The Potential Role of Mother-in-Law in Prevention of Mother-to-Child Transmission of HIV: A Mixed Methods Study from the Kilimanjaro Region, Northern Tanzania.

In the Kilimanjaro region the mother-in-law has traditionally had an important role in matters related to reproduction and childcare. The aim of this study was to explore the role of the mothers-in-law in prevention of mother-to-child transmission (PMTCT) service utilization and adherence to infant feeding guidelines. The study was conducted during 2007-2008 in rural and urban areas of Moshi district in the Kilimanjaro region of Tanzania. Mixed methods were used and included focus group discussions with mothers-in-law, mothers and fathers; in-depth interviews with mothers-in-law, mothers, fathers and HIV-infected mothers, and a survey of 446 mothers bringing their four-week-old infants for immunisation at five reproductive and child health clinics. The study demonstrated that the mother-in-law saw herself as responsible for family health issues in general and child care in particular. However she received limited trust, and couples, in particular couples living in urban areas, tended to exclude her from decisions related to childbearing and infant feeding. Mothers-in-law expected their daughters-in-law to breastfeed in a customary manner and were generally negative towards the infant feeding methods recommended for HIV-infected mothers; exclusive replacement feeding and exclusive breastfeeding. Decreasing influence of the mother-in-law and increasing prominence of the conjugal couples in issues related to reproduction and child care, reinforce the importance of continued efforts to include male partners in the PMTCT programme. The potential for involving mothers-in-law in the infant feeding component, where she still has influence in some areas, should be further explored

On the NP-Hardness of Approximating Ordering Constraint Satisfaction Problems

We show improved NP-hardness of approximating Ordering Constraint Satisfaction Problems (OCSPs). For the two most well-studied OCSPs, Maximum Acyclic Subgraph and Maximum Betweenness, we prove inapproximability of $14/15+\epsilon$ and $1/2+\epsilon$. An OCSP is said to be approximation resistant if it is hard to approximate better than taking a uniformly random ordering. We prove that the Maximum Non-Betweenness Problem is approximation resistant and that there are width-$m$ approximation-resistant OCSPs accepting only a fraction $1 / (m/2)!$ of assignments. These results provide the first examples of approximation-resistant OCSPs subject only to P $\neq$ \NP

Bruk av norske spesialstyrker i krisehåndtering - utfordringer og muligheter

“Det er sannsynlig at noe usannsynlig vil skje”, sa Aristoteles. 22. juli 2011 skjedde det usannsynlige i Norge, terrorangrepet på Regjeringskvartalet og på AUFs sommerleir på Utøya. Kriser, ulykker og katastrofer utgjør alvorlige utfordringer for samfunnet. Norge, som småstat, må utnytte sine begrensede ressurser på en best mulig måte når en krise rammer. Stortinget har besluttet at Forsvaret skal bidra til ivaretakelse av samfunnssikkerhet innenfor rammen av tilgjengelige ressurser, kompetanse og kapasiteter. Hensikten med denne oppgaven er å se nærmere på hvordan norske spesialstyrker kan benyttes i krisehåndtering nasjonalt eller i situasjoner utlands der norske borgere er involvert. Den overordnede problemstillingen er hvilke utfordringer og muligheter som gjør seg gjeldende ved bruk av spesialstyrker i krisehåndtering hjemme og ute? Oppgaven er delt inn i tre hoveddeler. Først søker jeg å skape en begrepsmessig forståelse for hva spesialstyrker og spesialoperasjoner er. Samt krisebegrepets innhold og utvikling, og Forsvaret og spesialstyrkenes rolle i krisehåndtering. I del to studerer jeg tre caser hvor spesialstyrkene har vært benyttet eller vurdert benyttet, hjemme og ute, og hvilke utfordringer og muligheter beslutningstakerne ble stilt overfor. I del tre av oppgaven analyserer jeg de utfordringer og muligheter gjennomgangen av de tre casene identifiserte. Disse casene gir et bilde av hvordan spesialstyrkene kan benyttes som en forsterkning av sivile ressurser, andre militære ressurser, eller som et handlingsalternativ hvis en situasjon skulle eskalere eller komme ut av kontroll. Oppgaven bidrar til å identifisere muligheter bruk av spesialstyrkene gir, særlig spesialstyrkenes evne til å gi strategisk ledelse mer “å spille på”, samt styrkenes evne til å kunne trekke på Forsvarets fellesoperative ressurser. Samtidig viser oppgaven at det er store utfordringer knyttet til bruken av spesialstyrkene i nasjonale kriser, spesielt i forhold til juridiske tolkninger, militære begrensninger og politisk vilje

Behavioural response of farmed Atlantic salmon (Salmo salar L.) to artificial underwater lights : Wavelet analysis of acoustic telemetry data

publishedVersio

Low adherence to exclusive breastfeeding in Eastern Uganda: A community-based cross-sectional study comparing dietary recall since birth with 24-hour recall

BACKGROUND: Exclusive breastfeeding is recommended as the best feeding alternative for infants up to six months and has a protective effect against mortality and morbidity. It also seems to lower HIV-1 transmission compared to mixed feeding. We studied infant feeding practices comparing dietary recall since birth with 24-hour dietary recall. METHODS: A cross-sectional survey on infant feeding practices was performed in Mbale District, Eastern Uganda in 2003 and 727 mother-infant (0–11 months) pairs were analysed. Four feeding categories were made based on WHO's definitions: 1) exclusive breastfeeding, 2) predominant breastfeeding, 3) complementary feeding and 4) replacement feeding. We analyzed when the infant fell into another feeding category for the first time. This was based on the recall since birth. Life-table analysis was made for the different feeding categories and Cox regression analysis was done to control for potential associated factors with the different practices. Prelacteal feeding practices were also addressed. RESULTS: Breastfeeding was practiced by 99% of the mothers. Dietary recall since birth showed that 7% and 0% practiced exclusive breastfeeding by 3 and 6 months, respectively, while 30% and 3% practiced predominant breastfeeding and had not started complementary feeding at the same points in time. The difference between the 24-hour recall and the recall since birth for the introduction of complementary feeds was 46 percentage points at two months and 59 percentage points at four months. Prelacteal feeding was given to 57% of the children. High education and formal marriage were protective factors against prelacteal feeding (adjusted OR 0.5, 0.2 – 1.0 and 0.5, 0.3 – 0.8, respectively). CONCLUSION: Even if breastfeeding is practiced at a very high rate, the use of prelacteal feeding and early introduction of other food items is the norm. The 24-hour recall gives a higher estimate of exclusive breastfeeding and predominant breastfeeding than the recall since birth. The 24-hour recall also detected improper infant feeding practices especially in the second half year of life. The dietary recall since birth might be a feasible alternative to monitor infant feeding practices in resource-poor settings. Our study reemphasizes the need for improving infant feeding practices in Eastern Uganda

Malaria Parasitaemia among Infants and Its Association with Breastfeeding Peer Counselling and Vitamin A Supplementation: A Secondary Analysis of a Cluster Randomized Trial

Background: Malaria is the second highest contributor to the disease burden in Africa and there is a need to identify low cost prevention strategies. The objectives of this study were to estimate the prevalence of malaria parasitaemia among infants and to measure the association between peer counselling for exclusive breastfeeding (EBF), vitamin A supplementation, anthropometric status (weight and length) and malaria parasitaemia. Methods: A cluster randomized intervention trial was conducted between 2006 and 2008 where 12 of 24 clusters, each comprising one or two villages, in Eastern Uganda were allocated to receive peer counselling for EBF. Women in their third trimester of pregnancy (based on the last normal menstrual period) were recruited in all 24 clusters and followed up until their children’s first birthday. Blood was drawn from 483 infants between 3 and 12 months of age, to test for malaria parasitaemia. Results: The prevalence of malaria parasitaemia was 11% in the intervention areas and 10% in the control areas. The intervention did not seem to decrease the prevalence of malaria (PR 1.7; 95% CI: 0.9, 3.3). After controlling for potential confounders, infants not supplemented with Vitamin A had a higher prevalence for malaria compared to those who had been supplemented (PR 6.1; 95% CI: 2.1, 17.6). Among children supplemented with vitamin A, every unit increase in lengthfor- age Z (LAZ) scores was associated with a reduced prevalence in malaria (PR 0.5; 95% CI:0.4, 0.6). There was no association between LAZ scores and malaria among children that had not been supplemented. Conclusion: Peer counselling for exclusive breastfeeding did not decrease the prevalence of malaria parasitaemia. Children that had not received Vitamin A supplementation had a higher prevalence of malaria compared to children that had been supplemented

A Hypergraph Dictatorship Test with Perfect Completeness

A hypergraph dictatorship test is first introduced by Samorodnitsky and Trevisan and serves as a key component in their unique games based \PCP construction. Such a test has oracle access to a collection of functions and determines whether all the functions are the same dictatorship, or all their low degree influences are $o(1).$ Their test makes $q\geq3$ queries and has amortized query complexity $1+O(\frac{\log q}{q})$ but has an inherent loss of perfect completeness. In this paper we give an adaptive hypergraph dictatorship test that achieves both perfect completeness and amortized query complexity $1+O(\frac{\log q}{q})$.Comment: Some minor correction

Are we doing enough? Improved breastfeeding practices at 14 weeks but challenges of non-initiation and early cessation of breastfeeding remain: Findings of two consecutive cross-sectional surveys in KwaZulu-Natal, South Africa

Background KwaZulu-Natal (KZN) Initiative for breastfeeding support (KIBS) was a multipronged intervention to support the initiation and sustaining of breastfeeding, implemented between 2014 and 2017. We present results of two surveys conducted before and after KIBS implementation to assess changes in infant feeding practices in KZN over this time period. Methods Two cross-sectional surveys were conducted in primary health care clinics. Multistage stratified random sampling was used to select clinics and participants. Sample size was calculated to provide district estimates of 14-week exclusive breastfeeding (EBF) rates at baseline (KIBS1), and provincial estimates at endpoint (KIBS2). At KIBS1 the sample required was nine participating clinics in each of 11 districts (99 clinics) with 369 participants per district (N = 4059), and at KIBS2 was 30 clinics in KZN with 30 participants per clinic (N = 900). All caregivers aged ≥15 years attending the clinic with infants aged 13- < 16 weeks were eligible to participate. Data was collected using structured interviews on android devices. Multi-variable logistic regression was used to adjust odds ratios for differences between time points. Results At KIBS1 (May2014- March2015), 4172 interviews were conducted with carers, of whom 3659 (87.6%) were mothers. At KIBS2 (January–August 2017), 929 interviews were conducted which included 788 (84.8%) mothers. Among all carers the proportion exclusively breastfeeding was 44.6 and 50.5% (p = 0.1) at KIBS1 and KIBS2 respectively, but greater improvements in EBF were shown among mothers (49.9 vs 59.1: p = 0.02). There were reductions in mixed breastfeeding among all infants (23.2% vs 16.3%; p = 0.016). Although there was no change in the proportion of carers who reported not breastfeeding (31.9% vs 32.8%; p = 0.2), the duration of breastfeeding among mothers who had stopped breastfeeding was longer at KIBS2 compared to KIBS1 (p = 0.0015). Mothers who had returned to work or school were less likely to be breastfeeding (adjusted odds ratio [AOR] 3.76; 95% CI 3.1–4.6), as were HIV positive mothers (AOR 2.1; 95% CI 1.7–2.6). Conclusion Despite improvements to exclusive breastfeeding, failure to initiate and sustain breastfeeding is a challenge to achieving optimal breastfeeding practices. Interventions are required to address these challenges and support breastfeeding particularly among working mothers and HIV positive mothers.publishedVersio

Association of maternal HIV‐1 severity with dental caries: an observational study of uninfected 5‐ to 7‐yr‐old children of HIV‐1‐infected mothers without severe immune suppression

Treatment programs to prevent perinatal and postnatal HIV-1 transmission have become available in sub-Saharan Africa, leading to an emerging population of HIV-1 exposed uninfected (HEU) children. Exposure to HIV-1 in utero and during breastfeeding may increase the risk of morbidity and mortality in HEU children. This study estimated the association of the severity of maternal HIV-1 infection as assessed by CD4 count and viral load at baseline (7 d postpartum), with dmft count of their 5- to 7-yr-old HEU offspring. A follow-up study was conducted of HIV-1-infected mother–HEU children pairs (n = 164) from the Ugandan site of the ANRS 12341-PROMISE- PEP trial (ClinicalTrials.gov, number NCT00640263). HIV-1-infected mothers were interviewed and the HEU children were examined for caries using the World Health Organization's survey methods for field conditions and the dmft index. Directed acyclic graphs and negative binomial regression were used for analyses. The prevalence of 1 or more dmft was 48%. Negative binomial regression showed no association between the dmft count and maternal CD4 counts 7 d postpartum but a 10% lower dmft count with longer breastfeeding duration was found. Maternal CD4 count at birth was not associated with the dental caries experience in uninfected children born to women without severe immune suppression, while there appeared to be a protective effect of high viral load and breastfeeding duration.publishedVersio

Questioning the ethics of international research on formula milk supplementation in low-income African countries

Over the past three decades, the increase in funding for priority public health issues largely affecting low/middle-income countries (LMICs) has led to the growth in international research involving researchers or research sponsors from a high-income country (HIC) conducting research in LMICs. The ethical considerations in such international research were raised in the 1990s and several ethical guidelines specifically addressing international research were published.1 2 However, in 2022, we still find examples of research undertaken by HIC principal investigators and funders, with no benefit and large potential for harm, being undertaken in LMICs