Same day HIV diagnosis and antiretroviral therapy initiation affects retention in Option B+ prevention of mother-to-child transmission services at antenatal care in Zomba District, Malawi.

INTRODUCTION: Data from the Option B+ prevention of mother-to-child transmission (PMTCT) program in Malawi show considerable variation between health facilities in retention on antiretroviral therapy (ART). In a programmatic setting, we studied whether the "model of care," based on the degree of integration of antenatal care (ANC), HIV testing and counselling (HTC) and ART service provision-influenced uptake of and retention on ART. METHODS: We conducted a retrospective cohort study of pregnant women seeking ANC at rural primary health facilities in Zomba District, Malawi. Data were extracted from standardized national ANC registers, ART registers and ART master cards. The "model of care" of Option B+ service delivery was determined at each health facility, based on the degree of integration of ANC, HTC and ART. Full integration (Model 1) of HTC and ART initiation at ANC was compared with integration of HTC only into ANC services (Model 2) with subsequent referral to an existing ART clinic for treatment initiation. RESULTS AND DISCUSSION: A total of 10,528 women were newly registered at ANC between October 2011 and March 2012 in 23 rural health facilities (12 were Model 1 and 11 Model 2). HIV status was ascertained in 8,572 (81%) women. Among 914/8,572 (9%) HIV-positive women enrolling at ANC, 101/914 (11%) were already on ART; of those not on treatment, 456/813 (56%) were started on ART. There was significantly higher ART uptake in Model 1 compared with Model 2 sites (63% vs. 51%; p=0.001), but significantly lower ART retention in Model 1 compared with Model 2 sites (79% vs. 87%; p=0.02). Multivariable analysis showed that initiation of ART on the same day as HIV diagnosis, but not model of care, was independently associated with reduced retention in the first six months (adjusted odds ratio 2.27; 95% CI: 1.34-3.85; p=0.002). CONCLUSIONS: HIV diagnosis and treatment on the same day was associated with reduced retention on ART, independent of the level of PMTCT service integration at ANC

Influence of maturity, smoking, and drying of fresh maize on sensory acceptability and nutritional content of the developed porridges

This study investigated the potential of using the underutilized fresh maize in the preparation of porridge to contribute toward complementary feeding of children, and reductions in pre‐harvest losses. Fresh maize was harvested at different stages of maturity, blanched, smoked, and sun dried before milling into flours that were blended with soy flours for preparation of test porridges. The test flours were analyzed using the Association of the Official Analytical Chemists (AOAC) methods to determine their nutrient composition before preparation of the porridges. A trained consumer panel of 12 people, mothers and nursery school children tasted the porridges to rank acceptability and preference. Analysis of nutritional data showed that the test flours contained similar amounts of proteins, fats, and carbohydrates as the commonly used dried maize–soy flour blends. All the test porridges were generally accepted by the mothers and children due to the unique smoky and roasted aroma, brown color and the sweeter flavor even without the addition of sugar. Grainy texture and the presence of residues were the only unacceptable attributes in some of the test porridges. In conclusion, fresh maize–soy floor blends can be potentially used in complementary feeding of children at home and school as an alternative to other traditional maize flours. Optimization and fortification can help make the flours nutrient‐dense and most appropriate for child feeding at scale