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2.
Nat Med ; 25(8): 1205-1212, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31332393

RESUMEN

Exclusive breastfeeding (EBF)-giving infants only breast-milk (and medications, oral rehydration salts and vitamins as needed) with no additional food or drink for their first six months of life-is one of the most effective strategies for preventing child mortality1-4. Despite these advantages, only 37% of infants under 6 months of age in Africa were exclusively breastfed in 20175, and the practice of EBF varies by population. Here, we present a fine-scale geospatial analysis of EBF prevalence and trends in 49 African countries from 2000-2017, providing policy-relevant administrative- and national-level estimates. Previous national-level analyses found that most countries will not meet the World Health Organization's Global Nutrition Target of 50% EBF prevalence by 20256. Our analyses show that even fewer will achieve this ambition in all subnational areas. Our estimates provide the ability to visualize subnational EBF variability and identify populations in need of additional breastfeeding support.


Asunto(s)
Lactancia Materna/estadística & datos numéricos , África/epidemiología , Femenino , Infecciones por VIH/transmisión , Humanos , Lactante , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa , Prevalencia , Factores de Tiempo , Organización Mundial de la Salud
3.
Adv Nutr ; 10(3): 380-390, 2019 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-31093650

RESUMEN

The Global Burden of Disease study (GBD) is an ambitious effort to estimate the disease burden attributable to various risk factors. The results from the GBD are used around the world to monitor the UN established Sustainable Development Goals, set health policies and research strategies, among others. The GBD along with other studies, such as those from the Maternal Child Epidemiology Estimation Group and the Lancet Breastfeeding Series Group, produce estimates of the nutrition-related global burden of disease that exhibit considerable differences. These differences are difficult to reconcile due to the estimation methods, which in recent years have substantially increased in complexity. In this paper, we give a detailed review of the methods used by GBD and other entities to estimate the global burden of disease that is attributable to undernutrition and suboptimal breastfeeding. Further, we compare the methods to determine causes for differences in estimates. We find that the main determinant of differences in estimates is what causes of death are linked to each risk factor. Methods used to estimate nutrition-related disease burden need to be more clearly documented to foster discussion and collaboration on the important assumptions required to produce estimates.


Asunto(s)
Lactancia Materna/estadística & datos numéricos , Carga Global de Enfermedades/métodos , Salud Global/estadística & datos numéricos , Desnutrición/mortalidad , Estadística como Asunto/métodos , Causas de Muerte , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Factores de Riesgo , Desarrollo Sostenible
4.
Nature ; 555(7694): 41-47, 2018 02 28.
Artículo en Inglés | MEDLINE | ID: mdl-29493591

RESUMEN

Insufficient growth during childhood is associated with poor health outcomes and an increased risk of death. Between 2000 and 2015, nearly all African countries demonstrated improvements for children under 5 years old for stunting, wasting, and underweight, the core components of child growth failure. Here we show that striking subnational heterogeneity in levels and trends of child growth remains. If current rates of progress are sustained, many areas of Africa will meet the World Health Organization Global Targets 2025 to improve maternal, infant and young child nutrition, but high levels of growth failure will persist across the Sahel. At these rates, much, if not all of the continent will fail to meet the Sustainable Development Goal target-to end malnutrition by 2030. Geospatial estimates of child growth failure provide a baseline for measuring progress as well as a precision public health platform to target interventions to those populations with the greatest need, in order to reduce health disparities and accelerate progress.


Asunto(s)
Desarrollo Infantil , Trastornos del Crecimiento/epidemiología , Crecimiento , Desnutrición/epidemiología , Síndrome Debilitante/epidemiología , África/epidemiología , Preescolar , Femenino , Objetivos , Trastornos del Crecimiento/prevención & control , Humanos , Lactante , Recién Nacido , Masculino , Desnutrición/prevención & control , Prevalencia , Salud Pública/estadística & datos numéricos , Delgadez/epidemiología , Delgadez/prevención & control , Síndrome Debilitante/prevención & control , Organización Mundial de la Salud
5.
Epidemiol. serv. saúde ; 25(1): [20], jan.-mar. 2016.
Artículo en Portugués | LILACS, BDS | ID: biblio-986853

RESUMEN

Apesar de seus benefícios estabelecidos, a amamentação não é mais uma norma em muitas comunidades. Os determinantes multifatoriais da amamentação necessitam de medidas de suporte em diversos níveis, de legislações e políticas a atitudes e valores sociais, condições de trabalho e emprego para mulheres, e serviços de saúde para possibilitar que as mulheres amamentem. Quando intervenções relevantes são oferecidas adequadamente, as práticas de amamentação são responsivas e podem melhorar rapidamente. Os melhores resultados são obtidos quando intervenções são implementadas concomitantemente por diversos canais. A propaganda de substitutos ao leite materno afeta negativamente a amamentação: as vendas em todo o mundo em 2014 de 44,8 bilhões de dólares demonstram a grande ambição competitiva da indústria com a alimentação infantil. Não amamentar está associado com menor inteligência e perdas econômicas de aproximadamente 302 bilhões de dólares anualmente ou 0,49% do produto nacional bruto mundial. A amamentação fornece, em curto e longo prazos, vantagens para a saúde, econômicas e ambientais para as crianças, mulheres e para a sociedade. Para alcançar estes ganhos, suporte político e investimento financeiro são necessários para proteger, promover e dar suporte à amamentação.


Asunto(s)
Humanos , Recién Nacido , Lactante , Lactancia Materna , Política de Salud , Nutrición del Niño , Estilo de Vida Saludable
6.
Lancet ; 387(10017): 491-504, 2016 Jan 30.
Artículo en Inglés | MEDLINE | ID: mdl-26869576

RESUMEN

Despite its established benefits, breastfeeding is no longer a norm in many communities. Multifactorial determinants of breastfeeding need supportive measures at many levels, from legal and policy directives to social attitudes and values, women's work and employment conditions, and health-care services to enable women to breastfeed. When relevant interventions are delivered adequately, breastfeeding practices are responsive and can improve rapidly. The best outcomes are achieved when interventions are implemented concurrently through several channels. The marketing of breastmilk substitutes negatively affects breastfeeding: global sales in 2014 of US$44·8 billion show the industry's large, competitive claim on infant feeding. Not breastfeeding is associated with lower intelligence and economic losses of about $302 billion annually or 0·49% of world gross national income. Breastfeeding provides short-term and long-term health and economic and environmental advantages to children, women, and society. To realise these gains, political support and financial investment are needed to protect, promote, and support breastfeeding.


Asunto(s)
Lactancia Materna/economía , Lactancia Materna/tendencias , Inversiones en Salud , Empleo/economía , Femenino , Industria de Alimentos/economía , Producto Interno Bruto , Humanos , Lactante , Inteligencia , Mercadotecnía , Sustitutos de la Leche/economía , Mujeres Trabajadoras
8.
Food Nutr Bull ; 36(4): 373-86, 2015 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-26314734

RESUMEN

BACKGROUND: Suboptimal breastfeeding results in 800 000 child deaths annually. There are multiple causes of suboptimal breastfeeding, including marketing of breast-milk substitutes. OBJECTIVES: To describe sales and marketing of breast-milk substitutes and their influence on World Health Organization-recommended breastfeeding behaviors, focusing on low- and middle-income countries. METHODS: Literature review. RESULTS: Global sales of breast-milk substitutes reached US$40 billion in 2013. Growth in sales exceeds 10% annually in many low- and middle-income countries, while it is close to stagnant in high-income countries. Breast-milk substitutes are marketed directly to consumers via mass media and print advertisements and indirectly via incentives, free supplies, and promotions to and through health workers and facilities, retailers, and policy makers. Internet marketing via company web sites and social media is on the rise. Marketing influences social norms by making formula use seem to be extensive, modern, and comparable to or better than breast milk. Clear evidence of a negative impact is found when breast-milk substitutes are provided for free in maternity facilities and when they are promoted by health workers and in the media. Influences through other channels are plausible, but rigorous studies are lacking. It was not possible with the data available to quantify the impact of marketing relative to other factors on suboptimal breastfeeding behaviors. Marketing remains widespread even in countries that have adopted the International Code of Marketing of Breast-milk Substitutes to restrict such activities. CONCLUSION: Adoption of stricter regulatory frameworks coupled with independent, quantitative monitoring and compliance enforcement are needed to counter the impacts of formula marketing globally.


Asunto(s)
Lactancia Materna/métodos , Publicidad Directa al Consumidor , Sustitutos de la Leche , Leche Humana , Organización Mundial de la Salud , Publicidad Directa al Consumidor/métodos , Evaluación del Impacto en la Salud , Promoción de la Salud , Humanos , Renta , Lactante , Fórmulas Infantiles , Mortalidad Infantil , Fenómenos Fisiológicos Nutricionales del Lactante , Recién Nacido , Medios de Comunicación de Masas , Política Nutricional , Pobreza
9.
Matern Child Nutr ; 10(4): 562-74, 2014 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-24847768

RESUMEN

Undernutrition in infants and young children is a global health priority while overweight is an emerging issue. Small-scale studies in low- and middle-income countries have demonstrated consumption of sugary and savoury snack foods and soft drinks by young children. We assessed the proportion of children 6-23 months of age consuming sugary snack foods in 18 countries in Asia and Africa using data from selected Demographic and Health Surveys and household expenditures on soft drinks and biscuits using data from four Living Standards Measurement Studies (LSMS). Consumption of sugary snack foods increased with the child's age and household wealth, and was generally higher in urban vs. rural areas. In one-third of countries, >20% of infants 6-8 months consumed sugary snacks. Up to 75% of Asian children and 46% of African children consumed these foods in the second year of life. The proportion of children consuming sugary snack foods was generally higher than the proportion consuming fortified infant cereals, eggs or fruit. Household per capita daily expenditures on soft drinks ranged from $0.03 to $0.11 in three countries for which LSMS data were available, and from $0.01 to $0.04 on biscuits in two LSMS. Future surveys should include quantitative data on the purchase and consumption of snack foods by infants and young children, using consistent definitions and methods for identifying and categorising snack foods across surveys. Researchers should assess associations between snack food consumption and stunting and overweight, and characterise household, maternal and child characteristics associated with snack food consumption.


Asunto(s)
Bebidas Gaseosas , Países en Desarrollo , Conducta Alimentaria , Alimentos Fortificados , Desnutrición/epidemiología , Bocadillos , África/epidemiología , Asia/epidemiología , Conducta de Elección , Estudios Transversales , Encuestas sobre Dietas , Grano Comestible , Huevos , Preferencias Alimentarias , Frutas , Trastornos del Crecimiento/epidemiología , Trastornos del Crecimiento/etiología , Humanos , Lactante , Alimentos Infantiles , Desnutrición/complicaciones
10.
Matern Child Nutr ; 9(2): 217-32, 2013 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-22099216

RESUMEN

There are potential health risks associated with the use of early weaning to prevent mother-to-child transmission of human immunodeficiency virus (HIV) in resource-poor settings. Our objective was to examine growth and nutrient inadequacies among a cohort of children weaned early. Children participating in the Breastfeeding Antiretrovirals and Nutrition (BAN) Study in Lilongwe, Malawi, had HIV-infected mothers, were weaned at 6 months and fed LNS until 12 months. 40 HIV-negative, BAN-exited children were compared with 40 HIV-negative, community children matched on age, gender and local health clinic. Nutrient intake was calculated from 24-h dietary recalls collected from BAN-exited children. Anthropometric measurements were collected from BAN-exited and matched community children at 15-16 months, and 2 months later. Longitudinal random effects sex-stratified models were used to evaluate anthropometric differences between the two groups. BAN-exited children consumed adequate energy, protein and carbohydrates but inadequate amounts of fat. The prevalence of inadequate micronutrient intakes were: 46% for vitamin A; 20% for vitamin B6; 69% for folate; 13% for vitamin C; 19% for iron; 23% for zinc. Regarding growth, BAN-exited girls gained weight at a significantly lower rate {0.02 g kg(-1) per day [95% confidence interval (CI): 0.01, 0.03]} than their matched comparison [0.05 g kg(-1) per day (95% CI: 0.03, 0.07)]; BAN girls grew significantly slower [0.73 cm month(-1) (95% CI: 0.40,1.06)] than their matched comparison (1.55 cm month(-1) [95% CI: 0.98, 2.12]). Among this sample of BAN-exited children, early weaning was associated with dietary deficiencies and girls experienced reduced growth velocity. In resource-poor settings, HIV prevention programmes must ensure that breastfeeding stop only once a nutritionally adequate and safe diet without breast milk can be provided.


Asunto(s)
Dieta , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Destete , Adulto , Antirretrovirales/administración & dosificación , Ácido Ascórbico/administración & dosificación , Peso Corporal , Lactancia Materna/métodos , Grasas de la Dieta/administración & dosificación , Proteínas en la Dieta/administración & dosificación , Ingestión de Energía , Femenino , Ácido Fólico/administración & dosificación , Estudios de Seguimiento , Seronegatividad para VIH , Humanos , Lactante , Hierro de la Dieta/administración & dosificación , Estudios Longitudinales , Malaui , Masculino , Desnutrición/epidemiología , Desnutrición/prevención & control , Micronutrientes/administración & dosificación , Estado Nutricional , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Riesgo , Estaciones del Año , Factores Socioeconómicos , Encuestas y Cuestionarios , Vitamina A/administración & dosificación , Vitamina B 6/administración & dosificación , Vitaminas/administración & dosificación , Adulto Joven , Zinc/administración & dosificación
11.
Am J Clin Nutr ; 95(3): 759-65, 2012 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-22258269

RESUMEN

BACKGROUND: Breastfeeding increases metabolic demands on the mother, and excessive postnatal weight loss increases maternal mortality. OBJECTIVE: We evaluated the efficacy of a lipid-based nutrient supplement (LNS) for prevention of excess weight loss in breastfeeding, HIV-infected women. DESIGN: The BAN (Breastfeeding, Antiretrovirals, and Nutrition) Study was a randomized controlled trial in Lilongwe, Malawi. At delivery, HIV-infected mothers and their infants were randomly assigned according to a 2-arm (with and without LNS) by 3-arm (maternal triple-antiretroviral prophylaxis, infant-nevirapine prophylaxis, or neither) factorial design. The 28-wk LNS intervention provided daily energy (700 kcal), protein (20 g), and micronutrients (except for vitamin A) to meet lactation needs. Women were counseled to breastfeed exclusively for 24 wk and to wean by 28 wk. Weight change (0-28 wk) was tested in an intent-to-treat analysis by using 2-factor ANOVA and with longitudinal mixed-effects models. RESULTS: At delivery, the LNS (n = 1184) and control (n = 1185) groups had similar mean weights and BMIs. Women receiving the LNS had less 0-28-wk weight loss (-1.97 compared with -2.56 kg, P = 0.003). This difference remained significant after adjustment for maternal antiretroviral drug therapy and baseline BMI. Women receiving antiretroviral drugs had more weight loss than did those not receiving antiretroviral drugs (-2.93 compared with -1.90 kg, P < 0.001). The benefit of the LNS for reducing weight loss was observed both in those receiving antiretroviral drugs (-2.56 compared with -3.32 kg, P = 0.019) and in those not receiving antiretroviral drugs (-1.63 compared with -2.16 kg, P = 0.034). CONCLUSIONS: The LNS reduced weight loss among HIV-infected, breastfeeding women, both in those taking maternal antiretroviral prophylaxis to prevent postnatal HIV transmission and in those not receiving antiretroviral prophylaxis. Provision of an LNS may benefit HIV-infected, breastfeeding women in resource-limited settings. This trial was registered at clinicaltrials.gov as NCT00164762.


Asunto(s)
Lactancia Materna , Infecciones por VIH/transmisión , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Pérdida de Peso , Adulto , Antirretrovirales/administración & dosificación , Suplementos Dietéticos , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , VIH-1/patogenicidad , Humanos , Lípidos/administración & dosificación , Estudios Longitudinales , Malaui/epidemiología , Nevirapina/administración & dosificación , Embarazo , Adulto Joven
12.
AIDS Educ Prev ; 23(3): 281-95, 2011 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-21696245

RESUMEN

International guidelines recommend EBF to age 6 months among HIV-infected mothers choosing to breast-feed and cessation thereafter if replacement feeding is acceptable, feasible, affordable, sustainable, and safe. When mothers wean, they are challenged to provide an adequate replacement diet. This study investigates the use and acceptability of a lipid-based nutrient supplement (LNS) as a breast-milk substitute when provided to infants (6-12 mo) of HIV-positive mothers, as part of the Breast-feeding, Antiretroviral, and Nutrition (BAN) Study. A sub-sample of mothers (n = 45) participated in interviews that explored EBF, weaning, and strategies to feed LNS. Mothers reported several weaning strategies, including gradual reduction of breast-feeding, expressing breast-milk into a cup, and separation of mother and child. LNS, a peanut-based micronutrient fortified paste, was highly accepted and incorporated into the traditional diet. Weaning is a feasible HIV prevention method among this population in Malawi when supported by the provision of LNS as a breast-milk substitute.


Asunto(s)
Lactancia Materna , Infecciones por VIH/prevención & control , Infecciones por VIH/transmisión , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Aceptación de la Atención de Salud , Destete , Adulto , Antivirales/uso terapéutico , Estudios de Factibilidad , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Lactante , Malaui , Leche Humana , Madres , Embarazo , Complicaciones Infecciosas del Embarazo/prevención & control
13.
BMJ ; 341: c6580, 2010 Dec 22.
Artículo en Inglés | MEDLINE | ID: mdl-21177735

RESUMEN

OBJECTIVES: To estimate the rates and timing of mother to infant transmission of HIV associated with breast feeding in mothers who seroconvert postnatally, and their breast milk and plasma HIV loads during and following seroconversion, compared with women who tested HIV positive at delivery. DESIGN: Prospective cohort study. SETTING: Urban Zimbabwe. PARTICIPANTS: 14 110 women and infants enrolled in the Zimbabwe Vitamin A for Mothers and Babies (ZVITAMBO) trial (1997-2001). MAIN OUTCOME MEASURES: Mother to child transmission of HIV, and breast milk and maternal plasma HIV load during the postpartum period. RESULTS: Among mothers who tested HIV positive at baseline and whose infant tested HIV negative with polymerase chain reaction (PCR) at six weeks (n=2870), breastfeeding associated transmission was responsible for an average of 8.96 infant infections per 100 child years of breast feeding (95% CI 7.92 to 10.14) and varied little over the breastfeeding period. Breastfeeding associated transmission for mothers who seroconverted postnatally (n=334) averaged 34.56 infant infections per 100 child years (95% CI 26.60 to 44.91) during the first nine months after maternal infection, declined to 9.50 (95% CI 3.07 to 29.47) during the next three months, and was zero thereafter. Among women who seroconverted postnatally and in whom the precise timing of infection was known (≤90 days between last negative and first positive test; n=51), 62% (8/13) of transmissions occurred in the first three months after maternal infection and breastfeeding associated transmission was 4.6 times higher than in mothers who tested HIV positive at baseline and whose infant tested HIV negative with PCR at six weeks. Median plasma HIV concentration in all mothers who seroconverted postnatally declined from 5.0 log(10) copies/mL at the last negative enzyme linked immunosorbent assay (ELISA) to 4.1 log(10) copies/mL at 9-12 months after infection. Breast milk HIV load in this group was 4.3 log(10) copies/mL 0-30 days after infection, but rapidly declined to 2.0 log(10) copies/mL and <1.5 log(10) copies/mL by 31-90 days and more than 90 days, respectively. Among women whose plasma sample collected soon after delivery tested negative for HIV with ELISA but positive with PCR (n=17), 75% of their infants were infected or had died by 12 months. An estimated 18.6% to 20.4% of all breastfeeding associated transmission observed in the ZVITAMBO trial occurred among mothers who seroconverted postnatally. CONCLUSIONS: Breastfeeding associated transmission is high during primary maternal HIV infection and is mirrored by a high but transient peak in breast milk HIV load. Around two thirds of breastfeeding associated transmission by women who seroconvert postnatally may occur while the mother is still in the "window period" of an antibody based test, when she would test HIV negative using one of these tests. Trial registration Clinical trials.gov NCT00198718.


Asunto(s)
Lactancia Materna/efectos adversos , Infecciones por VIH/transmisión , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Adulto , Ensayo de Inmunoadsorción Enzimática , Femenino , Infecciones por VIH/epidemiología , Seropositividad para VIH/epidemiología , Humanos , Lactante , Masculino , Leche Humana/virología , Atención Posnatal , Estudios Prospectivos , Factores de Riesgo , Carga Viral , Vitamina A/uso terapéutico , Vitaminas/uso terapéutico , Zimbabwe/epidemiología
14.
AIDS Educ Prev ; 21(2): 141-55, 2009 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-19397436

RESUMEN

A process evaluation of nurses' implementation of an infant-feeding counseling protocol was conducted for the Breastfeeding, Antiretroviral and Nutrition (BAN) Study, a prevention of mother-to-child transmission of HIV clinical trial in Lilongwe, Malawi. Six trained nurses counseled HIV-infected mothers to exclusively breastfeed for 24 weeks postpartum and to stop breastfeeding within an additional four weeks. Implementation data were collected via direct observations of 123 infant feeding counseling sessions (30 antenatal and 93 postnatal) and interviews with each nurse. Analysis included calculating a percent adherence to checklists and conducting a content analysis for the observation and interview data. Nurses were implementing the protocol at an average adherence level of 90% or above. Although not detailed in the protocol, nurses appropriately counseled mothers on their actual or intended formula milk usage after weaning. Results indicate that nurses implemented the protocol as designed. Results will help to interpret the BAN Study's outcomes.


Asunto(s)
Lactancia Materna , Infecciones por VIH/prevención & control , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Relaciones Enfermero-Paciente , Educación del Paciente como Asunto/métodos , Adulto , Femenino , Infecciones por VIH/transmisión , Humanos , Lactante , Recién Nacido , Malaui , Destete
15.
Am J Public Health ; 97(7): 1249-54, 2007 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-17538064

RESUMEN

OBJECTIVES: We assessed the association between exposure to an educational intervention that emphasized safer breastfeeding practices and postnatal HIV transmission among 437 HIV-positive mothers in Zimbabwe, 365 of whom did not know their infection status. METHODS: Mothers were tested for HIV and were encouraged--but not required--to learn their HIV status. Intervention exposure was assessed by a questionnaire, Turnbull methods were used to estimate postnatal HIV transmission, and multivariate Cox proportional hazard models were constructed to assess the association between intervention exposure and postnatal HIV transmission. RESULTS: Cumulative postnatal HIV transmission was 8.2%; each additional intervention contact was associated with a 38% reduction in postnatal HIV transmission. HIV-positive mothers who were exposed to both print and video materials were 79% less likely to infect their infants compared with mothers who had no exposure. These findings were similar for mothers who did not know their HIV status. CONCLUSIONS: The promotion of exclusive breastfeeding has the potential to reduce postnatal HIV transmission among women who do not know their HIV status, and child survival and HIV prevention programs should support this practice.


Asunto(s)
Lactancia Materna , Infecciones por VIH/prevención & control , VIH-1 , Educación en Salud/métodos , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Leche Humana/virología , Serodiagnóstico del SIDA , Adulto , Consejo , Ensayo de Inmunoadsorción Enzimática , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , Humanos , Lactante , Recién Nacido , Evaluación de Resultado en la Atención de Salud , Reacción en Cadena de la Polimerasa , Modelos de Riesgos Proporcionales , Zimbabwe/epidemiología
16.
Pediatr Infect Dis J ; 26(6): 519-26, 2007 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-17529870

RESUMEN

BACKGROUND: HIV causes substantial mortality among African children but there is limited data on how this is influenced by maternal or infant infection status and timing. METHODS: Children enrolled in the ZVITAMBO trial were divided into 5 groups: those born to HIV-negative mothers (NE, n = 9510), those born to HIV-positive mothers but noninfected (NI, n = 3135), those infected in utero (IU, n = 381), those infected intrapartum (IP, n = 508), and those infected postnatally (PN, n = 258). Their mortality was estimated. RESULTS: Two-year mortality was 2.9% (NE infants), 9.2% (NI), 67.5% (IU), 65.1% (IP), and 33.2% (PN). Between 8 weeks and 6 months, mortality in IU infants quintupled (from 309 to 1686/1000 c-y). The median time from infection to death was 208, 380, and >500 days for IU, IP, and PN infants, respectively. Among NI children, advanced maternal disease was predictive of mortality. Acute respiratory infection was the major cause of death. CONCLUSIONS: Perinatally infected infants are at particular risk of death between 2 and 6 months: cotrimoxazole prophylaxis and early pediatric HAART should be scaled up. Uninfected infants of infected mothers have at least twice the mortality risk of infants born to uninfected mothers: all HIV-exposed infants should be targeted with child survival interventions. HIV-positive mothers with more advanced disease are not only more likely to infect their infants, but their infants are more likely to die, whether infected or not: provision of antiretroviral treatment to pregnant and lactating women is an urgent need for both mothers and their children.


Asunto(s)
Mortalidad del Niño , Infecciones por VIH/mortalidad , Mortalidad Infantil , Adolescente , Adulto , Causas de Muerte , Preescolar , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Humanos , Lactante , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa , Masculino , Embarazo , Infecciones del Sistema Respiratorio/complicaciones , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/mortalidad , Factores de Riesgo , Factores de Tiempo , Zimbabwe/epidemiología
17.
Am J Clin Nutr ; 85(5): 1327-34, 2007 May.
Artículo en Inglés | MEDLINE | ID: mdl-17490970

RESUMEN

BACKGROUND: Women infected with HIV face a combination of health threats that include compromised nutrition and adverse gynecological conditions. This relation among HIV, nutrition, and gynecological conditions is complex and has rarely been investigated. OBJECTIVE: Our objective was to investigate nutritional biomarkers associated with several gynecological conditions among US women with or at risk of HIV infection. DESIGN: Data on 369 HIV-infected and 184 HIV-uninfected women with both nutritional and gynecological outcomes were analyzed from a cross-sectional nutritional substudy of the HIV Epidemiology Research Study (HERS). We examined micronutrient distributions comparing HIV-infected with HIV-uninfected participants and both subgroups with the US population. We then modeled the relation of 16 micronutrient serum concentrations to various gynecological conditions, producing partially adjusted odds ratios, adjusted for study site, risk cohort, and HIV status. RESULTS: HIV-infected women's median antioxidant concentrations were lower than the medians of the US population. HERS women had lower median concentrations for vitamin A, selenium, and zinc irrespective of HIV status. Trichomoniasis prevalence was inversely related to serum alpha-carotene. Lower concentrations of vitamins A, C, and E and beta-carotene were associated with an increased risk of bacterial vaginosis. Higher concentrations of serum zinc were associated with lower risk of human papillomavirus. Candida colonization was higher among women with higher concentrations of total-iron-binding capacity. CONCLUSION: We identified several significant associations of micronutrient concentrations with the prevalence of gynecological conditions. These findings warrant further investigation into possible causal relations.


Asunto(s)
Infecciones por VIH/sangre , Infecciones por VIH/complicaciones , Estado de Salud , Estado Nutricional , Infecciones por Papillomavirus/epidemiología , Vaginosis Bacteriana/epidemiología , Adulto , Biomarcadores/sangre , Estudios Transversales , Femenino , Infecciones por VIH/epidemiología , Encuestas Epidemiológicas , Humanos , Micronutrientes/sangre , Oportunidad Relativa , Infecciones por Papillomavirus/sangre , Factores de Riesgo , Vaginosis Bacteriana/sangre , Vitaminas/sangre
18.
Contemp Clin Trials ; 28(1): 59-67, 2007 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-17000137

RESUMEN

OBJECTIVE: To learn the attitudes and concerns of the local community on participating in research, infant feeding practices, and maternal nutrition in order to inform the design of a clinical trial in Lilongwe, Malawi on the safety and efficacy of antiretroviral and nutrition interventions to reduce postnatal transmission of HIV. DESIGN: Formative research methods were used, including semi-structured interviews, focus group discussions, home observations, and taste trials. Data were collected, analyzed, and incorporated into the protocol within 3 months. RESULTS: Participants were supportive of the clinical trial, although their overall understanding of research was limited. Mothers agreed that infants' blood could be drawn by venipuncture, yet concern was raised about the amount of blood proposed to be collected from both infants and mothers. Data demonstrated that rapid breastfeeding cessation would be difficult and malnutrition could be a risk if infants were weaned early. Mothers selected a maternal supplement suitable for use in the clinical trial. CONCLUSIONS: The protocol was rapidly modified to achieve cultural acceptability while maintaining study objectives. Without the formative research, several significant areas would have been undetected and may have jeopardized the implementation of the trial. Additional research was carried out to develop a meaningful informed consent process, the amount of blood collected was reduced to acceptable levels, and the protocol was modified to reduce the risk of malnutrition. Researchers who conduct clinical trials are encouraged to incorporate formative research into their protocol design to ensure participant understanding of the research, to safeguard participants, and to increase feasibility and acceptance of the clinical research in the community.


Asunto(s)
Participación de la Comunidad/métodos , Infecciones por VIH/prevención & control , Infecciones por VIH/transmisión , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Ensayos Clínicos Controlados Aleatorios como Asunto/métodos , Proyectos de Investigación , Adulto , Antirretrovirales/uso terapéutico , Lactancia Materna , Suplementos Dietéticos , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/psicología , Conocimientos, Actitudes y Práctica en Salud , Humanos , Lactante , Recién Nacido , Entrevistas como Asunto , Malaui , Cooperación del Paciente
19.
AIDS ; 20(15): 1981-4, 2006 Oct 03.
Artículo en Inglés | MEDLINE | ID: mdl-16988523

RESUMEN

We examined the relationship between sex and the risk of intrauterine, intrapartum and postnatal HIV transmission among 4495 infants born to HIV-infected mothers in Harare, Zimbabwe. Intrauterine transmission was 8.6%, and consistent with other studies was higher among girl than boy infants (AOR 1.53; 95% CI 1.23-1.91). Unlike previous studies, we observed no independent effect of infant sex on intrapartum or breastfeeding-associated HIV transmission. Sex-specific postnatal prevention strategies are not warranted in this population.


Asunto(s)
Infecciones por VIH/transmisión , VIH-1 , Complicaciones Infecciosas del Embarazo , Sexo , Adulto , Lactancia Materna , Femenino , Humanos , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa , Masculino , Embarazo , Infección Puerperal , Factores de Riesgo , Zimbabwe
20.
Int Breastfeed J ; 1(1): 2, 2006 Mar 09.
Artículo en Inglés | MEDLINE | ID: mdl-16722580

RESUMEN

BACKGROUND: To prevent postnatal transmission of HIV in settings where safe alternatives to breastfeeding are unavailable, the World Health Organization (WHO) recommends exclusive breastfeeding followed by early, rapid cessation of breastfeeding. Only limited data are available on the attitudes of health workers toward this recommendation and the impact of these attitudes on infant feeding counselling messages given to mothers. METHODS: As part of the Breastfeeding, Antiretroviral, and Nutrition (BAN) clinical trial, we carried out an in-depth qualitative study of the attitudes, beliefs, and counselling messages of 19 health workers in Lilongwe, Malawi. RESULTS: Although none of the workers had received formal training, several reported having counseled HIV-positive mothers about infant feeding. Health workers with counselling experience believed that HIV-infected mothers should breastfeed exclusively, rather than infant formula feed, citing poverty as the primary reason. Because of high levels of malnutrition, all the workers had concerns about early cessation of breastfeeding. CONCLUSION: Important differences were observed between the WHO recommendations and the attitudes and practices of the health workers. Understanding these differences is important for designing effective interventions.

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