Translating global recommendations on HIV and infant feeding to the local context: the development of culturally sensitive counselling tools in the Kilimanjaro Region, Tanzania

BACKGROUND: This paper describes the process used to develop an integrated set of culturally sensitive, evidence-based counselling tools (job aids) by using qualitative participatory research. The aim of the intervention was to contribute to improving infant feeding counselling services for HIV positive women in the Kilimanjaro Region of Tanzania. METHODS: Formative research using a combination of qualitative methods preceded the development of the intervention and mapped existing practices, perceptions and attitudes towards HIV and infant feeding (HIV/IF) among mothers, counsellors and community members. Intervention Mapping (IM) protocol guided the development of the overall intervention strategy. Theories of behaviour change, a review of the international HIV/IF guidelines and formative research findings contributed to the definition of performance and learning objectives. Key communication messages and colourful graphic illustrations related to infant feeding in the context of HIV were then developed and/or adapted from existing generic materials. Draft materials were field tested with intended audiences and subjected to stakeholder technical review. RESULTS: An integrated set of infant feeding counselling tools, referred to as 'job aids', was developed and included brochures on feeding methods that were found to be socially and culturally acceptable, a Question and Answer Guide for counsellors, a counselling card on the risk of transmission of HIV, and an infant feeding toolbox for demonstration. Each brochure describes the steps to ensure safer infant feeding using simple language and images based on local ideas and resources. The brochures are meant to serve as both a reference material during infant feeding counselling in the ongoing prevention of mother to child transmission (pMTCT) of HIV programme and as take home material for the mother. CONCLUSION: The study underscores the importance of formative research and a systematic theory based approach to developing an intervention aimed at improving counselling and changing customary feeding practices. The identification of perceived barriers and facilitators for change contributed to developing the key counselling messages and graphics, reflecting the socio-economic reality, cultural beliefs and norms of mothers and their significant others

The origin, composition and rates of organic nitrogen deposition: A missing piece of the nitrogen cycle?

Organic forms of nitrogen are widespread in the atmosphere and their deposition may constitute a substantive input of atmospheric N to terrestrial and aquatic ecosystems. Recent studies have expanded the pool of available measurements and our awareness of their potential significance. Here, we use these measurements to provide a coherent picture of the processes that produce both oxidized and reduced forms of organic nitrogen in the atmosphere, examine how those processes are linked to human activity and how they may contribute to the N load from the atmosphere to ecosystems. We summarize and synthesize data from 41 measurements of the concentrations and fluxes of atmospheric organic nitrogen (AON). In addition, we examine the contribution of reduced organic nitrogen compounds such as amino acids, bacterial/particulate N, and oxidized compounds such as organic nitrates to deposition fluxes of AON. The percentage contribution of organic N to total N loading varies from site to site and with measurement methodology but is consistently around a third of the total N load with a median value of 30% (Standard Deviation of 16%). There are no indications that AON is a proportionally greater contributor to N deposition in unpolluted environments and there are not strong correlations between fluxes of nitrate and AON or ammonium and AON. Possible sources for AON include byproducts of reactions between NO_x and hydrocarbons, marine and terrestrial sources of reduced (amino acid) N and the long- range transport of organic matter (dust, pollen etc.) and bacteria. Both dust and organic nitrates such as PAN appear to play an important role in the overall flux of AON to the surface of the earth. For estimates of organic nitrate deposition, we also use an atmospheric chemical transport model to evaluate the spatial distribution of fluxes and the globally integrated deposition values. Our preliminary estimate of the magnitude of global AON fluxes places the flux between 10 and 50 Tg of N per year with substantial unresolved uncertainties but clear indications that AON deposition is an important aspect of local and global atmospheric N budgets and deserves further consideration