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Search Results: 1 - 10 of 13714 matches for " Anna Coutsoudis "
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Breast-feeding and HIV: an update
Anna Coutsoudis
Southern African Journal of HIV Medicine , 2004,
Abstract: Breast-feeding is a route of transmission of HIV from an infected mother to her infant. However, breast-feeding is an important pillar of child survival and the ideal way of feeding an infant, as well as providing a unique biological and emotional basis for child development. This article highlights the dilemma created by the risks and benefits of breastfeeding and will discuss factors that increase the risk of HIV transmission during breast-feeding as well as strategies that could be employed to reduce these risks. Many questions remain unanswered. Southern African Journal of HIV Medicine Vol. 5 (4) 2004: 45-48
Acceptability of donated breast milk in a resource limited South African setting
Irene Coutsoudis, Alissa Petrites, Anna Coutsoudis
International Breastfeeding Journal , 2011, DOI: 10.1186/1746-4358-6-3
Abstract: The study was conducted at a public hospital and nearby clinic in Durban, South Africa. The qualitative data was derived from eight focus group discussions which included four groups with mothers; one with male partners; and one with grandmothers, investigating attitudes towards receiving donated breast milk for infants. There was also one group each with nurses and doctors about their attitudes towards donated breast milk and its use in the hospital. The focus groups were conducted in September and October 2009 and each group had between four and eleven participants, leading to a total of 48 participants.Although breast milk was seen as important to child health there were concerns about undermining of breast milk because of concerns about HIV and marketing and promotion of formula milks. In addition there were concerns about the safety of donor breast milk and discomfort about using another mother's milk. Participants believed that education on the importance of breast milk and transparency on the processes involved in sourcing and preparing donor milk would improve the acceptability.This study has shown that there are obstacles to the acceptability of donor milk, mainly stemming from lack of awareness/familiarity with the processes around donor breast milk and that these could be readily addressed through education. Even the more psychological concerns would also likely be reduced over time as these educational efforts progress. With government and health care worker endorsement and commitment, breast milk donation could have a promising role in improving child health.The importance of breast milk for infants' growth, development and overall health is widely recognized [1,2]. Moreover, breast milk is of special importance for preterm, low birthweight and other vulnerable infants [3].The World Health Organization (WHO) recommends that for infants who cannot receive breast milk from their own mothers, the next preferred option is donated breast milk (donor milk) [4
Feasibility and safety of setting up a donor breastmilk bank in a neonatal prem unit in a resource limited setting: An observational, longitudinal cohort study
Irene Coutsoudis, Miriam Adhikari, Nadia Nair, Anna Coutsoudis
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-356
Abstract: Low birth weight infants < 1800 g and under 32 weeks gestational age were followed up in the NPU over a 3 week period; feeding data and morbidity data was collected in order to determine if there were any adverse events associated with donor breastmilk. Samples of pasteurized breastmilk were cultured to check for any bacterial contamination.191 infants met the inclusion criteria of whom 96 received their mother's own breastmilk. Of the 95 infants who were potentially eligible to receive donor milk, only 40 did in fact receive donor milk. There was no evidence of bacterial contamination in the samples analyzed, and no evidence of adverse events from feeding with donor breastmilk.It is feasible to supply donor breastmilk to infants in an NPU in a resource limited setting, however staff needs to be sensitized to the importance of donor breastmilk to improve uptake rates. Secondly we showed that it is possible to supply donor breastmilk according to established guidelines with no adverse events therefore making it possible to prevent NEC and other side effects often associated with formula feeding of premature infants.The particular benefits of human breastmilk for preterm and term infants have been well described in medical literature [1]. Human milk provides important nutritional components, digestive enzymes, immunological factors, growth factors, and hormones that make it a clinical standard of care for preterm (including very low-birth-weight) and term infants [2]. The beneficial effects of human milk (fresh and pasteurized) on rates of pediatric infection such as necrotizing enterocolitis (NEC) and sepsis have also been clearly demonstrated [3-5]. Donor breastmilk has been encouraged as the milk of choice when a mother's own breastmilk is not available due to illness/infections, medications, or other social reasons [6]. Using human milk is of particular importance for preterm infants of HIV infected mothers as early introduction of formula feeds could be the sourc
Effect of nutritional supplementation of breastfeeding HIV positive mothers on maternal and child health: findings from a randomized controlled clinical trial
Gurpreet Kindra, Anna Coutsoudis, Francesca Esposito
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-946
Abstract: To assess the effect of nutritional supplementation to HIV infected lactating mothers on nutritional and health status of mothers and their infants.A randomized controlled clinical trial to study the impact of nutritional supplementation on breastfeeding mothers. Measurements included anthropometry; body composition indicators; CD4 count, haemoglobin and albumin; as well as incidence rates of opportunistic infections; depression and quality of life scores. Infant measurements included anthropometry, development and rates of infections.The supplement made no significant impact on any maternal or infant outcomes. However in the small group of mothers with low BMI, the intake of supplement was significantly associated with preventing loss of lean body mass (1.32 kg vs. 3.17 kg; p = 0.026). There was no significant impact of supplementation on the infants.A 50 g daily nutritional supplement to breastfeeding mothers had no or limited effect on mother and child health outcomes.ISRCTN68128332 (http://www.controlled-trials.com/ISRCTN68128332 webcite)Breastfeeding is the optimal source of nutrition for all infants [1,2]. Although breastfeeding is associated with a risk of post-natal vertical transmission of HIV; it has been well established that in resource-poor communities, there are serious repercussions of not breastfeeding or even of a short duration breastfeeding on HIV free survival of the infants [3-8]. Studies have shown that effective antiretroviral prophylaxis to the mother or infant during breastfeeding can reduce vertical transmission to as low as 1% [7,9-12]. WHO therefore revised its PMTCT (prevention of mother to child transmission) guidelines in 2010 to help maximize HIV free survival of infants by recommending longer breastfeeding with prophylaxis as well as the timely start of antiretroviral therapy (ART) in the mothers [13].Women in resource-constrained settings such as sub-Saharan Africa are carrying a double burden of HIV and food insecurity and are ther
HIV, infant feeding and more perils for poor people: new WHO guidelines encourage review of formula milk policies
Coutsoudis,Anna; Coovadia,Hoosen M; Wilfert,Catherine M;
Bulletin of the World Health Organization , 2008, DOI: 10.1590/S0042-96862008000300014
Abstract: the release of the new who guidelines on hiv and infant feeding, in a global context of widespread impoverishment, requires countries to re-examine their infant-feeding policies in relation to broader socioeconomic issues. this widening scope is necessitated by compelling new reports on the scale of global underdevelopment in developing countries. this paper explores these issues by addressing feeding choices made by hiv-infected mothers and programmes supplying free formula milks within a global environment of persistent poverty. accumulating evidence on the increase in malnutrition, morbidity and mortality associated with the avoidance or early cessation of breastfeeding by hiv-infected mothers, and the unanticipated hazards of formula feeding, demand a deeper assessment of the measures necessary for optimum policies on infant and child nutrition and for the amelioration of poverty. piecemeal interventions that increase resources directed at only a fraction of a family's impoverishment, such as basic materials for preparation of hygienic formula feeds and making flawed decisions on choice of infant feeding, are bound to fail. these are not alternatives to taking fundamental steps to alleviate poverty. the economic opportunity costs of such programmes, the equity costs of providing resources to some and not others, and the leakages due to temptation to sell capital goods require careful evaluation. providing formula to poor populations with high hiv prevalence cannot be justified by the evidence, by humanitarian considerations, by respect for local traditions or by economic outcomes. exclusive breastfeeding, which is threatened by the hiv epidemic, remains an unfailing anchor of child survival.
Scaling-Up Exclusive Breastfeeding Support Programmes: The Example of KwaZulu-Natal
Chris Desmond, Ruth M. Bland, Gerard Boyce, Hoosen M. Coovadia, Anna Coutsoudis, Nigel Rollins, Marie-Louise Newell
PLOS ONE , 2008, DOI: 10.1371/journal.pone.0002454
Abstract: Background Exclusive breastfeeding (EBF) for six months is the mainstay of global child health and the preferred feeding option for HIV-infected mothers for whom replacement feeding is inappropriate. Promotion of community-level EBF requires effective personnel and management to ensure quality counselling and support for women. We present a costing and cost effectiveness analysis of a successful intervention to promote EBF in high HIV prevalence area in South Africa, and implications for scale-up in the province of KwaZulu-Natal. Methods and Findings The costing of the intervention as implemented was calculated, in addition to the modelling of the costs and outcomes associated with running the intervention at provincial level under three different scenarios: full intervention (per protocol), simplified version (half the number of visits compared to the full intervention; more clinic compared to home visits) and basic version (one third the number of visits compared to the full intervention; all clinic and no home visits). Implementation of the full scenario costs R95 million ($14 million) per annum; the simplified version R47 million ($7 million) and the basic version R4 million ($2 million). Although the cost of the basic scenario is less than one tenth of the cost of the simplified scenario, modelled effectiveness of the full and simplified versions suggest they would be 10 times more effective compared to the basic intervention. A further analysis modelled the costs per increased month of EBF due to each intervention: R337 ($48), R206 ($29), and R616 ($88) for the full, simplified and basic scenarios respectively. In addition to the average cost effectiveness the incremental cost effectiveness ratios associated with moving from the less effective scenarios to the more effective scenarios were calculated and reported: Nothing – Basic R616 ($88), Basic – Simplified R162 ($23) and Simplified – Full R879 ($126). Conclusions The simplified scenario, with a combination of clinic and home visits, is the most efficient in terms of cost per increased month of EBF and has the lowest incremental cost effectiveness ratio.
Exclusive Breastfeeding, Diarrhoeal Morbidity and All-Cause Mortality in Infants of HIV-Infected and HIV Uninfected Mothers: An Intervention Cohort Study in KwaZulu Natal, South Africa
Nigel C. Rollins, James Ndirangu, Ruth M. Bland, Anna Coutsoudis, Hoosen M. Coovadia, Marie-Louise Newell
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0081307
Abstract: Introduction Antiretroviral drug interventions significantly reduce the risk of HIV transmission to infants through breastfeeding. We report diarrhoea prevalence and all-cause mortality at 12 months of age according to infant feeding practices, among infants born to HIV-infected and uninfected mothers in South Africa. Methods A non-randomised intervention cohort study that followed both HIV-infected and HIV-uninfected mothers and their infants until 18 months of age. Mothers were supported in their infant feeding choice. Detailed morbidity and vital status data were collected over the first year. At the time, only single dose nevirapine was available to prevent mother-to-child transmission of HIV. Results Among 2,589 infants, detailed feeding data and vital status were available for 1,082 HIV-exposed infants and 1,155 HIV non-exposed infants. Among exclusively breastfed (EBF) infants there were 9.4 diarrhoeal days per 1,000 child days (95%CI. 9.12-9.82) while among infants who were never breastfed there were 15.6 diarrhoeal days per 1,000 child days (95%CI. 14.62-16.59). Exclusive breastfeeding was associated with fewer acute, persistent and total diarrhoeal events than mixed or no breastfeeding in both HIV-exposed infants and also infants of HIV uninfected mothers. In an adjusted cox regression analysis, the risk of death among all infants by 12 months of age was significantly greater in those who were never breastfed (aHR 3.5, p<0.001) or mixed fed (aHR 2.65, p<0.001) compared with those who were EBF. In separate multivariable analyses, infants who were EBF for shorter durations had an increased risk of death compared to those EBF for 5-6 months [aHR 2.18 (95% CI, 1.56-3.01); p<0.001]. Discussion In the context of antiretroviral drugs being scaled-up to eliminate new HIV infections among children, there is strong justification for financial and human resource investment to promote and support exclusive breastfeeding to improve HIV-free survival of HIV-exposed and non-exposed infants.
Duration, Pattern of Breastfeeding and Postnatal Transmission of HIV: Pooled Analysis of Individual Data from West and South African Cohorts
Renaud Becquet,Ruth Bland,Valériane Leroy,Nigel C. Rollins,Didier K. Ekouevi,Anna Coutsoudis,Fran?ois Dabis,Hoosen M. Coovadia,Roger Salamon,Marie-Louise Newell
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0007397
Abstract: Both breastfeeding pattern and duration are associated with postnatal HIV acquisition; their relative contribution has not been reliably quantified.
Children Who Acquire HIV Infection Perinatally Are at Higher Risk of Early Death than Those Acquiring Infection through Breastmilk: A Meta-Analysis
Renaud Becquet, Milly Marston, Fran?ois Dabis, Lawrence H. Moulton, Glenda Gray, Hoosen M. Coovadia, Max Essex, Didier K. Ekouevi, Debra Jackson, Anna Coutsoudis, Charles Kilewo, Valériane Leroy, Stefan Z. Wiktor, Ruth Nduati, Philippe Msellati, Basia Zaba, Peter D. Ghys, Marie-Louise Newell, the UNAIDS Child survival group
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0028510
Abstract: Background Assumptions about survival of HIV-infected children in Africa without antiretroviral therapy need to be updated to inform ongoing UNAIDS modelling of paediatric HIV epidemics among children. Improved estimates of infant survival by timing of HIV-infection (perinatally or postnatally) are thus needed. Methodology/Principal Findings A pooled analysis was conducted of individual data of all available intervention cohorts and randomized trials on prevention of HIV mother-to-child transmission in Africa. Studies were right-censored at the time of infant antiretroviral initiation. Overall mortality rate per 1000 child-years of follow-up was calculated by selected maternal and infant characteristics. The Kaplan-Meier method was used to estimate survival curves by child's HIV infection status and timing of HIV infection. Individual data from 12 studies were pooled, with 12,112 children of HIV-infected women. Mortality rates per 1,000 child-years follow-up were 39.3 and 381.6 for HIV-uninfected and infected children respectively. One year after acquisition of HIV infection, an estimated 26% postnatally and 52% perinatally infected children would have died; and 4% uninfected children by age 1 year. Mortality was independently associated with maternal death (adjusted hazard ratio 2.2, 95%CI 1.6–3.0), maternal CD4<350 cells/ml (1.4, 1.1–1.7), postnatal (3.1, 2.1–4.1) or peri-partum HIV-infection (12.4, 10.1–15.3). Conclusions/Results These results update previous work and inform future UNAIDS modelling by providing survival estimates for HIV-infected untreated African children by timing of infection. We highlight the urgent need for the prevention of peri-partum and postnatal transmission and timely assessment of HIV infection in infants to initiate antiretroviral care and support for HIV-infected children.
Infant feeding counselling for HIV-infected and uninfected women: appropriateness of choice and practice
Bland,RM; Rollins,NC; Coovadia,HM; Coutsoudis,A; Newell,ML;
Bulletin of the World Health Organization , 2007, DOI: 10.1590/S0042-96862007000400014
Abstract: objective: to examine infant feeding intentions of hiv-infected and uninfected women and the appropriateness of their choices according to their home resources; and to determine their adherence to their intentions in the first postnatal week. methods: feeding intentions of pregnant women were compared against four resources that facilitate replacement feeding: clean water, adequate fuel, access to a refrigerator and regular maternal income. first-week feeding practices were documented. findings: the antenatal feeding intentions of 1253 hiv-infected women were: exclusive breastfeeding 73%; replacement feeding 9%; undecided 18%. three percent had access to all four resources, of whom 23% chose replacement feeding. of those choosing replacement feeding, 8% had access to all four resources. a clean water supply and regular maternal income were independently associated with intention to replacement feed (adjusted odds ratio (aor) 1.94, 95% confidence interval (ci) 1.2-3.2; aor 2.1, 95% ci: 1.2-3.5, respectively). significantly more hiv-infected women intending to exclusively breastfeed, rather than replacement feed, adhered to their intention in week one (exclusive breastfeeding 78%; replacement feeding 42%; p < 0.001). of 1238 hiv-uninfected women, 82% intended to exclusively breastfeed; 2% to replacement feed; and 16% were undecided. seventy-five percent who intended to exclusively breastfeed adhered to this intention postnatally, and only 11 infants (< 1%) received no breast milk. the number of antenatal home visits significantly influenced adherence to feeding intention. conclusion: most hiv-infected women did not have the resources for safe replacement feeding, instead choosing appropriately to exclusively breastfeed. adherence to feeding intention among hiv-infected women was higher in those who chose to exclusively breastfeed than to replacement feed. with appropriate counselling and support, spillover of suboptimal feeding practices to hiv-negative women is minim
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