The practice of exclusive breastfeeding among mothers attending a postnatal clinic in Tswaing subdistrict, North West province

Objectives: The aim of this study was to determine reported infant feeding practice with reference to exclusive breastfeeding; exclusive formula feeding and mixed feeding at six weeks postpartum among women attending a postnatal clinic in the Tswaing subdistrict of North West province; and the strength of the association between maternal human immunodeficiency virus (HIV) status and exclusive breastfeeding. Design: Three hundred and eighty-six randomly selected women from seven primary healthcare clinics in Tswaing subdistrict; who were in their sixth postnatal week between November 2009 and February 2010; were enrolled in this study. Data were collected using a researcher-formulated questionnaire to ascertain demographics; including HIV status; as well as reported infant feeding practice. Secondary analysis was carried out to determine the strength of the association between the HIV status of the subjects and exclusive breastfeeding. Setting and subjects: This study was conducted among women over the age of 18 years attending their first six weeks postnatal visit in seven primary healthcare clinics that provide postnatal care in the rural Tswaing subdistrict of the North West Province. Outcome measures: The self-reported infant feeding practice at six weeks postpartum; demographic determinants of reported infant feeding practice; and the strength of the association between maternal HIV status and reported infant feeding practice; particularly exclusive breastfeeding; constituted the main outcome measures. Results: Comparatively; more HIV-negative (n = 157); than HIV-positive women (n = 43); reported that they were breastfeeding exclusively and had received infant feeding counselling (n = 258 vs. n = 65; p-value 0.05). Exposure to infant feeding counselling and a negative HIV status were associated with higher exclusive breastfeeding rates. Conclusion: HIV-positive women are still at risk of transmitting HIV to their nursing infants on account of suboptimal infant feeding methods in the prevention of mother-to-child transmission (PMTCT) context. This calls for further research in this area; and in the interim; more support to pregnant and nursing HIV-positive mothers; with a view to achieving the aims of the PMTCT programme

The role of urinary soluble endoglin in the diagnosis of pre-eclampsia: comparison with soluble fms-like tyrosine kinase 1 to placental growth factor ratio.

OBJECTIVE: Endoglin, an anti-angiogenic glycoprotein expressed on endothelial cells, has been proposed recently as a biomarker of pre-eclampsia (PE). Given that PE is characterised by an imbalance of angiogenic factors, we sought to determine the clinical utility of urinary soluble endoglin, relative to the soluble fms-like tyrosine kinase 1 to placental growth factor (PlGF) ratio, in the diagnosis of PE during gestation. DESIGN: Prospective observational cohort. SETTING: Tertiary referral university hospital. POPULATION: Two hundred and thirty-four pregnant women were enrolled prospectively in the following groups: healthy controls, n = 63; gestational age (GA), median (interquartile range), 33 weeks (27-39 weeks); chronic hypertension, n = 27; GA, 33 weeks (30-36 weeks); mild PE, n = 38; GA, 37 weeks (34-40 weeks); severe PE, n = 106; GA, 32 weeks (29-37 weeks). METHODS: Free urinary levels of soluble endoglin, soluble fms-like tyrosine kinase 1 and PlGF were measured by sensitive and specific immunoassay. Levels for all urinary analytes were normalised to creatinine. MAIN OUTCOME MEASURES: Urinary soluble endoglin, and the soluble fms-like tyrosine kinase 1 to PlGF ratio. RESULTS: In healthy controls, urinary soluble endoglin levels were increased significantly at term relative to those earlier in gestation. Severe PE was characterised by an increased urinary level of soluble endoglin, soluble fms-like tyrosine kinase 1, protein to creatinine ratio and soluble fms-like tyrosine kinase 1 to PlGF ratio compared with all other groups. There was a direct correlation between urinary soluble endoglin and proteinuria that remained after GA correction (R = 0.382, P < 0.001). Urinary soluble endoglin could not differentiate mild PE from severe preterm PE. Overall, soluble endoglin had the ability to discriminate PE from chronic hypertension and healthy controls only in women who were evaluated at <37 weeks of GA. The sensitivity, specificity and accuracy of urinary soluble endoglin alone in the diagnosis of PE or in the identification of women with PE requiring a mandated delivery before 37 weeks of gestation were 70%, 86% and 76%, respectively. These values were inferior to those of the soluble fms-like tyrosine kinase 1 to PlGF ratio (P < 0.001). The addition of urinary soluble endoglin did not improve the diagnostic accuracy of the soluble fms-like tyrosine kinase 1 to PlGF ratio alone. CONCLUSIONS: We have provided evidence that soluble endoglin is present and elevated in the urine of women who develop preterm PE. Urinary soluble endoglin has only limited ability to determine the severity of PE and to distinguish between PE and chronic hypertension both preterm and at term. Compared with urinary soluble endoglin, the soluble fms-like tyrosine kinase 1 to PlGF ratio remains a better marker of disease presence, severity and outcome.