Higher likelihood of 6-months exclusive breastfeeding among HIV infected than uninfected mothers: a household survey in Kenya

Abstract Background Exclusive breastfeeding (EBF) (breast milk feeding without additional food or drink, except medicine) is associated with deceased risk of postnatal transmission of HIV from mother to child. Methods This analysis used data from a household survey in Western Kenya in 2011. Participants were mothers with HIV and uninfected mothers, aged ≥14 years who gave birth in the prior year (ever breastfed) within the Kenya Medical Research Institute/US Centers for Disease Control and Prevention (KEMRI/CDC) Health and Demographic Surveillance System. Data on breastfeeding counseling and knowledge and practices regarding breastfeeding were collected. Rates and correlates of EBF were determined using multivariable logistic regression. Results Of 652 mothers enrolled in the study, 435 were included in this analysis. Median age was 28 years among 154 mothers with HIV and 25 years among 281 uninfected mothers. Mothers with HIV were more likely than uninfected mothers to report breastfeeding counseling at a health facility (88.9% vs. 51.6%, respectively, p  1 h) were less likely to practice EBF for six months 62% (aOR 0.38; 95%CI: 0.20,0.94), 72% (aOR 0.28; 95%CI: 0.10,1.00), 54% (aOR 0.46; 95% CI: 0.22,1.00) and 46% (aOR 0.54; 95%CI: 0.30,1.00) respectively. Conclusions Mothers with HIV were more likely to report breastfeeding counseling at a health facility, EBF for six months and less likely to practice premastication than uninfected mothers. Lessons learned from breastfeeding counseling in mothers with HIV could be used to improve awareness and change breastfeeding practices for all mothers

Institutional challenges in putting ecosystem service knowledge in practice

The promise that ecosystem service assessments will contribute to better decision-making is not yet proven. We analyse how knowledge on ecosystem services is actually used to inform land and water management in 22 case studies covering different social-ecological systems in European and Latin American countries. None of the case studies reported instrumental use of knowledge in a sense that ecosystem service knowledge would have served as an impartial arbiter between policy options. Yet, in most cases, there was some evidence of conceptual learning as a result of close interaction between researchers, practitioners and stakeholders. We observed several factors that constrained knowledge uptake, including competing interests and political agendas, scientific disputes, professional norms and competencies, and lack of vertical and horizontal integration. Ecosystem knowledge played a small role particularly in those planning and policy-making situations where it challenged established interests and the current distribution of benefits from ecosystems. The factors that facilitated knowledge use included application of transparent participatory methods, social capital, policy champions and clear synergies between ecosystem services and human well-being. The results are aligned with previous studies which have emphasized the importance of building local capacity, ownership and trust for the long-term success of ecosystem service research. (C) 2017 The Authors. Published by Elsevier B.V.Peer reviewe

Stakeholders’ perspectives on the operationalisation of the ecosystem service concept: results from 27 case studies

The ecosystem service (ES) concept is becoming mainstream in policy and planning, but operational influence on practice is seldom reported. Here, we report the practitioners’ perspectives on the practical implementation of the ES concept in 27 case studies. A standardised anonymous survey (n=246), was used, focusing on the science-practice interaction process, perceived impact and expected use of the case study assessments. Operationalisation of the concept was shown to achieve a gradual change in practices: 13% of the case studies reported a change in action (e.g. management or policy change), and a further 40% anticipated that a change would result from the work. To a large extent the impact was attributed to a well conducted science-practice interaction process (>70%). The main reported advantages of the concept included: increased concept awareness and communication; enhanced participation and collaboration; production of comprehensive science-based knowledge; and production of spatially referenced knowledge for input to planning (91% indicated they had acquired new knowledge). The limitations were mostly case-specific and centred on methodology, data, and challenges with result implementation. The survey highlighted the crucial role of communication, participation and collaboration across different stakeholders, to implement the ES concept and enhance the democratisation of nature and landscape planning.JRC.D.2-Water and Marine Resource