April
11
2010

Adolescents and HIV

Causes of acute hospitalization in adolescence: burden and spectrum of HIV-related morbidity in a country with an early-onset and severe HIV epidemic: a prospective survey.

Ferrand RA, Bandason T, Musvaire P, Larke N, Nathoo K, Mujuru H, Ndhlovu CE, Munyati S, Cowan FM, Gibb DM, Corbett EL. PLoS Med. 2010;7:e1000178.

Survival to older childhood with untreated, vertically acquired HIV infection, which was previously considered extremely unusual, is increasingly well described. However, the overall impact on adolescent health in settings with high HIV seroprevalence has not previously been investigated. In this study adolescents (aged 10-18 y) systematically recruited from acute admissions to the two public hospitals in Harare, Zimbabwe, answered a questionnaire and underwent standard investigations including HIV testing, with consent. Pre-set case-definitions defined cause of admission and underlying chronic conditions. Participation was 94%. 139 (46%) of 301 participants were HIV-positive (median age of diagnosis 12 y: interquartile range [IQR] 11-14 y), median CD4 count = 151; IQR 57-328 cells/microl), but only four (1.3%) were herpes simplex virus-2 (HSV-2) positive. Age (median 13 y: IQR 11-16 y) and sex (57% male) did not differ by HIV status, but HIV-infected participants were significantly more likely to be stunted (z-score<-2: 52% versus 23%, p<0.001), have pubertal delay (15% versus 2%, p<0.001), and be maternal orphans or have an HIV-infected mother (73% versus 17%, p<0.001). 69% of HIV-positive and 19% of HIV-negative admissions were for infections, most commonly tuberculosis and pneumonia. 84 (28%) participants had underlying heart, lung, or other chronic diseases. Case fatality rates were significantly higher for HIV-related admissions (22% versus 7%, p<0.001), and significantly associated with advanced HIV, pubertal immaturity, and chronic conditions. HIV is the commonest cause of adolescent hospitalisation in Harare, mainly due to adult-spectrum opportunistic infections plus a high burden of chronic complications of paediatric HIV. Low HSV-2 prevalence and high maternal orphanhood rates provide further evidence of long-term survival following mother-to-child transmission. Better recognition of this growing phenomenon is needed to promote earlier HIV diagnosis and care.

For full text access click here:
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000178
Editor’s note: Zimbabwe, a few years ahead of other countries in the region, may be the proverbial ‘canary in the mine’, alerting us to what will become increasingly evident – the unrecognised numbers of adolescents with HIV infection who were infected through mother-to-child (vertical) transmission. Adolescents (10 to 18 years) get lost in our epidemiological and clinical categories of <15 years and 15 to 49 years. Adolescents also get lost in our service provision, with freestanding services and youth-friendly clinics for adolescents rare in many settings. Legal barriers may prevent young people from learning their HIV status without guardian consent. Provider-initiated HIV testing and counselling offered to all adolescents in high HIV prevalence countries would go a long way to overcoming late diagnosis (the median age is 11 to 12 years), delayed antiretroviral treatment, blunted growth, and slow pubertal development. But to really make a difference in their growth, health, and survival, adolescents with HIV infection shouldn’t have to wait until they are sick to find out they have HIV. There is no time to lose – a considerable epidemic of long time survivors of vertical transmission is expected during the coming decade and strategic planning must start now or speed up rapidly. The later the diagnosis is made, the higher is the mortality.
No votes yet
  • Share this!
0 comments. Add a comment
The content of this field is kept private and will not be shown publicly.
  • Web page addresses and e-mail addresses turn into links automatically.

More information about formatting options

April
11
2010

Adolescents and HIV

Effectiveness of an HIV/STD Risk-Reduction Intervention for Adolescents When Implemented by Community-Based Organizations: A Cluster-Randomized Controlled Trial.

Jemmott JB 3rd, Jemmott LS, Fong GT, Morales KH. Am J Public Health. 2010; 100: 720-726

The authors evaluated the effectiveness of an HIV/STD risk-reduction intervention when implemented by community-based organizations. In a cluster randomized controlled trial, 86 community-based organizations that served African American adolescents aged 13 to 18 years were randomized to implement either an HIV/STD risk-reduction intervention whose efficacy has been demonstrated or a health-promotion control intervention. Community-based organizations agreed to implement 6 intervention groups, a random half of which completed 3-, 6-, and 12-month follow-up assessments. The primary outcome was consistent condom use in the 3 months prior to each follow-up assessment, averaged over the follow-up assessments. Participants were 1707 adolescents, 863 in HIV/STD-intervention community-based organizations and 844 in control-intervention community-based organizations. HIV/STD-intervention participants were more likely to report consistent condom use (odds ratio [OR]=1.39; 95% confidence interval [CI]=1.06, 1.84) than were control intervention participants. HIV/STD-intervention participants also reported a greater proportion of condom protected intercourse (β=0.06; 95% CI=0.00, 0.12) than did the control group. This is the first large, randomized intervention trial to demonstrate that community-based organizations can successfully implement an HIV/STD risk-reduction intervention whose efficacy has been established.

For abstract access click here: http://www.ncbi.nlm.nih.gov/pubmed/20167903
Editor’s note: What happens after risk reduction approaches for adolescents are shown to be effective in randomised controlled trials? Does knowledge translate into programming on the ground? Implementation research can help bridge the gap by demonstrating whether and under what conditions risk reduction approaches work in the real world. This trial among African-American adolescents found that community-based organisations could implement a ‘proven’ intervention and achieve significantly increased condom use outcomes. But importantly, it also found that the effectiveness of the intervention did not increase with more intensive facilitator training. When an efficacious intervention retains its beneficial effects outside tightly controlled research settings and is implemented by community-based organisations without requiring intensive training, it is time to think about introducing it more generally for similar adolescents in similar settings.
No votes yet
  • Share this!
0 comments. Add a comment
The content of this field is kept private and will not be shown publicly.
April
11
2010

Condoms

Does it fit okay? Problems with condom use as a function of self-reported poor fit.

Crosby RA, Yarber WL, Graham CA, Sanders SA. Sex Transm Infect. 2010;86:36-8.

The study was set up to identify associations between men's self-reports of ill-fitting condoms and selected condom use problems, using an event-specific analysis. A convenience sample of men was recruited via advertisements in newspapers (two urban and one small town) and a blog on the website of a condom sales company. Men completed a questionnaire posted on the website of The Kinsey Institute for Research in Sex, Gender, and Reproduction. Inclusion criteria were: at least 18 years old, used condoms for penile-vaginal intercourse in the past 3 months and the ability to read English. In controlled, event-specific, analyses of 436 men, those reporting ill-fitting condoms (44.7%) were significantly more likely to report breakage (adjusted odds ratio (AOR 2.6), slippage (AOR 2.7), difficulty reaching orgasm, both for their female partners (AOR 1.9) and for themselves (AOR 2.3). In addition, they were more likely to report irritation of the penis (AOR 5.0) and reduced sexual pleasure, both for their female partner (AOR 1.6) and for themselves (AOR 2.4). Furthermore, they were more likely to report that condoms interfered with erection (AOR 2.0), caused erection loss (AOR 2.3), or became dry during sex (AOR 1.9). Finally, they were more likely to report removing condoms before penile-vaginal sex ended (AOR 2.0). Men and their female sex partners may benefit from public health efforts designed to promote the improved fit of condoms.

For abstract access click here: http://www.ncbi.nlm.nih.gov/pubmed/20157178
Editors’ note: Given that condoms are widely used to prevent pregnancy and that correct and consistent condom use is the cornerstone of HIV prevention for sexually active people, it is amazing that more research on the effects of ill-fitting condoms on penile erection, sexual pleasure, and discontinuation before the end of the sex act has not been done. This convenience sample of men from 28 countries (74% living in the US) defined ‘ill-fitting’ as ‘too long or too short’ and/or too narrow or too wide’. Almost 45% of men reporting ill-fitting condom use at the last sex act. It is not clear whether the problem is with the product itself or how it is applied. No wonder condoms get bad press! Much more work is needed to find out how this problem can be rectified – too many lives depend upon correct and consistent condom use.
No votes yet
  • Share this!
0 comments. Add a comment
The content of this field is kept private and will not be shown publicly.
April
11
2010

Condoms

Low-Level CD4(+) T Cell Activation in HIV-Exposed Seronegative Subjects: Influence of Gender and Condom Use.

Camara M, Dieye TN, Seydi M, Diallo AA, Fall M, Diaw PA, Sow PS, Mboup S, Kestens. J Infect Dis. 2010;201:835-42

Immune activation has been suggested to increase susceptibility to human immunodeficiency virus type 1 (HIV-1) transmission, while at the same time it could be deemed essential for mounting an effective antiviral immune response. In this study, Camara and colleagues compared levels of T cell activation between exposed seronegative partners in HIV-1 discordant couples and HIV-unexposed control subjects in Dakar, Senegal. Exposed seronegative subjects showed lower levels of CD38 expression on CD4(+) T cells than did control subjects. However, this was found to be associated with concurrent differences in the use of condoms: exposed seronegative subjects reported a higher degree of condom use than did control subjects, which correlated inversely with CD38 expression. In addition, they observed markedly higher levels of T cell activation in women compared with men, irrespective of sexual behaviour. These findings question the relevance of low-level CD4(+) T cell activation in resistance to HIV-1 infection and underscore the need to take gender and sexual behaviour characteristics of high-risk populations into account when analyzing correlates of protective immunity

For abstract access click here: http://www.ncbi.nlm.nih.gov/pubmed/20136413
Editors’ note: Basic scientists have found that host factors such as genetic predisposition (e.g. CCR5-delta 32 mutation), intrinsic cellular defences (e.g. β-chemokines), and innate or adaptive immune responses (e.g. natural killer cell activity) may help explain why HIV-seronegative people resist HIV infection when they are exposed sexually multiple times. It is true that viral load in the partner is important, as are the characteristics of the infecting virus, however the low levels of immune activation found in a number of studies of exposed, seronegative people have been intriguing. It may mean fewer activated T cells are around for HIV to invade. However, this study suggests that basic scientists should be paying more attention to human behaviour and to sex. HIV-negative partners in Senegalese serodiscordant couples that always used condoms had decreased CD4+ T- cell activation compared to HIV-negative low risk controls. This was likely due to less exposure to genital secretions that can cause immune activation. This finding was independent of infection with herpes simplex virus-2 and was more marked in men (85% of male versus 46% of female seronegative partners reported always using condoms). More than condom use may be playing a role too since women generally seem to have higher T-cell activation. In studies of seronegative exposed individuals aimed at finding promising avenues for therapeutics and vaccine development, it is important to know about the people behind the samples: their sex and their condom use practices.
No votes yet
  • Share this!
0 comments. Add a comment
The content of this field is kept private and will not be shown publicly.
April
11
2010

Reproductive Health

Impact of Antiretroviral Therapy on Incidence of Pregnancy among HIV-Infected Women in Sub-Saharan Africa: A Cohort Study.

Myer L, Carter RJ, Katyal M, Toro P, El-Sadr WM, Abrams EJ. PLoS Med. 2010;7:e1000229.

With the rapid expansion of antiretroviral therapy services in sub-Saharan Africa there is growing recognition of the importance of fertility and childbearing among HIV-infected women. However there are few data on whether antiretroviral therapy initiation influences pregnancy rates. The authors analyzed data from the Mother-to-Child Transmission-Plus (MTCT-Plus) Initiative, a multicountry HIV care and treatment programme for women, children, and families. From 11 programmes in seven African countries, women were enrolled into care regardless of HIV disease stage and followed at regular intervals; antiretroviral therapy was initiated according to national guidelines on the basis of immunological and/or clinical criteria. Standardized forms were used to collect sociodemographic and clinical data, including incident pregnancies. Overall 589 incident pregnancies were observed among the 4,531 women included in this analysis (pregnancy incidence, 7.8/100 person-years [PY]). The rate of new pregnancies was significantly higher among women receiving antiretroviral therapy (9.0/100 PY) compared to women not on antiretroviral therapy (6.5/100 PY) (adjusted hazard ratio, 1.74; 95% confidence interval, 1.19-2.54). Other factors independently associated with increased risk of incident pregnancy included younger age, lower educational attainment, being married or cohabiting, having a male partner enrolled into the program, failure to use nonbarrier contraception, and higher CD4 cell counts. Antiretroviral therapy use is associated with significantly higher pregnancy rates among HIV-infected women in sub-Saharan Africa. While the possible behavioural or biomedical mechanisms that may underlie this association require further investigation, these data highlight the importance of pregnancy planning and management as a critical but neglected component of HIV care and treatment services.

For full text access click here:
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000229
Editors’ note:  Although the incidence of pregnancy ranged 5-fold across these seven countries, the association between antiretroviral therapy and pregnancy was consistent across countries. Within 4 years of starting on treatment, one-third of women became pregnant, constituting an almost 80% increased incidence over women who were not yet eligible for antiretroviral therapy. There is no doubt that antiretroviral therapy can improve well-being, increase sexual activity, and lead to renewed fertility intentions through increased hope and planning for the future. However, 30% of pregnancies in sub-Saharan Africa, regardless of HIV status, are unintentional. This multi-country, women-centred, family-focused care and treatment initiative surprisingly did not include standardised counselling on pregnancy and contraceptive use, although barrier and non-barrier contraceptive methods were provided on site or by referral, and did not explore fertility desires and pregnancy plans. As a result, options for fertility planning were not systematically discussed with women, treatment regimens were not adjusted to reduce the impact of nevirapine on hormonal contraceptive blood levels for those women who chose this method of contraception, and the opportunity to help women shape their own futures and that of their families appears to have been missed. This study provides strong justification for the integration of family planning services into antiretroviral therapy programmes.
MTCT and prevention
No votes yet
  • Share this!
0 comments. Add a comment
The content of this field is kept private and will not be shown publicly.
April
11
2010

Reproductive Health

Climate change and family planning: least-developed countries define the agenda.

Bryant L, Carver L, Butler CD, Anage A. Bull World Health Organ. 2009;87:852-7.

The links between rapid population growth and concerns regarding climate change have received little attention. Some commentators have argued that slowing population growth is necessary to reduce further rises in carbon emissions. Others have objected that this would give rise to dehumanizing 'population control' programmes in developing countries. Yet the perspective of the developing countries that will be worst affected by climate change has been almost completely ignored by the scientific literature. This deficit is addressed by this paper, which analyses the first 40 National Adaptation Programmes of Action reports submitted by governments of least-developed countries to the Global Environment Facility for funding. Of these documents, 93% identified at least one of three ways in which demographic trends interact with the effects of climate change: (i) faster degradation of the sources of natural resources; (ii) increased demand for scarce resources; and (iii) heightened human vulnerability to extreme weather events. These findings suggest that voluntary access to family planning services should be made more available to poor communities in least-developed countries. The authors stress the distinction between this approach, which prioritizes the welfare of poor communities affected by climate change, and the argument that population growth should be slowed to limit increases in global carbon emissions. The paper concludes by calling for increased support for rights-based family planning services, including those integrated with HIV services, as an important complementary measure to climate change adaptation programmes in developing countries.

For full text access click here:
http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862009001100014&lng=en&nrm=iso&tlng=en
Editors’ note: These 40 National Adaption Programmes of Action (NAPA) reports, created by governments with consultative input from civil society and local groups, articulate the priorities of least-developed countries and small island developing states for climate change adaptation. Only 3 countries did not cite concern about the impact of rapid population growth in exacerbating the effects of climate change or impeding their ability to adapt to it. The fact that ministries of the environment authored the reports while population issues are concerns for ministries of health may explain why only 6 countries proposed strategies to address population growth. Our calls to integrate sexual and reproductive health services into HIV programming are amplified here by the call to get family planning out of its reproductive health sector ‘silo’ into multisectoral environmental adaption efforts, including mainstreaming family planning into the agricultural sector. International efforts to assist least-developed countries to adapt to climate change clearly must rectify the chronic global underspend on family planning development assistance and support integration of sexual and reproductive health and HIV programmes and the blending of rights-based family planning programmes into climate change adaptation strategies.
MTCT and prevention
No votes yet
  • Share this!
0 comments. Add a comment
The content of this field is kept private and will not be shown publicly.
April
11
2010

Basic Science

Targeting early infection to prevent HIV-1 mucosal transmission.

Haase AT. Nature. 2010;464:217-23.

Measures to prevent sexual mucosal transmission of human immunodeficiency virus (HIV)-1 are urgently needed to curb the growth of the acquired immunodeficiency syndrome (AIDS) pandemic and ultimately bring it to an end. Studies in animal models and acute HIV-1 infection reviewed here reveal potential viral vulnerabilities at the mucosal portal of entry in the earliest stages of infection that might be most effectively targeted by vaccines and microbicides, thereby preventing acquisition and averting systemic infection, CD4 T-cell depletion and pathologies that otherwise rapidly ensue.

For abstract access click here: http://www.ncbi.nlm.nih.gov/pubmed/20220840
Editors’ note: Sexual mucosal transmission of HIV is the most common mode of acquisition. This excellent review of what we know now about the events from mucosal exposure to established systemic infection sets out the clear challenges before us and describes the window of opportunity that the earliest stage of infection presents. With vaginal transmission probabilities estimated at 1 in 100 to 1 in 1000, HIV can have a difficult time getting a toehold. Although people with HIV infection generally have several genetically distinct HIV viruses, surprisingly, due to what is called a ‘genetic bottleneck’, only one virus or infected cell initiates productive infection in almost 80% of people who become infected, with the remaining 20% becoming infected with two to five viruses. After exposure, prevention has to start by stopping the establishment of this small founder population in the first week of infection, taking advantage of its vulnerability to reduce its basic reproductive rate below 1. There are only a few days before dissemination and establishment of systemic infection in the second week with massive depletion of memory CD4 T cells in the gut and immune activation providing a new supply of target cells for HIV. Understanding what happens in early infection may not only help explain why male circumcision partially protects heterosexual men and how modest protection occurred in the Thai RV144 vaccine trial, it will lead to the design of targeted biomedical strategies that prevent establishment of HIV infection when HIV exposure occurs at mucosal surfaces.
Basic science
No votes yet
  • Share this!
0 comments. Add a comment
The content of this field is kept private and will not be shown publicly.
April
11
2010

Basic Science

HIV-1 elite controllers: Beware of super-infections.

Clerc O, Colombo S, Yerly S, Telenti A, Cavassini M. J Clin Virol. 2010 47:376-8

Super- and co-infection with HIV-1 are generally associated with accelerated disease progression. The authors report on the outcome of super-infection in two HIV-1 infected individuals previously known as elite controllers. Both presented an acute retroviral syndrome following super-infection and showed an immuno-virological progression thereafter. Host genotyping failed to reveal any of the currently recognized protective factors associated with slow disease progression. This report indicates that elite controllers should be informed of the risk of super-infection, and illustrates the complexity of mounting broad anti-HIV immunity.

For abstract access click here: http://www.ncbi.nlm.nih.gov/pubmed/20153976
Editors’ note: Since superinfection was first described in 2002, there have been case reports and reviews but its frequency is difficult to assess. In countries with many circulating recombinant forms of HIV, dual infections are clearly frequent since they are needed for viruses to switch bits of RNA. This report of superinfection in two people injecting drugs in Lausanne who were elite controllers is perplexing. Elite controllers, as opposed to long-term non-progressors, have persistently undetectable viral loads and remain immunocompetent in the absence of antiretroviral therapy. It is estimated that less than 1 per cent of people living with HIV are elite controllers. These two individuals, who were elite controllers for the first years of their HIV infection with subtype B, deteriorated rapidly after becoming infected with a CRF11_cpx  recombinant strain. Other HIV-negative people in Lausanne who acquired this recombinant strain did not present an accelerated course of disease. The reasons for both results remain unclear but in the case of superinfection in elite controllers, this case report reinforces the importance of ‘positive health, dignity, and prevention’ as a strategy to avoid superinfection.
Basic science
No votes yet
  • Share this!
0 comments. Add a comment
The content of this field is kept private and will not be shown publicly.
April
11
2010

Breastfeeding

Elevations in mortality associated with weaning persist into the second year of life among uninfected children born to HIV-infected mothers.

Kuhn L, Sinkala M, Semrau K, Kankasa C, Kasonde P, Mwiya M, Hu CC, Tsai WY, Thea DM, Aldrovandi GM.  Clin Infect Dis. 2010;50:437-44.

Early weaning has been recommended to reduce postnatal human immunodeficiency virus (HIV) transmission. Kuhn et al evaluated the safety of stopping breast-feeding at different ages for mortality of uninfected children born to HIV-infected mothers. During a trial of early weaning, 958 HIV-infected mothers and their infants were recruited and followed up from birth to 24 months postpartum in Lusaka, Zambia. One-half of the cohort was randomized to wean abruptly at 4 months, and the other half of the cohort was randomized to continue breast-feeding. The authors examined associations between uninfected child mortality and actual breast-feeding duration and investigated possible confounding and effect modification. The mortality rate among 749 uninfected children was 9.4% by 12 months of age and 13.6% by 24 months of age. Weaning during the interval encouraged by the protocol (4-5 months of age) was associated with a 2.03-fold increased risk of mortality (95% confidence interval [CI], 1.13-3.65), weaning at 6-11 months of age was associated with a 3.54-fold increase (95% CI, 1.68-7.46), and weaning at 12-18 months of age was associated with a 4.22-fold increase (95% CI, 1.59-11.24). Significant effect modification was detected, such that risks associated with weaning were stronger among infants born to mothers with higher CD4(+) cell counts (>350 cells/microL). Shortening the normal duration of breast-feeding for uninfected children born to HIV-infected mothers living in low-resource settings is associated with significant increases in mortality extending into the second year of life. Intensive nutritional and counselling interventions reduce but do not eliminate this excess mortality.

For full text access click here:
http://www.journals.uchicago.edu/doi/abs/10.1086/649886?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dncbi.nlm.nih.gov
Editors’ note: Although women without HIV infection are strongly encouraged to breastfeed their babies for at least 24 months, concerns about breast milk HIV transmission in mothers with HIV infection have led to recommendations for exclusive breastfeeding for 6 months with abrupt weaning thereafter. In this study, all babies received trimethoprim-sulfamethoxasole to 12 months of age and those in the early weaning group received a fortified weaning cereal and a 3-month supply of commercial infant formula when they reached 4 months of age. Over the 24-month period of follow-up, weaning doubled the risk of death compared with continued breastfeeding, and it is likely that in the real world outside a trial setting that the risk of death would be even higher. Clearly, in striking the balance between protecting infants against non-HIV morbidity and mortality and protecting them from HIV, the new WHO recommendations swing strongly in favour of continued breastfeeding until at least 12 months. Daily nevirapine is recommended for the infant until the end of breastfeeding if the woman received AZT to prevent transmission during pregnancy. If she received a three-drug regimen during pregnancy, then a continued regimen of triple therapy is recommended through the end of the breastfeeding period. Encouraging women to extend the breastfeeding period well into the second year of life along with antiretroviral coverage will reduce both HIV-related and non-HIV related mortality.
MTCT and prevention
No votes yet
  • Share this!
0 comments. Add a comment
The content of this field is kept private and will not be shown publicly.
April
11
2010

Breastfeeding

Establishing individual peer counselling for exclusive breastfeeding in Uganda: implications for scaling-up.

Nankunda J, Tylleskär T, Ndeezi G, Semiyaga N, Tumwine JK; PROMISE-EBF Study Group. Matern Child Nutr. 2010;6:53-66.

Exclusive breastfeeding remains critical for child survival, potentially reducing childhood morbidity and mortality. In Uganda, 98% of children are ever breastfed, but exclusive breastfeeding levels remain low. Supporting mothers in breastfeeding exclusively can improve breastfeeding practices. This paper describes experiences of establishing individual peer counselling for exclusive breastfeeding in the Uganda site of the Promoting Infant Health and Nutrition in Sub-Saharan Africa: Safety and Efficacy of Exclusive Breastfeeding Promotion in the Era of HIV trial, and highlights some implications for scaling-up. Twelve women were identified by their communities, one from each of 12 clusters. They were trained for 6 days and followed up for 1 year while they counselled mothers. Their knowledge and attitudes towards exclusive breastfeeding were assessed before and immediately after training, and also 10 months into peer counselling. Observations, field notes and records of interactions with peer counsellors were used to record experiences from this intervention. The communities were receptive to peer counselling and women participated willingly. After training and 10 months' follow-up, their knowledge and attitude to exclusive breastfeeding improved. All were retained in the study, and mothers accepted them in their homes. They checked for mothers several times if they missed them on the first attempt. Husbands and grandmothers played key roles in infant feeding decisions. Involving the communities in selection helped to identify reliable breastfeeding peer counsellors who were acceptable to mothers and were retained in the study. Other key issues to consider for scaling-up such interventions include training and follow up of peer counsellors, which led to improved knowledge and attitudes towards exclusive breastfeeding.

For full text access click here:
http://www3.interscience.wiley.com/cgi-bin/fulltext/122359924/HTMLSTART
Editors’ note: Exclusive breastfeeding for 6 months means feeding only breast milk without adding anything, even water, except for prescribed medicines and vitamins. In Uganda, it is common practice to feed babies before breast milk comes (pre-lacteal feeds) and to introduce complementary foods early, as many mothers believe that breast milk is not enough. This small qualitative study of peer counselling to promote exclusive breastfeeding started by sensitising existing community leadership structures to gain community confidence. Village leaders convened meetings of village women at which 2 to 3 candidates were proposed for interview by the study team, among whom one was selected. This report describes the training and the evolution of attitudes of the peer counsellors, along with lessons learned that have implications for scaling up peer counselling for exclusive breastfeeding in similar environments. These include understanding the social dynamics and power structures at the community and household level and the importance of continuous support and supervision of peer counsellors. National and local communication campaigns promoting excusive breastfeeding are needed to provide supportive environments for such grassroots’ peer counselling.
MTCT and prevention
No votes yet
  • Share this!
0 comments. Add a comment
The content of this field is kept private and will not be shown publicly.