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Dar es Salaam, Tanzania, Research on Poverty Alleviation [REPOA], 2007. 26 p. (Special Paper 07.25)The intention of this paper is to highlight the key issues of children and vulnerability in Tanzania. The paper states that a national framework for social protection must be established to address these overwhelming facets of insecurity and vulnerability for children in Tanzania. The framework needs to reduce vulnerability, strengthen capabilities and must therefore put priority on improving the rural economy and rural conditions of life, and on improving health care and other services in rural areas to reduce the toll of ill-health on children and their caregivers. According to the paper pre-natal and obstetric care must be improved so that at birth babies and their mothers are provided health services which minimise their risk of death. Moreover, individuals who require special support may be identified through a combination of community and local government systems, with strengthened organised community groups to care for the most vulnerable. The paper further states that the level of support provided by several programmes to a relatively small number of children, for clothing, for example, is far in excess of the average expenditures by the majority of households on their children. The challenge is to provide support mechanisms which are not stigmatising, nor discriminatory, but which ensure that all children, no matter what their circumstances, benefit from and contribute to their own development and that of the nation to their fullest capacity. In conclusion the paper emphasises that the implications of this analysis suggest that investments are most critically needed to ensure that there is equitable access to quality health care, and that much more serious attention is needed towards the social attitudes towards children and young people and practices of caring for children, not only as infants, but also as older children.
Geneva, Switzerland, WHO, 2006.  p.Even though children living with HIV/AIDS respond very well to treatment with antiretroviral therapy (ART), to date few children living with HIV/AIDS have access to ART mostly due to a lack of cheap feasible diagnostic tests for infants, lack of affordable child-friendly ARV drugs and lack of trained health personnel. This course aims to address the issue of lack of trained personnel. With an ever increasing burden of HIV and a high percentage of children infected, health workers urgently require accurate, up to date training and information on assessment and management of HIV in children. The IMCI complementary course on HIV is designed to assist health workers to assess, classify, treat and follow up HIV exposed infants and children, to identify the role of family and community in caring for the child with HIV/AIDS and also to enhance health workers' skills in counseling of caretakers around HIV/AIDS. (excerpt)
Rational Pharmaceutical Management Plus. Report of UNICEF-WHO consultation: Development of a Programming Guide for Scaling Up Treatment, Care and Support for HIV-Infected and Exposed Children in Resource-Constrained Settings, New York City, USA: January 11-13, 2006.
Arlington, Virginia, Management Sciences for Health, Rational Pharmaceutical Management Plus, 2006 Jan 24. 22 p. (USAID Development Experience Clearinghouse DocID / Order No: PN-ADG-534; USAID Cooperative Agreement No. HRN-A-00-00-00016-00)While many countries in resource-limited settings have made considerable progress in scaling up access to HIV care and treatment for adults, the provision of services, especially antiretroviral therapy (ART) for children, is still in the early stages. The United Nations Children's Fund (UNICEF) and the World Health Organization (WHO) have agreed to develop appropriate programming guidance to assist countries in the scale up of pediatric HIV care and support. The consultation was convened jointly by UNICEF and WHO with the following goal and objectives. Goal-- The aim of this meeting is to review the draft UNICEF / WHO programming guidance and identify essential revisions and modifications and outline next steps. Specific Objectives -- 1. Review and agree on the essential package of services for treatment, care and support of HIV-exposed and HIV-infected infants and children. This will include, but not be limited to: a. Routine HIV testing; b. Follow up of children exposed to HIV and ensuring early testing (polymerase chain reaction [PCR] for infants and for older children, rapid antibody) through child and family care programs; c. Delivery of long-term care of symptomatic children in health care settings, including provision of cotrimoxazole prophylaxis and ART; d. Training to improve skill levels of health care providers and laboratory staff; e. Delivery of home-based care to both exposed and infected children; f. Provision of psychosocial support and counseling for HIV-infected children; g. Quality improvement activities. 2. Review the draft programming guidance to confirm its applicability, suitability, and relevance to the key intended audience. 3. To examine and endorse the identified key program elements of the draft programming guidance. (excerpt)
Development and testing of the South African National Nutrition Guidelines for People Living with HIV / AIDS.
SAJCN. South African Journal of Clinical Nutrition. 2003 Feb; 16(1):12-16.Malnutrition is a common consequence of HIV infection, and weight loss is used as a diagnostic criterion for HIV/AIDS. The relationship between HIV/AIDS and malnutrition and wasting is well described, with nutritional status compromised by reduced food intake, malabsorption caused by gastrointestinal involvement, increased nutritional needs as a result of fever and infection, and increased nutrient losses. Malnutrition contributes to the frequency and severity of opportunistic infections seen in HIV/AIDS and nutritional status is a major factor in survival. Failure to maintain body cell mass leads to death at 54% of ideal body weight. The effectiveness of nutrition intervention has been documented and dietary nutrition counselling is considered critical in the treatment of HIV/AIDS, especially in view of the fact that drug treatment is inaccessible to many people living with the virus in Africa. (excerpt)
[Arlington, Virginia], FHI, IMPACT, .  p. (USAID Cooperative Agreement No. HRN-A-00-97-00017-00; USAID Development Experience Clearinghouse DocID / Order No. PN-ADE-207)There is no one like you in the whole world. You have your own appearance, ability and talents. When your family is affected by HIV/AIDS you will discover new strengths and ways to cope when you face difficulties. You are a wonderful seed like the lotus seed. A beautiful lotus pond starts from one small lotus seed. You are a wonderful seed like the lotus seed. In you there is understanding and love and many different talents. From our ancestors we receive many talents. For example our ability to run fast, to sing beautifully, to make things with our hands, are all seeds we inherit from our ancestors. We also inherit seeds that are not so nice like the seeds of fear and anger. These seeds of fear and anger can make us unhappy. (excerpt)
Adolescence Education Newsletter. 2005 Jun; 8(1):12.IN JUNE 2004, UNICEF, in collaboration with national organizations, launched Learning for Life, an AIDS education project for Classes 9 and 11 in Tamil Nadu. The plan was to hold HIV/AIDS prevention sessions for 8,185 schools by March 2005. The sessions aimed to give young people an opportunity to learn basic facts about HIV/AIDS and provide them a forum to raise issues related to growing up or the challenges of adolescence. A key material used for these sessions was the "Learning for Life" training manual, which was designed according to the national guidelines developed by the National Council of Education Research and Training (NCERT) and the National AIDS Control Organization (NACO). Partnering UNICEF in this initiative were the Department of Education; Directorate of Teachers Education, Research and Training (DTERT); District Institute of Education and Training (DIET); Tamil Nadu State AIDS Control Soceity (TANSACS); AIDS Prevention and Control Project (APAC-VHS); and core NGOs. (excerpt)
[Geneva, Switzerland], UNAIDS, .  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)
WHO - UNAIDS - UNICEF Technical Consultation on HIV and Infant Feeding: Implementation of Guidelines. Report of a meeting -- Geneva, 20-22 April 1998.
Geneva, Switzerland, UNAIDS, 1998.  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)
UN Chronicle. 2005 Dec;  p..The new campaign of the United Nations Children's Fund (UNICEF), "Unite for Children, Unite against AIDS", hopes to focus global attention on the devastating impact that the HIV/AIDS pandemic has had on children. Ann Veneman, UNICEF Executive Director, in launching the campaign at UN Headquarters in New York on 25 October 2005, described what AIDS means to the youngest generation. "It is a disease that has redefined their childhoods, causing them to grow up too fast, or sadly not at all." In the worst-affected countries, where life expectancy has plummeted from the mid-60s to the early-30s, turning 18 no longer means reaching adulthood, but rather middle-age. A global campaign designed to strengthen the commitment to the fight against AIDS is crucial, explained Ms. Veneman, because "the scale of this problem is staggering, but the world has been largely unresponsive". "Unite for Children, Unite against AIDS" aims to prevent mother-to-child transmission, provide paediatric treatment, prevent infection among adolescents and young people, and protect and support children affected by HIV/AIDS. It also provides a platform for urgent and sustained programmes, advocacy and fund-raising to limit the impact of the disease on children and help halt its spread. (excerpt)
New York, New York, UNICEF, 2005. 25 p.The world must take urgent account of the specific impact of AIDS on children, or there will be no chance of meeting Millennium Development Goals (MDG) 6 - to halt and begin to reverse the spread of the disease by 2015. Failure to meet the goal on HIV/AIDS will adversely affect the world's chances of progress on the other MDGs. The disease continues to frustrate efforts to reduce extreme poverty and hunger, to provide universal primary education, and to reduce child mortality and improve maternal health. World leaders, from both industrialized and developing countries, have repeatedly made commitments to step up their efforts to fight the spread of HIV/AIDS. They are beginning to increase the political leadership and the resources needed to fight the disease. Significant progress is being made in charting the past and future course of the pandemic, in providing free antiretroviral treatment to those who need it, and in expanding the coverage of prevention services. But children are still missing out. (excerpt)
Arlington, Virginia, Family Health International [FHI], Institute for HIV / AIDS, 2005. 6 p. (Snapshots from the Field; USAID Cooperative Agreement No. HRN-A-00-97-00017-00; USAID Development Experience Clearinghouse Doc ID / Order No. PN-ADE-597)Nuru is an upbeat 17-year-old Kenyan who is well-liked and has many friends. The daughter of a trucker, she lives in a boarding-school, where she has come to know other young people from different parts of the country, different classes and different tribes. Known for her good judgment, Nuru has abstained from sexual activity and is something of a role model for her younger friend, Janet. But Nuru's boyfriend Leon, a soccer player at the school, recently left Nuru for the more free spirited Angel. Angel, who once had sex with a teacher to improve her grades, is kept by a sugar-daddy--who happens to be Janet's father. In a recent six-month period, Leon had sex with six different people and has since become HIV positive. In the teenagers' skittish community, this prompted some to question aloud whether Leon should continue playing team sports or whether another player could even safely wear Leon's jersey. Meanwhile, Nuru's friend Oscar is facing his own HIV dilemma as he adjusts to living with his HIV-positive uncle. In many ways, Nuru and her circle of friends define the challenges of adolescence for young Kenyans. The challenges are very real, but Nuru and her friends are not: Nuru (meaning light in Swahili), Janet, Leon, Oscar and Angel are all characters in a popular comic book series. The Nuru comic books have proven remarkably effective at reaching young people with health messages they may not hear in other ways. (excerpt)
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)
Evaluation of United Nations-supported pilot projects for the prevention of mother-to-child transmission of HIV. Overview of findings.
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)
Accelerating Access Initiative. Widening access to care and support for people living with HIV / AIDS. Progress report, June 2002.
Geneva, Switzerland, World Health Organization [WHO], 2002.  p.The World Health Organization (WHO) and Joint United Nations Programme on HIV/AIDS (UNAIDS) estimate that in 2001 about 3 million people died from AIDS, with the vast majority of these deaths occurring in developing countries. While the availability of antiretroviral (ARV) therapy has significantly reduced AIDS morbidity and mortality in the industrialized world, in developing countries, where 95% of HIVpositive people live, the overwhelming majority of HIV-positive people do not have access to these life-sustaining medications. WHO conservatively estimates that in 2002, around 6 million people in developing countries are in need of ARV therapy. Yet only about 230,000 people living with HIV in those countries have such access today. Half of these live in one country, Brazil. Access to medicines is dependent on their rational selection and use, the availability of financial resources, the strength of the health infrastructure and their affordability. As the high cost of medicines is a major factor limiting access to ARVs in developing countries, in May 2000 five UN organizations (the United Nations Population Fund [UNFPA], United Nations Children’s Fund [UNICEF], World Health Organization [WHO], World Bank and UNAIDS Secretariat) entered into a partnership offered by five pharmaceutical companies (Boehringer Ingelheim GmbH; Bristol-Myers Squibb; GlaxoSmithKline; Merck & Co., Inc.; and F. Hoffmann-La Roche Ltd. – later joined by Abbott Laboratories) to address the lack of affordability of HIV medicines and to work together to increase access to HIV/AIDS care and treatment in developing countries. (excerpt)
UNICEF and WHO call for stronger support for the implementation of the joint United Nations HIV and infant feeding framework.
Geneva, Switzerland, WHO, 2004 Dec 22.  p.The HIV epidemic continues to threaten and reverse child survival and development gains of the past decades. In 2004 alone, an estimated 640,000 and 510,000 children acquired HIV and died of AIDS, respectively. For high prevalence countries the impact of HIV infection on child survival is enormous. Estimates for 1999 of under five mortality rates attributable to HIV infection by Walker and colleagues for five highly burdened countries in Africa were over 30 per 1000 live births; Botswana (57.7); Zimbabwe (42.2); Swaziland (40.6); Namibia (36.5); and Zambia (33.6).1 The vast majority of children acquire HIV infection from their HIV-infected mothers during pregnancy, delivery or breastfeeding. In the absence of any interventions, 5-20% of infants born to HIV-infected women will be infected through breastfeeding. These women face the dilemma of choosing the right infant feeding option in trying to prevent HIV transmission to their infants while not exposing them to the risk of malnutrition and other illnesses due to not breastfeeding. (excerpt)
Global AIDSLink. 2002 Jan; (71):11, 17.In many Buddhist countries, people assume that monks would never entertain the prospect of working in HIV/AIDS, an illness associated in many people’s minds with immoral, rather than unsafe, behaviors. In some countries where monks have played more of a ceremonial or purely spiritual role, people wonder how monks will cope with the intense social action HIV/AIDS requires. At this stage someone usually raises the example of Thailand where monks have played a role in development activities for over two decades and have been active at grassroots level on HIV/AIDS for many years. For many countries in the Mekong region, Thailand’s example seems a hard act to follow. And it’s true that monks in Cambodia and Lao PDR, for instance, tend to be less well educated, at least in secular subjects, than their peers in Thailand. It is certainly true that their community temples have less resources. But, as UNICEF has been delighted to discover, there are many, many monks in the Mekong region for whom the realization of the extent of the AIDS problem has been a call to action. (excerpt)
Are WHO/UNAIDS/UNICEF-recommended replacement milks for infants of HIV-infected mothers appropriate in the South African context?
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)
New York, New York, UNICEF, 2002.  p. (UNICEF Fact Sheet)While the impact of HIV/AIDS on children and young people is generally well documented and understood, considerably less attention has been given to the dynamic between HIV/AIDS and armed conflict and their joint impact on children. (excerpt)
New York, New York, UNICEF, 2002.  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)
New York, New York, UNICEF, 2002.  p. (UNICEF Fact Sheet)By 2001, AIDS had killed one or both parents of 13.4 million children still under the age of 15. Their ranks will soon be swelled by millions of additional children who are living with sick and dying parents. The tragedy continues to worsen as the disease kills everlarger numbers of people. By 2010, the total number of children orphaned by HIV/AIDS is expected to nearly double to 25 million. HIV/AIDS has killed more people in sub-Saharan Africa than anywhere else, and the vast majority of orphans and other children affected by HIV/AIDS are also in this region. By the end of 2001, AIDS had orphaned approximately 995,000 children in Nigeria; 989,000 in Ethiopia; 782,000 in Zimbabwe; 662,000 in South Africa; and 572,000 in Zambia. As HIV/AIDS epidemics worsen in other regions – such as in the Caribbean and in parts of Asia – the number of children orphaned by AIDS in these areas will also increase dramatically. (excerpt)
New York, New York, UNICEF, 2002.  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)
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)
Child mortality associated with reasons for non-breastfeeding and weaning: Is breastfeeding best for HIV-positive mothers?
AIDS. 2003 Apr 11; 17(6):879-885.Objective: To estimate child mortality associated with reasons for the non-initiation of breastfeeding and weaning caused by preceding morbidity, compared with voluntary weaning as a result of maternal choice. Methods: Demographic and Health Surveys were analysed from 14 developing countries. Women reported whether they initiated lactation or weaned, and if so, their reasons for non-initiation or stopping breastfeeding were classified as voluntary choice or as a result of preceding maternal/infant illness. Rates of child mortality and survival analyses were estimated, by reasons for non-breastfeeding or weaning. Results: Mortality was highest among never-breastfed children. Child mortality among women who never initiated breastfeeding was significantly higher than among women who weaned. Preceding maternal/infant morbidity was the most common reason for not breastfeeding (63.9%), and the mortality of children never breastfed because of preceding morbidity was higher than in children not breastfed as a result of maternal choice; 326.8 per 1000 versus 34.8 per 1000, respectively. Mortality among breastfed children who were weaned because of preceding morbidity was higher than among those weaned voluntarily; 19.2 per 1000 versus 9.3 per 1000, respectively. Failure to initiate lactation was significantly more frequent among women reporting complications of delivery and with low birthweight infants. Conclusion: Child mortality as a result of the voluntary non-initiation of breastfeeding or voluntary weaning was lower than previously estimated, and this should be used as a benchmark when counselling HIV-positive mothers on the risks of non-breastfeeding or weaning to prevent mother-to-child transmission of HIV. (author's)