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Decreased emergence of HIV-1 drug resistance mutations in a cohort of Ugandan women initiating option B+ for PMTCT.
PloS One. 2017; 12(5):e0178297.BACKGROUND: Since 2012, WHO guidelines for the prevention of mother-to-child transmission (PMTCT) of HIV-1 in resource-limited settings recommend the initiation of lifelong antiretroviral combination therapy (cART) for all pregnant HIV-1 positive women independent of CD4 count and WHO clinical stage (Option B+). However, long-term outcomes regarding development of drug resistance are lacking until now. Therefore, we analysed the emergence of drug resistance mutations (DRMs) in women initiating Option B+ in Fort Portal, Uganda, at 12 and 18 months postpartum (ppm). METHODS AND FINDINGS: 124 HIV-1 positive pregnant women were enrolled within antenatal care services in Fort Portal, Uganda. Blood samples were collected at the first visit prior starting Option B+ and postpartum at week six, month six, 12 and 18. Viral load was determined by real-time RT-PCR. An RT-PCR covering resistance associated positions in the protease and reverse transcriptase HIV-1 genomic region was performed. PCR-positive samples at 12/18 ppm and respective baseline samples were analysed by next generation sequencing regarding HIV-1 drug resistant variants including low-frequency variants. Furthermore, vertical transmission of HIV-1 was analysed. 49/124 (39.5%) women were included into the DRM analysis. Virological failure, defined as >1000 copies HIV-1 RNA/ml, was observed in three and seven women at 12 and 18 ppm, respectively. Sequences were obtained for three and six of these. In total, DRMs were detected in 3/49 (6.1%) women. Two women displayed dual-class resistance against all recommended first-line regimen drugs. Of 49 mother-infant-pairs no infant was HIV-1 positive at 12 or 18 ppm. CONCLUSION: Our findings suggest that the WHO-recommended Option B+ for PMTCT is effective in a cohort of Ugandan HIV-1 positive pregnant women with regard to the low selection rate of DRMs and vertical transmission. Therefore, these results are encouraging for other countries considering the implementation of lifelong cART for all pregnant HIV-1 positive women.
Design and initial implementation of the WHO FP umbrella project - to strengthen contraceptive services in the sub Saharan Africa.
Reproductive Health. 2017 Jun 15; 14(1):1-6.BACKGROUND: Strengthening contraceptive services in sub Saharan Africa is critical to achieve the FP 2020 goal of enabling 120 million more women and girls to access and use contraceptives by 2020 and the Sustainable Development Goals (SDG) targets of universal access to sexual and reproductive health (SRH) services including family planning by 2030. METHOD: The World Health Organization (WHO) and partners have designed a multifaceted project to strengthen health systems to reduce the unmet need of contraceptive and family planning services in sub Saharan Africa. The plan leverages global, regional and national partnerships to facilitate and increase the use of evidence based WHO guidelines with a specific focus on postpartum family planning. The four key approaches undertaken are i) making WHO Guidelines adaptable & appropriate for country use ii) building capacity of WHO regional/country staff iii) providing technical support to countries and iv) strengthening partnerships for introduction and implementation of WHO guidelines. This paper describes the project design and elaborates the multifaceted approaches required in initial implementation to strengthen contraceptive services. CONCLUSION: The initial results from this project reflect that simultaneous application these approaches may strengthen contraceptive services in Sub Saharan Africa and ensure sustainability of the efforts. The lessons learned may be used to scale up and expand services in other countries.
Global Health: Science and Practice. 2014 Feb 11; 2(1):4-9.The postpartum period is a critical time to address high unmet family planning need and to reduce the risks of closely spaced pregnancies. Practical tools are included in the new resource for integrating postpartum family planning at points when women have frequent health system contact, including during antenatal care, labor and delivery, postnatal care, immunization, and child health care.
Update to CDC's U.S. Medical Eligibility Criteria for Contraceptive Use, 2010: revised recommendations for the use of contraceptive methods during the postpartum period.
MMWR. Morbidity and Mortality Weekly Report. 2011 Jul 8; 60(26):878-83.Initiation of contraception during the postpartum period is important to prevent unintended pregnancy and short birth intervals, which can lead to negative health outcomes for mother and infant. In 2010, CDC published U.S. Medical Eligibility Criteria for Contraceptive Use, 2010 (US MEC), providing evidence-based guidance for choosing a contraceptive method based on the relative safety of contraceptive methods for women with certain characteristics or medical conditions, including women who are postpartum. Recently, CDC assessed evidence regarding the safety of combined hormonal contraceptive use during the postpartum period. This report summarizes that assessment and the resulting updated guidance. These updated recommendations state that postpartum women should not use combined hormonal contraceptives during the first 21 days after delivery because of the high risk for venous thromboembolism (VTE) during this period. During 21-42 days postpartum, women without risk factors for VTE generally can initiate combined hormonal contraceptives, but women with risk factors for VTE (e.g., previous VTE or recent cesarean delivery) generally should not use these methods. After 42 days postpartum, no restrictions on the use of combined hormonal contraceptives based on postpartum status apply.
Postpartum Family Planning: Sharing Experiences, Lessons Learned and Tools for Programming -- Meeting report, 12 May 2009, Washington, D.C.
Baltimore, Maryland, Jhpiego, ACCESS, Family Planning Initiative [ACCESS-FP], 2009.  p.On May 12, 2009, more than 76 experts and leaders in reproductive health (RH) and maternal, neonatal and child health (MNCH) from more than 22 global health organizations and programs convened in Washington, D.C., for the “Postpartum Family Planning: Sharing Experiences, Lessons Learned and Tools for Programming” meeting. The meeting had three objectives: 1. Present and discuss experiences and lessons learned in implementing PPFP in a variety of settings; 2. Share tools and other resources to support PPFP programming; and 3. Discuss progress, continuing priorities for research and advancing MNCH / FP integration. (Excerpts)
Geneva, Switzerland, World Health Organization [WHO], Department of Making Pregnancy Safer, 2010.  p. (WHO/MPS/10.03)On October 29, 2008, WHO Technical Consultation on Postpartum and Postnatal Care was held in Geneva, Switzerland. This report reflects the discussions, proceedings and recommendations for follow-up. The World Health Organization (WHO) is in the process of revising and updating its guidance on postpartum and postnatal care delivered by skilled providers. The purposes of the revision are to encourage and support broader provision of care and to foster a new, woman-centred concept of care that promotes health and sustains attention to dangerous complications. This consultation report also discusses follow up activities after the revision of the WHO guidance.
The effect of Baby Friendly Hospital Initiative and postnatal support on breastfeeding rates -- Croatian experience.
Collegium Antropologicum. 2004 Jun; 28(1):235-243.The effects of implementation WHO/UNICEF Breastfeeding Hospital Initiative (BFHI) and community postnatal support on breastfeeding rates were examined during and after the breastfeeding promotion campaign in one county of Croatia. Comparison with a control group indicated increase of breastfeeding prevalence in a period of BFHI implementation 11994-1998) - 68% us. 87% at infant age 1 ma., 30% us. 54% at 3 mo., 11.5% vs. 28% at 6 mo., and 2% us. 3.5% at infant age 11-12 mo. (chi-square test, p < 0.05). More considerable increase has been noticed in period 1999-2000 which is characterized by breastfeeding support groups activity: 68% us. 87% at infant age I no., 30% us. 66% at 3 mo., 11.5% us. 49% at 6 mo., and 2% vs. 23% at infant age 11-12 ;TO. (chi-square test, p < 0.05). Our conclusion is that activities aiming to promote breastfeeding in maternity hospitals have had limited success. They have resulted in satisfactory increase of breastfeeding prevalence in early infant's period, but for far-reaching effect postnatal support is also required. (author's)
Geneva, Switzerland, WHO, Division of Family Health, 1993. , 143 p. (WHO/FHE/MSM/93.7)The WHO compendium of maternity services among countries in Africa, Latin America, North America, Asia, Europe, Oceania, and the former USSR provides statistics in tabular form for the year of the survey, data type, sample size, and source; the percentage of places with prenatal care services; the percentage of institutional deliveries; the percentage using a doctor, nurse or midwife, traditional birth attendant, or all for deliveries; and the percentage receiving postnatal care Sometimes the source is left blank, which means that the information was provided by researchers or individuals. Additional information may be added to the column on notes. If the source document is included in the WHO bibliographic database, a reference number is provided. The data are considered not suitable for data manipulation. Data were evaluate for a general level of reliability, and data considered completely out of line were excluded. Data which were available for regions, subregions, or local areas were included. Only information published before 1989 was included. A brief textual summary of information indicates that 55% of births in developing countries were attended by trained personnel. 37% of deliveries occurred in health institutions. About 80 million babies annually are stillborn at home. Regional variations reveal that women in Latin America have the highest level of maternal care: 3 out of 4 women receive prenatal care and trained attendants at delivery, and 2 out of 3 deliver in a hospital or health facility. Asian variations reveal that Western Asian women are usually assisted in delivery with a trained attendant (70%); about 50% deliver in health institutions and receive prenatal care. Southeastern Asian women (70%) receive prenatal care, and 60% have a trained attendant; only 40% deliver at a health facility. African differences showed that just under 90% received prenatal care in southern Africa, while in northern Africa, more than 50% deliver with a trained attendant and just under 33% deliver in a health facility. Just over 40% of Middle African women receive prenatal care, trained attendants, or institutional delivery. 68% of eastern African and 55% of western African women receive prenatal care and only 30% deliver at a health facility.
WORLD HEALTH. 1993 Nov-Dec; 46(6):30-1.The World Bank has released a report entitled Making Motherhood Safe, which stresses the importance of adapting safe motherhood strategies to local and national settings and provides many safe motherhood interventions to address very different situations. The World Health Organizations [WHO] Safe Motherhood Programme has supported many activities to promote maternal health. It has developed basic principles to bring about safe motherhood and healthy infants. They are categorized into time frames. The time frames are before and during pregnancy, during delivery, and after delivery. Key principles under before and during pregnancy are full access to health care, adequate nourishment before conception, prenatal care immediately after learning of pregnancy, tetanus toxoid immunization, and iron and folic acid supplements. During delivery, principles are access to emergency care and safe, nontraumatic, and aseptic conditions. Some after-delivery principles include aseptic severing of the cord, immediate care of the mother and child, immediate placement of the infant on the mother's breast, and immunization against tuberculosis and poliomyelitis. WHO advocates that traditional birth attendants have and use a clean delivery kit. It should be kept in a plastic envelope, box, or cloth bag. The kit must include soap, 2-3 sterilized cord ties, a razor blade or other instrument to cut the cord cleanly, and a clean piece of cloth or small gauze pads. Other items may include a plastic sheet as a delivery surface, a sharpened stick to clean dirt from under the fingernails, antiseptic solution or powder to dry the cord and prevent infection, pictogram instructions on how to use the kit, clean towels, color-coded tape to measure the chest circumference, and a single-dose dispenser for eye care.
IPPF MEDICAL BULLETIN. 1990 Apr; 24(2):2-4.Breast milk provides infants with their nutritional requirement plus antibodies to combat certain infections. Prolonged breast feeding and concurrent postpartum amenorrhea contribute to natural infertility, but considerable variability occurs among different populations. Further, certain variables exist that contribute greatly to the length of amenorrhea and infertility. They include nutritional status of the mother; length of breast feeding; giving supplements to the infant; frequency and duration of suckling; and geographic, social, and cultural factors. Many studies indicate that the longer a woman breast feeds, the longer she will experience amenorrhea. Anovulation is contingent on the frequency and distribution of nursing episodes day and night and the time of the infant feeds at the breast. Feeding an infant supplementary milk or food also reduces the inhibitory affect of breast feeding on ovarian activity and fertility, especially when supplements are introduced early. Educating mothers about the value of child spacing, breast feeding, maternal nutrition, and contraception should be done during pregnancy and the postpartum period, the times when mothers most often visit health clinics. Mothers should also be informed that it is not possible to anticipate how long they will be infertile while breast feeding, so contraceptive use should be encouraged. If possible, nursing mothers should avoid using hormonal contraceptives because they can interrupt lactation or pose a risk to the infant. IUDs are highly efficacious. If a woman is in a hospital to deliver, postpartum sterilization is another option. Barrier methods are effective, if used regularly, especially during this time of reduced fertility. Since the reoccurrence of menses is unpredictable and the efficacy is not know, nursing mothers should not rely on periodic abstinence.
Population Council Country Profiles. 1972 Mar; 1-18.Add to my documents.
Studies in Family Planning. November 1973; 4(11):293-304.The World Bank's philosophy and approach to family planning development assistance are presented. A detailed review of the Bank-assisted population projects in Indonesia and India is given. Recognizing that the rapid population growth most countries are now experiencing undermines, and often cancels out, efforts to improve living standards, in 1970 the Bank began to finance projects designed to limit excessive population growth. In addition to making money available to the governments that come with population projects, the Bank assists the governments in developing effective programs by providing technical assistance for both the development and implementation of projects. The Bank also attempts to educate opinion leaders to an awareness of the problem. The Bank has conducted sector reviews in 7 countries, resulting in a report submitted to the government in question. The Bank conducts sector reviews to develop the background knowledge necessary to identify and prepare a project it will assist. The Indian and the Indonesian projects are among the largest of the 7 projects so far assisted by the Bank. The Indonesia project is aimed at scaling up its present national program. New activities are being introduced and organizational changes are being made. Outside technical assistance is being provided for a specified period. The principal aim of the India project is to discover new methods of increasing the number of acceptors in a program that has reached a plateau. Different combinations of program inputs are being experimented with to see what works best and to measure what different activities cost.