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Search Results: 1 - 10 of 3253 matches for " Irene Coutsoudis "
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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
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
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
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
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.
Prevention is better than cure – the art of avoiding non-adherence to antiretroviral treatment
L Kwaan, G Kindra, L Mdutyana, A Coutsoudis
Southern African Journal of HIV Medicine , 2010,
Abstract: The much-used phrase ‘prevention is better than cure’ is applicable to many circumstances, including human mmunodeficiency virus (HIV) infection. In recent years suggestions have been made for a move towards treatment strategies that emphasise prevention of foreseeable adherence problems on a patient-by-patient basis, through focused patient preparation before commencing antiretroviral therapy (ART). This is well elucidated in a statement made in 2004 by Coetzee et al.:1 ‘As it is difficult to ascertain robust predictors of adherence, there has been a move to concentrate on patient preparation before the initiation of ART rather than the use of nonclinical predictors of adherence or selection criteria. A paradigm focused on preparation rather than selection is better suited to the aggressive targets for the scaling up of ART in countries with large epidemics (such as in South Africa), where the view of ART as a very expensive rationed intervention is rapidly changing.’
Changes in body composition and other anthropometric measures of female subjects on highly active antiretroviral therapy (HAART): A pilot study in KwaZulu-Natal, South Africa
F Esposito, A Coutsoudis, J Visser, G Kindra
Southern African Journal of HIV Medicine , 2008,
Abstract: Background and objectives. An understanding of the effect of highly active antiretroviral therapy (HAART) on various aspects of health, including nutritional status, is needed to ensure that population-specific guidelines can be developed for South Africa. This study aimed to investigate the changes in body composition and other anthropometric measures that occur in HIV-infected women after the initiation of HAART and to explore the relationship between these measures and CD4 lymphocyte count. Design and setting. A longitudinal study was carried out at the Umkhumbane Community Health Centre, KwaZulu-Natal. Subjects. 30 HIV-infected adult women who started HAART between March 2007 and October 2007. Methods. Anthropometric measurements and bioelectrical impedance analysis were performed at baseline and 24 weeks after commencing HAART. CD4 lymphocyte counts were done at baseline and at the 24-week visit. Results. There was a statistically significant increase in all anthropometric measures except waist-hip ratio and lean body mass. The mean weight change (± standard deviation) was 3.4±5.8 kg (p=0.006). Mean body mass index (BMI) (kg/m2) increased from 25.6±5.7 to 27.3±5.6 (p=0.007). Seventy per cent of subjects gained weight, 18.5% had a stable weight and 11.1% lost weight. Subjects with lower CD4 lymphocyte counts experienced greater increases in weight, BMI, fat mass and body fat percentage. No significant association was found between anthropometric changes and change in CD4 count between baseline and the 24-week visit. Conclusions. The findings demonstrate the value of including circumference measurements and body composition techniques as part of nutritional status assessment. Research is needed to determine the best methods of bringing about favourable anthropometric changes to enhance the health of patients on HAART. Southern African Journal of HIV Medicine Vol. 9 (4) 2008: pp. 36-42
The role that oilseeds, including new hi-oleic varieties can play in improving the profile of fat intake by the UK population  [PDF]
Janice Irene Harland
Agricultural Sciences (AS) , 2014, DOI: 10.4236/as.2014.53024

The production in the EU of the oilseeds, rapeseed and sunflower, has increased dramatically over the last 20 years. Much of the oil produced after crushing is used for culinary purposes; this enhanced intake of vegetable oil has led to a substantial change of fatty acid (FA) supply. This has been conclusively demonstrated by taking the UK oil supply data and by use of the FA profile of the key oils converting the supply data into a FA profile of the UK market place for 2008-2012. The most marked changes are a reduction in saturated fat (SFA) and an increase in monounsaturated fatty acids (MUFA) available for consumption. Furthermore the introduction of varieties of hi-oleic sunflower oil can further affect the market FA profile. The fat profiles of rapeseed and sunflower oils are considered healthy and they can have a positive impact when included in the diet, particularly as a replacement for oils or fats rich in SFA. In the UK and much of Europe, adult SFA intake continues to exceed recommendations. While reductions in the UK population’s SFA intake have occurred over the last 20 years, these are modest and it may be timely to identify ways in which SFA intake can be further reduced. To do this, the UK market FA supply data has been analysed alongside the profile of FA intake from adults recording their intake in national dietary surveys in order to identify if the market supply affects overall FA consumption. There is an indication that market oil supply is reflected in adults dietary intake of the main groups of FA. Consequently changes made to the oil profile of oilseeds by plant breeders and use of the resulting healthier oils by food manufacturers could have important roles to play in helping adults to achieve the recommended intake of SFA and also improve the overall fat quality in their diet leading to enhanced long-term health and well-being. Thus changes made in pri

The Relationship between Access to Mass Media and HIV/AIDS Related Knowledge, Beliefs and Behaviours in Kenya  [PDF]
Irene Muli, Stephen Lawoko
Psychology (PSYCH) , 2014, DOI: 10.4236/psych.2014.57084

Aim: We scrutinized the association between access to mass media and HIV/AIDS related knowledge, beliefs and behaviours in Kenya. Methods: Data on a representative sample of Kenyan women between 15 - 30 years of age (n = 3909) was retrieved from the Kenyan demographic and health survey (DHS 2008) and analyzed using Chi-square tests and binary logistic regression. Results: Media use was common with over 70% of participants using radio at least once a week. Between 3% - 30% of participants had poor to inadequate knowledge/beliefs about HIV/AIDS, with variations depending on demographic and social factors such as age, education, literacy, wealth and residential area. HIV/AIDS knowledge, beliefs and behaviours were associated with exposure to media, even after control for possible co-variation with social and demographic factor. Conclusion: Despite wide exposure to media among young Kenyan women, substantial proportions have poor to inadequate knowledge of the aetiology, risk/protective factors and control measures of HIV/AIDS. Yet, such knowledge was positively associated with media use. Media thus could ideally be used to implement a comprehensive awareness campaign in the general population about the aetiology, risk/protective factors and control measures in HIV/AIDS.

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