191978

    Global strategy for infant and young child feeding.

    World Health Organization [WHO]; UNICEF

    Geneva, Switzerland, WHO, 2003. vi, 30 p.

    The Executive Board of the World Health Organization, at its 101st session in January 1998, called for a revitalization of the global commitment to appropriate infant and young child nutrition, and in particular breastfeeding and complementary feeding. Subsequently, in close collaboration with the United Nations Children’s Fund, WHO organized a consultation (Geneva, 13–17 March 2000) to assess infant and young child feeding practices, review key interventions, and formulate a comprehensive strategy for the next decade. Following discussions at the Fifty-third World Health Assembly in May 2000 and the 107th session of the Executive Board in January 2001 of the outline and critical issues of the global strategy, the Fifty-fourth World Health Assembly (May 2001) reviewed progress and requested the Director-General to submit the strategy to the Executive Board at its 109th session and to the Fifty-fifth World Health Assembly, respectively in January and May 2002. During their discussion of the draft of the global strategy, members of the Executive Board commended the setting in motion of the consultative, science-based process that had led to its formulation as a guide for developing country-specific approaches to improving feeding practices. They also welcomed the strategy’s integrated and comprehensive approach. Several members made suggestions with regard to the exact wording of the draft strategy. These suggestions were taken carefully into account in preparing the strategy, as were comments from Member States following the Board’s 109th session and observations of other interested parties, including professional associations, nongovernmental organizations and the processed-food industry. Stressing the validity of a well-structured draft, the Executive Board recommended that the Health Assembly endorse the global strategy and that Member States implement it, as appropriate to national circumstances, in order to promote optimal feeding for all infants and young children. (excerpt)
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  16. 16
    191128
    Peer Reviewed

    Are WHO/UNAIDS/UNICEF-recommended replacement milks for infants of HIV-infected mothers appropriate in the South African context?

    Papathakis PC; Rollins NC

    Bulletin of the World Health Organization. 2004 Mar; 82(3):164-171.

    Little is known about the nutritional adequacy and feasibility of breastmilk replacement options recommended by WHO/ UNAIDS/UNICEF. The study aim was to explore suitability of the 2001 feeding recommendations for infants of HIV-infected mothers for a rural region in KwaZulu Natal, South Africa specifically with respect to adequacy of micronutrients and essential fatty acids, cost, and preparation times of replacement milks. Nutritional adequacy, cost, and preparation time of home-prepared replacement milks containing powdered full cream milk (PM) and fresh full cream milk (FM) and different micronutrient supplements (2 g UNICEF micronutrient sachet, government supplement routinely available in district public health clinics, and best available liquid paediatric supplement found in local pharmacies) were compared. Costs of locally available ingredients for replacement milk were used to calculate monthly costs for infants aged one, three, and six months. Total monthly costs of ingredients of commercial and home-prepared replacement milks were compared with each other and the average monthly income of domestic or shop workers. Time needed to prepare one feed of replacement milk was simulated. When mixed with water, sugar, and each micronutrient supplement, PM and FM provided <50% of estimated required amounts for vitamins E and C, folic acid, iodine, and selenium and <75% for zinc and pantothenic acid. PM and FM made with UNICEF micronutrient sachets provided 30% adequate intake for niacin. FM prepared with any micronutrient supplement provided no more than 32% vitamin D. All PMs provided more than adequate amounts of vitamin D. Compared with the commercial formula, PM and FM provided 8–60% of vitamins A, E, and C, folic acid, manganese, zinc, and iodine. Preparations of PM and FM provided 11% minimum recommended linoleic acid and 67% minimum recommended a-linolenic acid per 450 ml mixture. It took 21–25 minutes to optimally prepare 120 ml of replacement feed from PM or commercial infant formula and 30–35 minutes for the fresh milk preparation. PM or FM cost approximately 20% of monthly income averaged over the first six months of life; commercial formula cost approximately 32%. No home-prepared replacement milks in South Africa meet all estimated micronutrient and essential fatty acid requirements of infants aged <6 months. Commercial infant formula is the only replacement milk that meets all nutritional needs. Revisions of WHO/UNAIDS/UNICEF HIV and infant feeding course replacement milk options are needed. If replacement milks are to provide total nutrition, preparations should include vegetable oils, such as soybean oil, as a source of linoleic and a-linolenic acids, and additional vitamins and minerals. (author's)
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  17. 17
    184713

    HIV and infant feeding. A UNICEF fact sheet.

    UNICEF. HIV / AIDS Unit

    New York, New York, UNICEF, 2002. [2] p. (UNICEF Fact Sheet)

    Approximately one third of infants born to HIV-infected mothers will contract the virus. Without preventive interventions, transmission of the virus occurs during a mother’s pregnancy or during childbirth or breastfeeding. Without interventions, about 15 to 30 per cent of children become infected during pregnancy or delivery; about 10 to 20 per cent contract the virus through breastmilk if breastfed for two years. An estimated 800,000 children under the age of 15 contracted HIV in 2001, about 90 per cent of them through mother-to-child transmission (MTCT). The risks of HIV infection have to be compared with the risks of illness and death faced by infants who are not breastfed. Breastfeeding provides protection from death due to diarrhoea and respiratory and other infections, particularly in the first months of life. During the first two months, a child receiving replacement feeding is nearly six times more likely to die from these infectious diseases, compared to a breastfed child. Breastfeeding also provides complete nutrition, immune factors and the stimulation necessary for good development, and it contributes to birth spacing. (excerpt)
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  18. 18
    184709

    Mother-to-child transmission of HIV. A UNICEF fact sheet.

    UNICEF. HIV / AIDS Unit

    New York, New York, UNICEF, 2002. [2] p. (UNICEF Fact Sheet)

    Without preventive interventions, approximately 35 per cent of infants born to HIV-positive mothers contract the virus through mother-to-child transmission. In 2001, 800,000 children under the age of 15 contracted HIV, over 90 per cent of them through mother-to-child transmission. Infants can become infected during pregnancy, childbirth or breastfeeding. Some 15-20 per cent of infant infections occur in pregnancy, 50 per cent occur during labour and delivery, while breastfeeding accounts for a further 33 per cent of infant infections. Sub-Saharan Africa is home to 90 per cent of the world’s HIV infected children. Most of the 580,000 children under the age of 15 who died of HIV/AIDS in 2001 were African. For mothers living with HIV/AIDS, especially in developing countries, the decision on whether or not to breastfeed is a frightening dilemma. Infants not infected during pregnancy and childbirth, whose mothers are HIV positive, face a 10-15 per cent chance of acquiring HIV through breastfeeding, depending on how long they are breastfed. The use of breastmilk substitutes reduces this risk, but can expose them to other dangerous health risks, including diarrhoea. Many mothers in developing countries cannot afford breastmilk substitutes and lack access to clean water, which is essential for their safe preparation and use. A mother living with HIV/AIDS therefore faces many grave difficulties: worries about her own health and survival; the risk of infecting her baby through breastmilk; and the danger that her baby will develop other health problems if she does not breastfeed. (excerpt)
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  19. 19
    182682
    Peer Reviewed

    HIV-positive mothers in Uganda resort to breastfeeding.

    Wendo C

    Lancet. 2003 Aug 16; 362(9383):542.

    An increasing number of mothers with HIV in Uganda are breastfeeding their babies after UNICEF stopped donating free infant formula. Doctors implementing the prevention of mother-to-child HIV transmission (PMTCT) project said on Aug 7 that most of the women could not afford infant formula. “They have a choice of whether to breastfeed or buy infant formula”, said Saul Onyango, national PMTCT coordinator. (excerpt)
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  20. 20
    165360

    Early breastfeeding cessation as an option for reducing postnatal transmission of HIV in Africa: issues, risks, and challenges.

    Piwoz EG; Huffman SL; Lusk D; Zehner ER; O'Gara C

    Washington, D.C., Academy for Educational Development [AED], 2001 Aug. 40 p.

    This document examines the recent WHO recommendations for modifying breastfeeding to reduce postnatal transmission of HIV in Africa. Specifically, it reviews the three-stage strategy for "modified breastfeeding" for HIV- positive mothers that involves exclusive breastfeeding followed by an early transition to exclusive replacement feeding. Organized into six chapters, this document also describes a step-by-step process for making the transition from exclusive breastfeeding to exclusive replacement feeding. However, many of the behaviors discussed in this review represent a major change in traditional infant care practices in Africa, and their feasibility and impact on child survival have yet to be determined. It is recommended, therefore, that these guidelines be subjected to additional research and testing before being implemented.
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  21. 21
    159518

    HIV and infant feeding.

    Progress in Reproductive Health Research. 2000; (55):8.

    Evidence has grown that HIV can be transmitted through breast milk. Based on WHO and UNAIDS estimates, a child has 20% risk of infection when breast-fed by an HIV-positive mother. In this respect, UNAIDS, WHO, and UNICEF issued a joint policy statement on HIV and infant feeding, which states that breast-feeding should be upheld irrespective of HIV infection rates. The three agencies issued guidelines on HIV and infant feeding in 1998, calling for promotion of breast-feeding among mothers who are HIV-negative or of unknown HIV status. In October 2000, a WHO Technical Consultation was organized by the Programme on behalf of the UNAIDS/UNICEF/UNFPA/WHO Interagency Task Team on the Prevention of Mother-to-Child Transmission of HIV, concluding that 1998 guidelines should remain valid. For HIV-positive women who choose to breast-feed, exclusive breast-feeding is recommended for the first months of life and should be discontinued when an alternative form of feeding becomes feasible. The consultation also concluded that the benefit of decreasing mother-to-child HIV transmission with antiretroviral drug regimens greatly outweighs concerns related to development of drug resistance.
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  22. 22
    158211

    A changing emphasis for feeding choices for HIV seropositive mothers in East, Central and Southern Africa.

    Pillay K

    SOCIETES D'AFRIQUE ET SIDA. 1997 Jul-Oct; (17-18):12-4.

    Since the first descriptions that HIV-1 can be transmitted from mother to infant by breast-feeding, infant feeding practices in HIV-1 seropositive mothers had to be re-evaluated. In developed countries, public health policies recommend artificial feeding. A workshop sponsored by the South African Department of Health and the World Bank in collaboration with the Department of Pediatrics & Child Health, University of Natal and the Commonwealth Regional Health Community Secretariat for East, Central and Southern Africa was held in Durban, South Africa (May 20-21, 1996) to address the question on breast-feeding infants with seropositive mothers. The presentations of the program included the epidemiology of mother to infant transmission of HIV with special emphasis on breast-feeding, the biological aspects of HIV transmission through breastmilk, a review of international studies on breast-feeding and mother to infant transmission of HIV and an exploration of the potential impact of breast-feeding on interventions against mother to child transmission of HIV by antiretrovirals. Thus, a shift in emphasis on the question of feeding choices for HIV seropositive women in developing and intermediate income countries has occurred. However, this statement has yet to be converted into policy.
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  23. 23
    158181

    Breastfeeding and complementary feeding. Summary.

    United Nations. Administrative Committee on Coordination. Sub-Committee on Nutrition. Working Group on Breastfeeding and Complementary Feeding

    SCN NEWS. 1999 Jul; (18):7.

    Eight issues were discussed by this Working group and recommendations included in the following. All implementing agencies should adopt a rights-based approach to all of their infant feeding programs; and an intersectoral rights-based approach to child survival growth and development should be adopted by all implementing bodies. Regarding maternity legislation, it was requested that the Sub-Committee on Nutrition (SCN) Secretariat use its good offices to approach the new Director General of International Labor Organization and express concern over the process towards the re-negotiation of the Maternity Protection Convention. The Benefits of Breastfeeding Model (BOB) for assessing the economic value of breastfeeding should be used more widely to advocate for the introduction and strengthening of breastfeeding policies and programs. The Breastfeeding Counseling training course and its complementary feeding component needs to be more widely implemented, particularly in countries affected by the HIV epidemic to counter the tendency to abandon breastfeeding protection, promotion and support. In the context of mother-to-child transmission (MTCT) of HIV, global implementation of the International Code of Marketing of Breastmilk Substitutes and subsequent relevant World Health Assembly resolutions needs to be accelerated and strengthened. UN Children's Fund should prepare a briefing note explaining the continued relevance of the Code in the context of prevention of MTCT of HIV, explaining particularly the provisions concerning free and low cost supplies. It was recommended that additional research is needed on the relative safety of exclusive breastfeeding, on the effects of the alternative feeding options proposed in connection with MTCT of HIV on children's health and family well-being, and specifically on how mothers cope in practice using various feeding options. In all preventive MTCT initiatives, infant feeding practices and their effects on children's health need to be more closely monitored. (full text)
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  24. 24
    152772

    The development and evaluation of an intervention to inform and counsel Zimbabwean women about HIV transmission through breastfeeding. A study by the ZVITAMBO Project, Johns Hopkins University School of Hygiene and Public Health, the Support for Analysis and Research in Africa (SARA) Project and the LINKAGES Project at the Academy for Educational Development.

    Academy for Educational Development [AED]. Breastfeeding, LAM, Complementary Feeding, and Maternal Nutrition Program [LINKAGES]

    Washington, D.C., AED, LINKAGES, [2000]. [2] p.

    In 1998, the policy recommendations of UN organizations regarding breast-feeding shifted, following reports of evidence that HIV can be transmitted from infected mothers to their babies during breast-feeding. From a recommendation in the early 1990s that all babies in developing countries should be breast-fed, the UN recommends that HIV-positive women be fully informed about various feeding options and supported in their individual decisions about how to feed their babies. With a view of this recommendation, the Zimbabwe Vitamin A for Mothers and Babies Project (ZVITAMBO) was developed. This Project is a large clinical trial being conducted in Harare to assess the impact of a large dose of vitamin A provided to mothers and/or newborn babies on infant mortality, new HIV infections among postnatal women, and HIV transmission through breast-feeding. It also explores ways to fully inform pregnant and early postnatal women about the risks and benefit of breast-feeding, mixed feeding, and replacement feeding for infant health and mother-to-child transmission of HIV. Results from the qualitative and quantitative studies conducted by ZVITAMBO will provide guidance to the government of Zimbabwe and other agencies about how best to counsel women about infant feeding in the context of high HIV prevalence.
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