Saturday, September 29, 2007
Integrated health and transport strategies could help reduce maternal and child mortality rates
Thursday, September 27, 2007
Cost-effective public health interventions are not reaching developing country populations who need them. Programmes to deliver these interventions are too often patchy, low quality, inequitable, and short-lived. We review the challenges of going to scale—ie, building on known, effective interventions to achieve universal coverage. One challenge is to choose interventions consistent with the epidemiological profile of the population. A second is to plan for context-specific delivery mechanisms effective in going to scale, and to avoid uniform approaches. A third is to develop innovative delivery mechanisms that move incrementally along the vertical-to-horizontal axis as health systems gain capacity in service delivery. The availability of sufficient funds is essential, but constraints to reaching universal coverage go well beyond financial issues. Accurate estimates of resource requirements need a full understanding of the factors that limit intervention delivery. Sound decisions need to be made about the choice of delivery mechanisms, the sequence of action, and the pace at which services can be expanded. Strong health systems are required, and the time frames and funding cycles of national and international agencies are often unrealistically short."
Wednesday, September 26, 2007
Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months of life: an intervention cohort study
Exclusive breastfeeding, though better than other forms of infant feeding and associated with improved child survival, is uncommon. We assessed the HIV-1 transmission risks and survival associated with exclusive breastfeeding and other types of infant feeding.
2722 HIV-infected and uninfected pregnant women attending antenatal clinics in KwaZulu Natal, South Africa (seven rural, one semiurban, and one urban), were enrolled into a non-randomised intervention cohort study. Infant feeding data were obtained every week from mothers, and blood samples from infants were taken monthly at clinics to establish HIV infection status. Kaplan-Meier analyses conditional on exclusive breastfeeding were used to estimate transmission risks at 6 weeks and 22 weeks of age, and Cox's proportional hazard was used to quantify associations with maternal and infant factors.
1132 of 1372 (83%) infants born to HIV-infected mothers initiated exclusive breastfeeding from birth. Of 1276 infants with complete feeding data, median duration of cumulative exclusive breastfeeding was 159 days (first quartile [Q1] to third quartile [Q3], 122–174 days). 14·1% (95% CI 12·0–16·4) of exclusively breastfed infants were infected with HIV-1 by age 6 weeks and 19·5% (17·0–22·4) by 6 months; risk was significantly associated with maternal CD4-cell counts below 200 cells per μL (adjusted hazard ratio [HR] 3·79; 2·35–6·12) and birthweight less than 2500 g (1·81, 1·07–3·06). Kaplan-Meier estimated risk of acquisition of infection at 6 months of age was 4·04% (2·29–5·76). Breastfed infants who also received solids were significantly more likely to acquire infection than were exclusively breastfed children (HR 10·87, 1·51–78·00, p=0·018), as were infants who at 12 weeks received both breastmilk and formula milk (1·82, 0·98–3·36, p=0·057). Cumulative 3-month mortality in exclusively breastfed infants was 6·1% (4·74–7·92) versus 15·1% (7·63–28·73) in infants given replacement feeds (HR 2·06, 1·00–4·27, p=0·051).
The association between mixed breastfeeding and increased HIV transmission risk, together with evidence that exclusive breastfeeding can be successfully supported in HIV-infected women, warrant revision of the present UNICEF, WHO, and UNAIDS infant feeding guidelines.
Tuesday, September 25, 2007
Nutrition in Mother and Child Health, G.J. Ebrahim 1983
As this resource is slightly dated here is a link to a recent metanalysis on pubmed. You can also access to other articles through the website.
Contraceptive efficacy of lactational amenorrhoea.
Kennedy KI, Visness CM.
Family Health International, Research Triangle Park, North Carolina 27709.
Pregnancy is rare among breastfeeding women with lactational amenorrhoea. The lactational amenorrhoea method (LAM) is the informed use of breastfeeding as a contraceptive method by a woman who is still amenorrhoeic, and who is not feeding her baby with supplements, for up to 6 months after delivery. Under these three conditions, LAM users are thought to have 98% protection from pregnancy. It can be difficult, however, to determine when supplementation of the baby's diet begins. We have analysed data from nine studies of the recovery of fertility in breastfeeding women to assess the effectiveness of lactational amenorrhoea alone, irrespective of whether supplements have been introduced, as a fertility regulation method post partum. Cumulative probabilities of ovulation during lactational amenorrhoea were 30.9 and 67.3 per 100 women at 6 and 12 months, respectively, compared with 27.2 at 6 months when all three criteria of the LAM were met. Cumulative pregnancy rates during lactational amenorrhoea were 2.9 and 5.9 per 100 women at 6 and 12 months, compared with 0.7 at 6 months for the LAM. The probability of pregnancy during lactational amenorrhoea calculated from these studies is similar to that of other modern contraceptive methods, and it seems reasonable for a woman to rely on lactational amenorrhoea without regard to whether she is fully or partly breastfeeding. So that amenorrhoea and fertility suppression can be maintained, counselling about good breastfeeding and weaning practices remains important.
PIP: Researchers analyzed data on 346 women from prospective studies conducted in 8 different countries which examined return of ovulation in breast feeding mothers to determine the contraceptive effectiveness of lactational amenorrhea. The countries included Mexico, Thailand, Egypt, Pakistan, Philippines, Canada, Australia, and England. As a result of the Bellagio conference on breast feeding, health researchers have promoted the lactational amenorrhea method (LAM) as a family planning method for 6 months postpartum. Lactational amenorrhea provided significant protection from pregnancy. The researchers learned that the effect of LAM during amenorrhea and before food supplementation was a life table pregnancy rate of 0.7/100 women at 6 months postpartum. Indeed when they considered food supplementation the rates for 6 months and 12 months postpartum stood at 2.9 and 5.9 respectively. These rates showed that LAM provided either greater than or equal protection against pregnancy during the 1st 12 months postpartum in the US than typical modern contraceptive method use. The researchers did observe, however, that LAM had high discontinuation rates. For example, by 12 months, menstruation had returned to 87.5% of all the women. The researchers recommended that health workers continue to promote breast feeding practices that encourage increased suckling since reduced suckling precipitates the return of ovulation. In fact, they hypothesized that improved breast feeding practices which increase the duration of lactational amenorrhea may actually result in greater protection. Since the findings revealed that LAM had low pregnancy rates and high discontinuation rates, LAM can be used to time when to begin other contraceptive methods.
PMID: 1346183 [PubMed - indexed for MEDLINE]
Another article from 1993
Advocacy groups and important websites
World Alliance for Breastfeeding Action (conveners of World Breastfeeding Week, August 1-7)