24 research outputs found
Implementation of the new WHO recommendations on HIV and infant feeding: Challenges and the way forward
Breast milk provides all the nutrient needs of the infant especially in the first six months of life and also protects the growing infant from pneumonia, diarrhoea, and malnutrition, which are the major causes of morbidity and mortality in the African Region. However breastfeeding is also known to transmit the Human Immunodeficiency Virus (HIV) from mother to the child. Several guidelines have been developed to guide policy makers, health workers and mothers on the most appropriate methods to feed HIV exposed infants. Previous HIV and infant feedingguidelines emphasized on preventing infants from becoming infected with HIV by counseling HIV-infected mothers to avoid all breastfeeding. Over the period, programme implementers and researchers have reported difficulties in implementing earlier recommendations and guidelines on HIV and infant feeding within health-care systems. New evidence now shows that giving Anti-Retroviral therapy (ARVs) to either the HIV-infected mother or HIV-exposed infant can significantly reduce the risk of transmitting HIV through breastfeeding. Thus, in 2010 World HealthOrganization (WHO) issued the latest guidelines on HIV and infant feeding entitled Principles and recommendations for infant feeding in the context of HIV and a summary of evidence. The 2010 WHO guidelines have changed the recommendations on how HIV infected mothers should feed their infants, and how health workers should support them. National authorities in each country can decide which infant feeding practice will be primarily promoted and supported by Maternal and Child Health services, i.e. breastfeeding with an antiretroviral intervention to reduce transmission or avoidance of all breastfeeding. Previous guidelines and  recommendations on infant feeding in the context of HIV have undergone frequent changes over the past decade. The adaptation and implementation of previous and current guidelines at national level have met challenges. These include lack of consensus among key stakeholders, inadequate funding for the additional cost of providing ARVs to the mother or the child and difficulties in communicating the recommendations in the new guidelines clearly to mothers, health workers and policy makers. To address these challenges a number of proposals have been suggested such as coordinated consensus building process, costing of interventions and a phased implementation approach to ensure successful scale up over time. This paper describes the process of adapting global HIV and infant feeding recommendations and guidelines at national level. It also reviews the challenges encountered in implementation and proposes the way forward in addressing them
Self-Reported Occupational Exposure to HIV and Factors Influencing its Management Practice: A Study of Healthcare Workers in Tumbi and Dodoma Hospitals, Tanzania.
Blood borne infectious agents such as hepatitis B virus (HBV), hepatitis C virus (HCV) and human immune deficiency virus (HIV) constitute a major occupational hazard for healthcare workers (HCWs). To some degree it is inevitable that HCWs sustain injuries from sharp objects such as needles, scalpels and splintered bone during execution of their duties. However, in Tanzania, there is little or no information on factors that influence the practice of managing occupational exposure to HIV by HCWs. This study was conducted to determine the prevalence of self-reported occupational exposure to HIV among HCWs and explore factors that influence the practice of managing occupational exposure to HIV by HCWs in Tanzania. Self-administered questionnaire was designed to gather information of healthcare workers' occupational exposures in the past 12 months and circumstances in which these injuries occurred. Practice of managing occupational exposure was assessed by the following questions: Nearly half of the HCWs had experienced at least one occupational injury in the past 12 months. Though most of the occupational exposures to HIV were experienced by female nurses, non-medical hospital staff received PEP more frequently than nurses and doctors. Doctors and nurses frequently encountered occupational injuries in surgery room and labor room respectively. HCWs with knowledge on the possibility of HIV transmission and those who knew whom to contact in event of occupational exposure to HIV were less likely to have poor practice of managing occupational exposure. Needle stick injuries and splashes are common among HCWs at Tumbi and Dodoma hospitals. Knowledge of the risk of HIV transmission due to occupational exposure and knowing whom to contact in event of exposure predicted practice of managing the exposure. Thus provision of health education on occupational exposure may strengthen healthcare workers' practices to manage occupational exposure
High risk for occupational exposure to HIV and utilization of post-exposure prophylaxis in a teaching hospital in Pune, India
<p>Abstract</p> <p>Background</p> <p>The risk for occupational exposure to HIV has been well characterized in the developed world, but limited information is available about this transmission risk in resource-constrained settings facing the largest burden of HIV infection. In addition, the feasibility and utilization of post-exposure prophylaxis (PEP) programs in these settings are unclear. Therefore, we examined the rate and characteristics of occupational exposure to HIV and the utilization of PEP among health care workers (HCW) in a large, urban government teaching hospital in Pune, India.</p> <p>Methods</p> <p>Demographic and clinical data on occupational exposures and their management were prospectively collected from January 2003–December 2005. US Centers for Diseases Control guidelines were utilized to define risk exposures, for which PEP was recommended. Incidence rates of reported exposures and trends in PEP utilization were examined using logistic regression.</p> <p>Results</p> <p>Of 1955 HCW, 557 exposures were reported by 484 HCW with an incidence of 9.5 exposures per 100 person-years (PY). Housestaff, particularly interns, reported the greatest number of exposures with an annual incidence of 47.0 per 100 PY. Personal protective equipment (PPE) was used in only 55.1% of these exposures. The incidence of high-risk exposures was 6.8/100 PY (n = 339); 49.1% occurred during a procedure or disposing of equipment and 265 (80.0%) received a stat dose of PEP. After excluding cases in which the source tested HIV negative, 48.4% of high-risk cases began an extended PEP regimen, of whom only 49.5% completed it. There were no HIV or Hepatitis B seroconversions identified. Extended PEP was continued unnecessarily in 7 (35%) of 20 cases who were confirmed to be HIV-negative. Over time, there was a significant reduction in proportion of percutaneous exposures and high-risk exposures (p < 0.01) and an increase in PEP utilization for high risk exposures (44% in 2003 to 100% in 2005, p = 0.002).</p> <p>Conclusion</p> <p>Housestaff are a vulnerable population at high risk for bloodborne exposures in teaching hospital settings in India. With implementation of a hospital-wide PEP program, there was an encouraging decrease of high-risk exposures over time and appropriate use of PEP. However, overall use of PPE was low, suggesting further measures are needed to prevent occupational exposures in India.</p
The level of knowledge of, attitude toward and emphasis given to HBV and HCV infections among healthcare professionals: Data from a tertiary hospital in Turkey
Integrated community case management and community-based health planning and services: a cross sectional study on the effectiveness of the national implementation for the treatment of malaria, diarrhoea and pneumonia
Promotion of exclusive breastfeeding among HIV-positive mothers: an exploratory qualitative study
Implementation Of The New Who Recommendations On Hiv And Infant Feeding: Challenges And The Way Forward
Breast milk provides all the nutrient needs of the infant especially in
the first six months of life and also protects the growing infant from
pneumonia, diarrhoea, and malnutrition, which are the major causes of
morbidity and mortality in the African Region. However breastfeeding is
also known to transmit the Human Immuno- deficiency Virus (HIV) from
mother to the child. Several guidelines have been developed to guide
policy makers, health workers and mothers on the most appropriate
methods to feed HIV exposed infants. Previous HIV and infant feeding
guidelines emphasized on preventing infants from becoming infected with
HIV by counseling HIV-infected mothers to avoid all breastfeeding. Over
the period, programme implementers and researchers have reported
difficulties in implementing earlier recommendations and guidelines on
HIV and infant feeding within health-care systems. New evidence now
shows that giving Anti-Retroviral therapy (ARVs) to either the
HIV-infected mother or HIV-exposed infant can significantly reduce the
risk of transmitting HIV through breastfeeding. Thus, in 2010 World
Health Organization (WHO) issued the latest guidelines on HIV and
infant feeding entitled Principles and recommendations for infant
feeding in the context of HIV and a summary of evidence. The 2010 WHO
guidelines have changed the recommendations on how HIV infected mothers
should feed their infants, and how health workers should support them.
National authorities in each country can decide which infant feeding
practice will be primarily promoted and supported by Maternal and Child
Health services, i.e. breastfeeding with an antiretroviral intervention
to reduce transmission or avoidance of all breastfeeding. Previous
guidelines and recommendations on infant feeding in the context of HIV
have undergone frequent changes over the past decade. The adaptation
and implementation of previous and current guidelines at national level
have met challenges. These include lack of consensus among key
stakeholders, inadequate funding for the additional cost of providing
ARVs to the mother or the child and difficulties in communicating the
recommendations in the new guidelines clearly to mothers, health
workers and policy makers. To address these challenges a number of
proposals have been suggested such as coordinated consensus building
process, costing of interventions and a phased implementation approach
to ensure successful scale up over time. This paper describes the
process of adapting global HIV and infant feeding recommendations and
guidelines at national level. It also reviews the challenges
encountered in implementation and proposes the way forward in
addressing them
Framework For Supporting Countries To Address The Food Crisis And Malnutrition In The African Region
Of the world's undernourished children, 80% live in 20 countries; nine
of these are in sub-Saharan Africa. Africa is home to 15 of the 16
countries where prevalence of hunger exceeds 35 per cent. This
precarious food security situation in Africa has been compounded by
economic and food crises which began in 2007, resulting in a rise by
about 83% in food commodity prices.When food is in short supply, safety
is compromised resulting in the consumption of unsafe food. Assuring
safe food and ending malnutrition require decisive actions in several
areas. In line with its Core Functions, global and regional agreements
and as a key player in health, the WHO's vital role in addressing the
food crisis is in preventing the effects of food insecurity,
undernutrition and unsafe food. In order to scale-up actions to address
the adverse effects of food insecurity and malnutrition in the African
Region, the forty-fourth session of the Regional Programme Meeting
(RPM44) discussed the topic Food Crisis in Africa: Implications for
Nutrition and Food Safety Actions in the Region. A framework was
therefore developed to facilitate joint actions in addressing the food
crisis and malnutrition in the WHO African Region for better impact at
country level. This paper provides a summary of the Framework which
highlight WHO's role in the area of nutrition. It has four guiding
principles: Country- level interventions, Community involvement and
ownership; Adoption of multi-sectoral approach; Protection of
vulnerable groups; and Evidence- based interventions. The Framework
proposes actions to be implemented in countries with support of WHO and
partners to meet the immediate food and nutritional needs of the
vulnerable and build longer-term resilience to contribute to national
food security. The expected impact of the implementation of these
actions with support from WHO and partners is prevention of morbidity,
mortality and the irreversible long-term effects of malnutrition on
health and cognitive development