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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
    336019
    Peer Reviewed

    Barriers to implementing WHO's exclusive breastfeeding policy for women living with HIV in sub-Saharan Africa: an exploration of ideas, interests and institutions.

    Eamer GG; Randall GE

    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.
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  5. 5
    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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  6. 6
    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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  7. 7
    287078

    Guidelines on infant feeding and HIV.

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

    MCH News. 1998 Jul; (9):5, 9.

    This statement was released in Geneva on 1 May 1998: In a concerted effort to stop the mother-to-child transmission of HIV, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and its co-sponsors the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) have developed a comprehensive set of guidelines that support the use of alternatives to breastfeeding for infants born to women infected with HIV, the virus that causes AIDS. The guidelines are intended to help governments devise national policies to reduce the risk of HIV transmission through breastfeeding and to assist health care managers in providing services and support to this end. The guidelines stress the importance of protecting, promoting and supporting breastfeeding as the best method of feeding for infants whose mothers are HIV-negative or who do not know their HIV status. But at the same time, they recognize the need to support alternatives to breastfeeding for mothers who test positive for the human immunodeficiency virus. (excerpt)
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  8. 8
    283078
    Peer Reviewed

    [New guidelines for preventing mother-to-child transmission of the human immunodeficiency virus] Nuevas orientaciones para prevenir la transmisión maternofilial del virus de la inmunodeficiencia humana.

    World Health Organization [WHO]

    Revista Panamericana de Salud Pública / Pan American Journal of Public Health. 2004; 16(4):289-294.

    During a meeting in Geneva, Switzerland, on 5 and 6 February 2004, a working group of experts from the World Health Organization (WHO) and other scientists, health officials, and community representatives from throughout the world revised the guidelines developed by WHO in 2000 on the use of antiretroviral agents. Special attention was paid to the role of such agents in the prevention of HIV transmission from mother to infant during pregnancy, labor, and breast-feeding. This paper summarizes the newly developed guidelines, which contain specific recommendations for low-resource settings. It is hoped that the information provided will help curb HIV transmission from mother to child in developing countries, where it accounts for the majority of cases of HIV infection in childhood. (author's)
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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
    192151

    Saving mothers, saving families: the MTCT-Plus Initiative. Case study.

    Rabkin M; El-Sadr WM

    Geneva, Switzerland, World Health Organization [WHO], 2003. 13 p. (Perspectives and Practice in Antiretroviral Treatment)

    The primary objective of the MTCT-Plus Initiative is to provide lifelong care and treatment for HIV/AIDS to families in resource-limited settings. In addition to reducing mortality and morbidity, the Initiative hopes to further reduce the mother-to-child-transmission of HIV; to promote voluntary counselling and testing and other preventive strategies; to strengthen local health care capacity; to decrease stigma among, enhance support for and empower people living with HIV/AIDS; and to develop a model for HIV care in resource-limited settings that can be generalized. An international review committee selected the initial sites after a request for applications was widely distributed in early 2002. Of the 47 eligible applicants – all of whom had ongoing programmes to prevent the mother-to-child-transmission of HIV, HIV prevalence of at least 5% and the ability to enroll at least 250 people per year – the committee selected 12 demonstration sites. An additional 13 sites were given planning grants. (excerpt)
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  11. 11
    279877

    Prevention of mother-to-child transmission of HIV infection generic training package.

    World Health Organization [WHO]

    Geneva, Switzerland, WHO, 2004. 2 p.

    Of the 40 million people living with HIV/AIDS worldwide at the end of 2003, 2.5 million are children under 15 years of age. In 2003 alone, 700,000 children were newly infected with HIV. Most of these infections result from mother-to-child transmission during pregnancy, labour and delivery or through breastfeeding. By integrating a comprehensive prevention of mother-to-child transmission (PMTCT) programme, through prevention and treatment interventions, as an essential part of maternal, child and newborn health programmes, the PMTCT programme can significantly reduce the number of HIV-infected infants and promote better health for children, mothers and their families. Human capacity building at all levels of the health system is one of the big challenges of setting up HIV/AIDS initiative. The rapidly growing HIV/AIDS pandemic requires global and in-country collaborative efforts to maximise the use of existing human resources and develop strengthened human capacity. Globally, up to 100,000 people need to be trained for the "3 by 5" initiative to reach the target. Meeting that training goal will require strong collaboration among communities, nations, and international organisations. This generic PMTCT training package is designed to provide a template for the development of a national training plan and an appropriate national PMTCT curriculum, based on a rapid adaptation process. For countries that already have begun PMTCT training and have draft materials, this generic training package can be used to update and strengthen the national curriculum and training plan. This training package is an evidence-based course on PMTCT and is targeted to resource-constrained settings. (excerpt)
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  12. 12
    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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  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
    274439

    Family planning and the prevention of mother-to-child transmission of HIV: a review of the literature.

    Best K

    Research Triangle Park, North Carolina, Family Health International [FHI], 2004 Apr. [58] p. (Working Paper Series No. WP04-01)

    This review summarizes the literature on integrating family planning services with other services to prevent HIV-positive births. In particular, it addresses efforts to prevent initial or later pregnancy among HIV-infected women, focusing on: 1) HIV-infected nonpregnant women likely accessing either family planning or VCT services and 2) HIV-infected pregnant women accessing ANC services, the usual site for PMTCT interventions. The review also addresses opportunities and efforts to prevent HIV-positive births by preventing infection among: 1) uninfected nonpregnant women who likely access family planning or VCT services and 2) uninfected pregnant women accessing ANC services. The organizational structure and scope of this review involves the intersection of two key variables: a woman’s HIV status and her pregnancy status. The discussion that follows will describe opportunities for PMTCT interventions involving family planning services in these contexts. (excerpt)
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  15. 15
    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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  16. 16
    189411
    Peer Reviewed

    Nevirapine to prevent mother-to-child transmission of HIV-1 among women of unknown serostatus.

    Stringer JS; Rouse DJ; Sinkala M; Marseille EA; Vermund SH

    Lancet. 2003 Nov 29; 362(9398):1850-1853.

    Each year, about 2 million babies are born to HIV-1- infected women. Despite widespread knowledge of proven methods to prevent mother-to-child transmission (MTCT) of the virus, most infants at risk of contracting the infection from their mothers receive no prophylactic intervention. This inaction leads to the infection and ultimate death of about 800 000 children per year. It has been known since 1994 that MTCT is largely preventable, and interventions appropriate for use in the developing world have been available since 1999. Singledose intrapartum and neonatal nevirapine—the simplest and perhaps most effective of the short-course antiretroviral regimens studied—has been available free of charge from the manufacturer since 2000. Nevertheless, few women have access to MTCT-prevention services. In the more than 3 years since its inception, the donation programme has shipped only 189 000 courses of the drug, a tiny fraction (<5%) of the estimate worldwide need. Why this feasible10 and cost-effective intervention has failed to reach so many of the women and infants who need it is a difficult question with no simple answers. Whatever the reasons, we believe that the continued low level of coverage of MTCT-prevention services is no longer acceptable from either a public health or a humanitarian perspective. We argue for a goal-directed approach to scaling-up of such services, in which we first acknowledge that the guiding objective should be to save babies from HIV-1 infection. To meet this objective, it will be necessary in many settings to dissociate the complex business of expanding HIV-1 testing services from the simpler matter of providing nevirapine prophylaxis. (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
    172110

    WHO briefing notes for UNGASS on HIV / AIDS. Prevention of mother-to-child transmission of HIV infection: WHO's activities.

    World Health Organization [WHO]

    Geneva, Switzerland, WHO, [2001]. [5] p.

    This document presents the efforts of WHO in preventing mother-to-child transmission (MTCT) of HIV infection. It reports that the WHO and its partners have put forward a framework for action to prevent MTCT, and will be issuing a strategy paper based on an extensive review of the evidence and the development of consensus on country needs.
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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
    163788

    Cooperative project helps to prevent AIDS spread in Henan province.

    China Population Today. 2001 Dec; 18(6):13.

    To prevent more children from falling victims to AIDS, a project will soon be implemented by UN International Children's Emergency Fund in collaboration with the Ministry of Health of China and Henan Provincial Health Division, in Shihe District of Xinyang City and Shangcai County of Zhumadian City, Henan Province. The project is focused on intervention of AIDS transmission from mother to baby. Mother-to-baby is one of the major channels for AIDS transmission. In the early 1990s, driven by profits, some organizations and individuals began to engage in illegal and tainted collection and trade in blood and blood products, which gave rise to the rapid proliferation of AIDS among blood donors. According to the Ministry of Health, since 1995, local health departments have conducted seven special surveys and identified Wenlou Village of Shangcai County as the village worst struck by AIDS. This project will provide counseling among target groups about HIV antibiotic tests, provide drug therapy to women tested positive to HIV during antenatal, childbirth and postnatal periods, and follow up with babies born to women tested positive to HIV. Breast-feeding is not recommended for such women. (full text)
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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
    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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  24. 24
    151584

    Mother-to-child transmission intervention.

    Joint United Nations Programme on HIV / AIDS [UNAIDS]. Intercountry Team for Eastern and Southern Africa

    SAfAIDS NEWS. 1998 Sep; 6(3):13.

    HIV is contributing substantially to rising child mortality, especially in Africa, Asia, and Latin America. In view of such, the Joint UN Programme on HIV/AIDS (UNAIDS) introduces the mother-to-child package designed to help HIV-positive mothers increase their chances of having a healthy child. This public health initiative aims to offer voluntary and confidential HIV counseling and testing to pregnant women and provides antiretroviral drugs, better birth care, and safe infant feeding methods to HIV-infected women. The UNAIDS Secretariat together with its collaborating cosponsor agencies, the UN International Children's Emergency Fund and the WHO, assists countries to deliver the package within the broader context of HIV prevention measures that help girls and women stay uninfected, and better access to care for infected women and their families. However, with the high cost of delivery, this initiative calls for action by an array of partners including governments, health care managers, and communities.
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