Preventing mother-to-child transmission: factors affecting mothers\' choice of feeding — a case study from Cameroon

This paper reports on factors influencing the decision of mothers regarding the type of feeding method for their babies in a rural setting in Cameroon. The aim of the study was to ascertain the proportion of mothers choosing the different methods of feeding, to determine the various factors influencing their choices, and to ascertain the relationships of these factors to their respective choices. Questionnaires were used on 108 HIV-positive mothers who had delivered babies and who were administered nevirapine at least 3 months prior to the study. A focus group discussion with mothers also took place. Findings were that more mothers (84%) chose breastfeeding than artificial feeding (16%), while a minority (4%) selected mixed feeding. Factors found to militate against artificial feeding were cost (69%), stigma (64%), family pressure (44%), inconvenience in preparation/administration (38%), prior education from health workers (23%), and loss of special attention from family (8%). On the other hand, advice of health worker (44%), ill health (19.5%), free milk (12.5%), job pressure (12.5%) and loss of beauty (12.5%) were found to militate against breastfeeding. A direct relationship was also found between age, educational level, income size, marital status and choice of feeding. Policies targeting stigma reduction and socio-cultural factors affecting the choice of feeding are needed to optimise uptake of the less risky methods of feeding which could in turn contribute to a reduction in transmission. Key words: HIV/AIDS, mother-to-child transmission prevention, feeding. La prévention de la transmission mère-enfant: les facteurs influençant le choix de la mère sur la méthode d'allaitement – une etude de cas du Cameroun RÉSUMÉ Cette communication présente des facteurs qui influencent la décision des mères concernant la méthode d\'allaitement de leur nourrissons, en zone rurale au Cameroun. Le but de cette étude était de s\'assurer de la proportion de mères qui choisissent de méthodes différentes d\'allaitement, de déterminer les facteurs influençant leur choix et d\'étudier la relation entre ces facteurs et les méthodes d\'allaitement choisies. Pour recueillir des données, un questionnaire a été utilisé auprès de 108 mères séropositives qui ont des nourrissons. Ces mères étaient sur le traitement de la névirapine depuis au moins 3 mois avant le début de cette étude. Une discussion d\'un groupe de foyer de mères a eu lieu. Les résultats ont montré que plus de 84% de mères ont choisi l\'allaitement maternel contre 16% qui ont choisi l\'allaitement artificiel alors qu\'une minorité (4%) ont choisi l\'allaitement mixte (maternel et artificiel). Les raisons contre l\'allaitement artificiel sont les suivants: le coût (69%); la stigmatisation (64%); les pressions familiales (44%); les inconvénients liés à la préparation et l\'administration du lait artificiel (38%); une éducation préliminaire de la part du personnel soignant (23%) et le manque de soins particuliers de la part de la famille (8%). D\'autre part, les facteurs qui favorisent l\'allaitement artificiel sont les suivants: les conseils du personnel de santé (44%); la mauvaise santé (19.5%); du lait artificiel gratuit (12.5%) et la perte de beauté (12.5%). Nous avons constaté une relation entre l\'âge de la femme, le niveau d\'éducation, le niveau du revenu, le statut civil et le choix d\'allaitement. Il est nécessaire de mettre en place des politiques visant la réduction de la stigmatisation et les facteurs socioculturels qui influencent le choix d\'une méthode d\'allaitement afin de maximiser une compréhension de méthodes d\'allaitement à moindre risque qui par la suite pourrait contribuer à la réduction de transmission. Mots clés :VIH/SIDA, prévention de la transmission mère-enfant, allaitement. Sahara J Vol.1(3) 2004: 132-13

Willingness to pay for treatment with highly active antiretroviral (HAART) drugs: a rural case study in Cameroon

This paper reports on the willingness of HIV/AIDS patients to pay for the most affordable triple therapy combination of antiretrovirals in a local setting in Cameroon. Questionnaires were used to evaluate willingness to pay, and patients who could still afford their medication 6 months after the survey were also investigated, to give an indication of actual ability to pay. In addition, oral interviews were carried out for clarification. In all, 84 patients out of a total of 186 were involved in the study. Results indicated that more men (39%) were willing to pay than women (22%), although more women (56%) were afflicted than men.Willingness to pay was directly dependent on cost with 69%, 22% and 9% of respondents indicating willingness to pay $1,$2 and $3 a day respectively. After 6 months of treatment, 22SAHARA-J (2004) 1(2): 107-113 Keywords: HIV/AIDS, treatment, access to antiretrovirals, drug costs, affordability. RÉSUMÉ Cette communication porte sur une bonne volonté des patients souffrants du VIH/SIDA à payer un prix assez abordable de la thérapie triple des anti-rétroviraux dans un milieu rural au Cameroun. Des questionnaires ont été utilisés afin d'évaluer cette bonne volonté à payer les médicaments. De plus, les patients qui avaient les moyens d'acheter leurs médicaments 6 mois après ces épreuves furent interviewés également. En plus de cela, les patients ont été interviewés avec le but d'obtenir des éclaircissements. Parmi les 186 patients, 84 participaient à l'étude. Les résultats de cette étude ont démontré que davantage d'hommes (39$1, $2 et$3 par jour respectivement. Au bout d'une période de 6 mois de traitement, 22% de patients étaient encore en thérapie. Une majorité de patients ont arrêté le traitement au bout de 6 mois faute de manque d'argent. En dehors du coût, le stigmate, l'incrédulité et les effets secondaires des médicaments étaient les facteurs principaux qui étaient contre la volonté de payer. Il est conseillé d'améliorer les services de consultation, de fournir de l'information, de réduire le coût de médicaments ainsi que les essais en laboratoire et l'élaboration des programmes de déstigmatisation afin d'améliorer la capacité de patients à payer pour les anti-rétroviraux. SAHARA-J (2004) 1(2): 107-113 Mots clés: le VIH/SIDA, le traitement, l'accès aux anti-rétroviraux, le coût de médicaments, avoir des moyens d'acheter

Global biogeography of coral recruitment: tropical decline and subtropical increase

Despite widespread climate-driven reductions of coral cover on tropical reefs, little attention has been paid to the possibility that changes in the geographic distribution of coral recruitment could facilitate beneficial responses to the changing climate through latitudinal range shifts. To address this possibility, we compiled a global database of normalized densities of coral recruits on settlement tiles (corals m(-2)) deployed from 1974 to 2012, and used the data therein to test for latitudinal range shifts in the distribution of coral recruits. In total, 92 studies provided 1253 records of coral recruitment, with 77 % originating from settlement tiles immersed for 3-24 mo, herein defined as long-immersion tiles (LITs); the limited temporal and geographic coverage of data from short-immersion tiles (SITs; deployed for 20 degrees latitude). These trends indicate that a global decline in coral recruitment has occurred since 1974, and the persistent reduction in the densities of recruits in equatorial latitudes, coupled with increased densities in sub-tropical latitudes, suggests that coral recruitment may be shifting poleward

Economic Support to Patients in HIV and TB Grants in Rounds 7 and 10 from the Global Fund to Fight AIDS, Tuberculosis and Malaria.

People with TB and/or HIV frequently experience severe economic barriers to health care, including out-of-pocket expenses related to diagnosis and treatment, as well as indirect costs due to loss of income. These barriers can both aggravate economic hardship and prevent or delay diagnosis, treatment and successful outcome, leading to increased transmission, morbidity and mortality. WHO, UNAIDS and the ILO argue that economic support of various kinds is essential to enable vulnerable people to protect themselves from infection, avoid delayed diagnosis and treatment, overcome barriers to adherence, and avert destitution. This paper analyses successful country proposals to the Global Fund to Fight AIDS, Tuberculosis and Malaria that include economic support in Rounds 7 and 10; 36 and 20 HIV and TB grants in Round 7 and 32 and 26, respectively, in Round 10. Of these, up to 84 percent included direct or indirect economic support for beneficiaries, although the amount constituted a very small proportion of the total grant. In TB grants, the objectives of economic support were generally clearly stated, and focused on mechanisms to improve treatment uptake and adherence, and the case was most clearly made for MDR-TB patients. In HIV grants, the objectives were much broader in scope, including mitigation of adverse economic and social effects of HIV and its treatment on both patients and families. The analysis shows that economic support is on the radar for countries developing Global Fund proposals, and a wide range of economic support activities are in place. In order to move forward in this area, the wealth of country experience that exists needs to be collated, assessed and disseminated. In addition to trials, operational research and programme evaluations, more precise guidance to countries is needed to inform evidence-based decision about activities that are cost-effective, affordable and feasible

How Plastic Can Phenotypic Plasticity Be? The Branching Coral Stylophora pistillata as a Model System

Phenotypic plasticity enables multicellular organisms to adjust morphologies and various life history traits to variable environmental challenges. Here, we elucidate fixed and plastic architectural rules for colony astogeny in multiple types of colonial ramets, propagated by cutting from genets of the branching coral Stylophora pistillata from Eilat, the Red Sea. We examined 16 morphometric parameters on 136 one-year old S. pistillata colonies (of seven genotypes), originating from small fragments belonging, each, to one of three single-branch types (single tips, start-up, and advanced bifurcating tips) or to structural preparative manipulations (representing a single or two growth axes). Experiments were guided by the rationale that in colonial forms, complexity of evolving phenotypic plasticity can be associated with a degree of structural modularity, where shapes are approached by erecting iterative growth patterns at different levels of coral-colony organization. Analyses revealed plastic morphometric characters at branch level, and predetermined morphometric traits at colony level (only single trait exhibited plasticity under extreme manipulation state). Therefore, under the experimental manipulations of this study, phenotypic plasticity in S. pistillata appears to be related to branch level of organization, whereas colony traits are controlled by predetermined genetic architectural rules. Each level of organization undergoes its own mode of astogeny. However, depending on the original ramet structure, the spherical 3-D colonial architecture in this species is orchestrated and assembled by both developmental trajectories at the branch level, and traits at the colony level of organization. In nature, branching colonial forms are often subjected to harsh environmental conditions that cause fragmentation of colony into ramets of different sizes and structures. Developmental traits that are plastic, responding to fragment structure and are not predetermine in controlling astogeny, allow formation of species-specific architecture product through integrated but variable developmental routes. This adaptive plasticity or regeneration is an efficient mechanism by which isolated fragments of branching coral species cope with external environmental forces

Telephone Consultation for Improving Health of People Living with or at Risk of HIV: A Systematic Review

BACKGROUND: Low cost, effective interventions are needed to deal with the major global burden of HIV/AIDS. Telephone consultation offers the potential to improve health of people living with HIV/AIDS cost-effectively and to reduce the burden on affected people and health systems. The aim of this systematic review was to assess the effectiveness of telephone consultation for HIV/AIDS care. METHODS: We undertook a comprehensive search of peer-reviewed and grey literature. Two authors independently screened citations, extracted data and assessed the quality of randomized controlled trials which compared telephone interventions with control groups for HIV/AIDS care. Telephone interventions were voice calls with landlines or mobile phones. We present a narrative overview of the results as the obtained trials were highly heterogeneous in design and therefore the data could not be pooled for statistical analysis. RESULTS: The search yielded 3321 citations. Of these, nine studies involving 1162 participants met the inclusion criteria. The telephone was used for giving HIV test results (one trial) and for delivering behavioural interventions aimed at improving mental health (four trials), reducing sexual transmission risk (one trial), improving medication adherence (two trials) and smoking cessation (one trial). Limited effectiveness of the intervention was found in the trial giving HIV test results, in one trial supporting medication adherence and in one trial for smoking cessation by telephone. CONCLUSIONS: We found some evidence of the benefits of interventions delivered by telephone for the health of people living with HIV or at risk of HIV. However, only limited conclusions can be drawn as we only found nine studies for five different interventions and they mainly took place in the United States. Nevertheless, given the high penetration of low-cost mobile phones in countries with high HIV endemicity, more evidence is needed on how telephone consultation can aid in the delivery of HIV prevention, treatment and care

Time constraints do not limit group size in arboreal guenons but do explain community size and distribution patterns

To understand how species will respond to environmental changes, it is important to know how those changes will affect the ecological stress that animals experience. Time constraints can be used as indicators of ecological stress. Here we test whether time constraints can help us understand group sizes, distribution patterns and community sizes of forest guenons (Cercopithecus/Allochrocebus). Forest guenons typically live in small to medium sized one-male multi-female groups and often live in communities with multiple forest guenon species. We developed a time-budget model using published data on time budgets, diets, body sizes, climate, and group sizes to predict maximum ecologically tolerable group and community sizes of forest guenons across 202 sub-Saharan African locations. The model correctly predicted presence/absence at 83% of these locations. Feeding-foraging time (an indicator of competition) limited group sizes, while resting and moving time constraints shaped guenon biogeography. Predicted group sizes were greater than observed group sizes but comparable to community sizes, suggesting community sizes are set by competition among guenon individuals irrespective of species. We conclude that time constraints and intra-specific competition are unlikely to be the main determinants of relatively small group sizes in forest guenons. Body mass was negatively correlated with moving time, which may give larger bodied species an advantage over smaller bodied species under future conditions when greater fragmentation of forests is likely to lead to increased moving time. Resting time heavily depended on leaf consumption and is likely to increase under future climatic conditions when leaf quality is expected to decrease