Implementation of the new WHO recommendations on HIV and infant feeding: Challenges and the way forward

Breast milk provides all the nutrient needs of the infant especially in the first six months of life and also protects the growing infant from pneumonia, diarrhoea, and malnutrition, which are the major causes of morbidity and mortality in the African Region. However breastfeeding is also known to transmit the Human Immunodeficiency Virus (HIV) from mother to the child. Several guidelines have been developed to guide policy makers, health workers and mothers on the most appropriate methods to feed HIV exposed infants. Previous HIV and infant feedingguidelines emphasized on preventing infants from becoming infected with HIV by counseling HIV-infected mothers to avoid all breastfeeding. Over the period, programme implementers and researchers have reported difficulties in implementing earlier recommendations and guidelines on HIV and infant feeding within health-care systems. New evidence now shows that giving Anti-Retroviral therapy (ARVs) to either the HIV-infected mother or HIV-exposed infant can significantly reduce the risk of transmitting HIV through breastfeeding. Thus, in 2010 World HealthOrganization (WHO) issued the latest guidelines on HIV and infant feeding entitled Principles and recommendations for infant feeding in the context of HIV and a summary of evidence. The 2010 WHO guidelines have changed the recommendations on how HIV infected mothers should feed their infants, and how health workers should support them. National authorities in each country can decide which infant feeding practice will be primarily promoted and supported by Maternal and Child Health services, i.e. breastfeeding with an antiretroviral intervention to reduce transmission or avoidance of all breastfeeding. Previous guidelines and  recommendations on infant feeding in the context of HIV have undergone frequent changes over the past decade. The adaptation and implementation of previous and current guidelines at national level have met challenges. These include lack of consensus among key stakeholders, inadequate funding for the additional cost of providing ARVs to the mother or the child and difficulties in communicating the recommendations in the new guidelines clearly to mothers, health workers and policy makers. To address these challenges a number of proposals have been suggested such as coordinated consensus building process, costing of interventions and a phased implementation approach to ensure successful scale up over time. This paper describes the process of adapting global HIV and infant feeding recommendations and guidelines at national level. It also reviews the challenges encountered in implementation and proposes the way forward in addressing them

Problems of decisional participation, leadership behaviour and role conflict in comprehensive secondary schools in South Wales

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Implementation Of The New Who Recommendations On Hiv And Infant Feeding: Challenges And The Way Forward

Breast milk provides all the nutrient needs of the infant especially in the first six months of life and also protects the growing infant from pneumonia, diarrhoea, and malnutrition, which are the major causes of morbidity and mortality in the African Region. However breastfeeding is also known to transmit the Human Immuno- deficiency Virus (HIV) from mother to the child. Several guidelines have been developed to guide policy makers, health workers and mothers on the most appropriate methods to feed HIV exposed infants. Previous HIV and infant feeding guidelines emphasized on preventing infants from becoming infected with HIV by counseling HIV-infected mothers to avoid all breastfeeding. Over the period, programme implementers and researchers have reported difficulties in implementing earlier recommendations and guidelines on HIV and infant feeding within health-care systems. New evidence now shows that giving Anti-Retroviral therapy (ARVs) to either the HIV-infected mother or HIV-exposed infant can significantly reduce the risk of transmitting HIV through breastfeeding. Thus, in 2010 World Health Organization (WHO) issued the latest guidelines on HIV and infant feeding entitled Principles and recommendations for infant feeding in the context of HIV and a summary of evidence. The 2010 WHO guidelines have changed the recommendations on how HIV infected mothers should feed their infants, and how health workers should support them. National authorities in each country can decide which infant feeding practice will be primarily promoted and supported by Maternal and Child Health services, i.e. breastfeeding with an antiretroviral intervention to reduce transmission or avoidance of all breastfeeding. Previous guidelines and recommendations on infant feeding in the context of HIV have undergone frequent changes over the past decade. The adaptation and implementation of previous and current guidelines at national level have met challenges. These include lack of consensus among key stakeholders, inadequate funding for the additional cost of providing ARVs to the mother or the child and difficulties in communicating the recommendations in the new guidelines clearly to mothers, health workers and policy makers. To address these challenges a number of proposals have been suggested such as coordinated consensus building process, costing of interventions and a phased implementation approach to ensure successful scale up over time. This paper describes the process of adapting global HIV and infant feeding recommendations and guidelines at national level. It also reviews the challenges encountered in implementation and proposes the way forward in addressing them

Framework For Supporting Countries To Address The Food Crisis And Malnutrition In The African Region

Of the world's undernourished children, 80% live in 20 countries; nine of these are in sub-Saharan Africa. Africa is home to 15 of the 16 countries where prevalence of hunger exceeds 35 per cent. This precarious food security situation in Africa has been compounded by economic and food crises which began in 2007, resulting in a rise by about 83% in food commodity prices.When food is in short supply, safety is compromised resulting in the consumption of unsafe food. Assuring safe food and ending malnutrition require decisive actions in several areas. In line with its Core Functions, global and regional agreements and as a key player in health, the WHO's vital role in addressing the food crisis is in preventing the effects of food insecurity, undernutrition and unsafe food. In order to scale-up actions to address the adverse effects of food insecurity and malnutrition in the African Region, the forty-fourth session of the Regional Programme Meeting (RPM44) discussed the topic Food Crisis in Africa: Implications for Nutrition and Food Safety Actions in the Region. A framework was therefore developed to facilitate joint actions in addressing the food crisis and malnutrition in the WHO African Region for better impact at country level. This paper provides a summary of the Framework which highlight WHO's role in the area of nutrition. It has four guiding principles: Country- level interventions, Community involvement and ownership; Adoption of multi-sectoral approach; Protection of vulnerable groups; and Evidence- based interventions. The Framework proposes actions to be implemented in countries with support of WHO and partners to meet the immediate food and nutritional needs of the vulnerable and build longer-term resilience to contribute to national food security. The expected impact of the implementation of these actions with support from WHO and partners is prevention of morbidity, mortality and the irreversible long-term effects of malnutrition on health and cognitive development