Malawian Mothers Research Articles

Psychometric Assessment of the Breastfeeding Self-Efficacy Scale-Short Form: A Confirmatory Factor Analysis in Malawian Mothers.

Exclusive breastfeeding to 6 months postpartum has been related to breastfeeding self-efficacy in diverse populations. Globally, this is measured using the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF). To evaluate the psychometric properties of the BSES-SF among women in Malawi; and to examine the relationship between breastfeeding self-efficacy and demographic and health factors. The study design was a prospective, cross-sectional survey with a 2 week follow-up reliability check. Postpartum women (N = 180) were recruited at a maternity hospital in Lilongwe, Malawi. In addition to the BSES-SF, the World Health Organization's Quality of Life Scale (QoL) was also administered. Furthermore, confirmatory factor analysis, Cronbach's alpha, and Pearson's correlations were used to examine the construct validity, reliability, test-retest reliability, and convergent validity. The confirmatory factor analysis supported a unidimensional structure of the Malawian version of the 12-item BSES-SF. Cronbach's alpha and the intra-class correlation coefficient were 0.79 and 0.75, respectively. BSES-SF scores had significant correlation with QoL domains (physical QoL: r = 0.31, p < .001; and environmental QoL: r = 0.22, p < .01). Participants' age, parity, and mode of delivery were positively correlated with breastfeeding self-efficacy scores. The findings of our study confirmed that the 12-item BSES-SF is a reliable and valid scale for assessing women's breastfeeding self-efficacy in Malawi.

Experiences of Malawian Mothers During Their Infants' Hospitalization.

Hospitalization of a newborn infant is stressful for all mothers. Hospitals in Malawi have limited nursing staff and support, so mothers are the primary care providers for their hospitalized infants. Few studies have explored the experience of these mothers as both care providers and mothers. The purpose of this study was to explore the experiences of mothers during the hospitalization of the infant. The goal was to increase knowledge of their primary concerns about the hospital stay. This was a descriptive qualitative study conducted at Queen Elizabeth Central Hospital in Malawi. Mothers were interviewed prior to their infant's discharge. We used the directed content analysis approach to analyze our data. Twenty mothers of preterm or full-term infants were interviewed. The primary concerns were perinatal experiences, the infant's condition and care including breastfeeding, support from family members, and support and care from healthcare providers. Additionally, mothers of preterm infants were concerned about the burdens of kangaroo mother care. In hospitals that provide limited nursing support to mothers and their infants, it is important to identify a support system for the mother and provide mothers with information on infant care. Future research should identify specific supports and resources in the community and hospital settings that are associated with positive hospital experiences.

Malawian mothers' experiences of raising children living with albinism: A qualitative descriptive study.

BackgroundAlbinism in humans is characterised by a reduced amount of pigment (melanin) present in the skin, hair follicles and the eye; approximately 7000–10 000 Malawians of all ages are affected. Children with these features face extreme forms of human rights abuses, even death.ObjectivesThis study aims to describe Malawian mothers’ experiences, perceptions and understanding of raising children with albinism (CWA).MethodsThe study was conducted in 2018 using a qualitative descriptive design, with purposive sampling and voluntary participation. Mothers, 18 years and older, who had given birth to a CWA and who attended the dermatology clinic of a local public hospital participated. An interview guide used during standardised, open-ended interviews was translated from English to Chichewa using forward and backward translation. Interviews were conducted in Chichewa, audio recorded, transcribed and forward and back translated from English to Chichewa. Thematic data analysis was employed.ResultsThe mean age of participants (N = 10) was 33 years; two had albinism. Emerging themes confirmed the existence of myths and stereotypes regarding albinism but from the mothers’ perspectives. Mothers reported: (1) some experiences of emotional pain, initially, but also love and acceptance of their children, despite adverse reactions of others; (2) their experiences of stigmatisation of their children and themselves, and of intended harm to their children, and (3) their own lack of knowledge and understanding of albinism.ConclusionIn our limited study, mothers’ self-reported experiences of raising CWA in Malawi highlight the need for educational programmes on albinism at national level, particularly for families with a CWA, health professionals and educators.

Small-Quantity Lipid-Based Nutrient Supplements Do Not Affect Plasma or Milk Retinol Concentrations Among Malawian Mothers, or Plasma Retinol Concentrations among Young Malawian or Ghanaian Children in Two Randomized Trials

ABSTRACTBackgroundVitamin A (VA) deficiency is prevalent in preschool-aged children in sub-Saharan Africa.ObjectivesWe assessed the effect of small-quantity lipid-based nutrient supplements (SQ-LNS) given to women during pregnancy and lactation and their children from 6 to 18 mo of age on women's plasma and milk retinol concentrations in Malawi, and children's plasma retinol concentration in Malawi and Ghana.MethodsPregnant women (≤20 wk of gestation) were randomized to receive daily: 1) iron and folic acid (IFA) during pregnancy only; 2) multiple micronutrients (MMN; 800 μg retinol equivalent (RE)/capsule), or 3) SQ-LNS (800 μg RE/20g) during pregnancy and the first 6 mo postpartum. Children of mothers in the SQ-LNS group received SQ-LNS (400 μg RE/20 g) from 6 to 18 mo of age; children of mothers in the IFA and MMN groups received no supplement. Plasma retinol was measured in mothers at ≤20 and 36 wk of gestation and 6 mo postpartum, and in children at 6 and 18 mo of age. Milk retinol was measured at 6 mo postpartum. VA status indicators were compared by group.ResultsAmong Malawian mothers, geometric mean (95% CI) plasma retinol concentrations at 36 wk of gestation and 6 mo postpartum were 0.97 μmol/L (0.94, 1.01 μmol/L) and 1.35 μmol/L (1.31, 1.39 μmol/L), respectively; geometric mean (95% CI) milk retinol concentration at 6 mo postpartum was 1.04 μmol/L (0.97, 1.13 μmol/L); results did not differ by intervention group. Geometric mean (95% CI) plasma retinol concentrations for Malawian children at 6 and 18 mo of age were 0.78 μmol/L (0.75, 0.81 μmol/L) and 0.81 μmol/L (0.78, 0.85 μmol/L), respectively, and for Ghanaian children they were 0.85 μmol/L (0.82, 0.88 μmol/L) and 0.88 μmol/L (0.85, 0.91 μmol/L), respectively; results did not differ by intervention group in either setting.ConclusionsSQ-LNS had no effect on VA status of mothers or children, possibly because of low responsiveness of the VA status indicators.

Starting from Home: Development of a Sustainable Parenting Education Program for Caregivers with Young Children in Rural Malawi

The purpose of this study was to design a community-based, needs-sensitive, and culturally appropriate parenting education program that is effective for rural Malawian caregivers. With the use of the five-stage model, qualitative methods and procedures were used for developing the program. The presented program emphasized securing sustainability and community empowerment by listening to the voices of Malawian mothers, community leaders, and Malawian facilitators who are also parents. In order to ensure the cultural appropriateness and feasibility of the program, contents were provided in both English and Chichewa, and utilized Malawian folklore, well-known Malawian songs, and children’s play during the home visit sessions. In the process of developing and implementing the parenting education program, Malawian caregivers’ prior knowledge, cultural assets, needs and wants were honored and actively reflected, in order to make the program locally relevant and meaningful.

Food purchasing decisions of Malawian mothers with young children in households experiencing the nutrition transition

As overweight/obesity prevalence increases in sub-Saharan Africa, information is needed about factors influencing food purchases in households with overweight members. This study assessed food purchasing decisions of Malawian mothers with young children (N = 54 dry season, N = 55 rainy season) among whom the mother, child, or both were overweight. Research assistants completed structured observations of mothers shopping for food during the dry season and of the types and quantities of foods in mothers' homes during the rainy season. After each observation, research assistants conducted an in-depth interview about factors that influenced food purchases, including asking mothers to sort 12 factors into piles that always, sometimes, or never influence their food purchases. Observations showed mothers most often shopped at outdoor markets to buy foods needed to prepare relish, such as tomatoes (71%), green leafy vegetables (58%), cooking oil (58%), and fish (40%). At home, maize flour (80%) and salt (66%) were the most common foods. Pile sorts and in-depth interviews revealed cost, taste preferences, freshness, and healthiness were the strongest factors influencing food purchases. Mothers described buying a smaller quantity or making substitutions (e.g., fish instead of meat) if a food is too expensive. Many mothers reported buying foods their family likes and prioritizing children's preferences. Freshness of foods, especially fruits and vegetables, and whether foods were perceived to be healthy also influenced food purchases, but mothers' knowledge of which foods were healthy was mixed. Mothers used some of their minimal funds to buy unhealthy foods (e.g., packaged or fried snacks) for their children, despite their overall emphasis on food cost and healthiness. These findings can be used by programs to reinforce healthy and decrease unhealthy food purchases by mothers with young children in Malawi.

Maternal Broadly Neutralizing Antibodies Can Select for Neutralization-Resistant, Infant-Transmitted/Founder HIV Variants.

Each year, >180,000 infants become infected via mother-to-child transmission (MTCT) of HIV despite the availability of effective maternal antiretroviral treatments, underlining the need for a maternal HIV vaccine. We characterized 224 maternal HIV envelope (Env)-specific IgG monoclonal antibodies (MAbs) from seven nontransmitting and transmitting HIV-infected U.S. and Malawian mothers and examined their neutralization activities against nontransmitted autologous circulating viruses and infant-transmitted founder (infant-T/F) viruses. Only a small subset of maternal viruses, 3 of 72 (4%), were weakly neutralized by maternal linear V3 epitope-specific IgG MAbs, whereas 6 out of 6 (100%) infant-T/F viruses were neutralization resistant to these V3-specific IgG MAbs. We also show that maternal-plasma broadly neutralizing antibody (bNAb) responses targeting the V3 glycan supersite in a transmitting woman may have selected for an N332 V3 glycan neutralization-resistant infant-T/F virus. These data have important implications for bNAb-eliciting vaccines and passively administered bNAbs in the setting of MTCT.IMPORTANCE Efforts to eliminate MTCT of HIV with antiretroviral therapy (ART) have met little success, with >180,000 infant infections each year worldwide. It is therefore likely that additional immunologic strategies that can synergize with ART will be required to eliminate MTCT of HIV. To this end, understanding the role of maternal HIV Env-specific IgG antibodies in the setting of MTCT is crucial. In this study, we found that maternal-plasma broadly neutralizing antibody (bNAb) responses can select for T/F viruses that initiate infection in infants. We propose that clinical trials testing the efficacy of single bNAb specificities should not include HIV-infected pregnant women, as a single bNAb might select for neutralization-resistant infant-T/F viruses.

An Observational Study on Early Dyadic Interactive Behaviors of Mothers With Early-Preterm, Late-Preterm, and Full-Term Infants in Malawi.

Mother-infant interactions are necessary for infant growth and development. However, preterm birth is associated with less positive mother-infant interactions than full-term birth. Malawi has the highest preterm birth rate in the world, but studies of the mother-infant relationship in Malawi are limited and studies that observed mother-infant interactions could not be located. This study explored mother-infant interactions among Malawian mothers of early-preterm, late-preterm, and full-term infants. This observational study explored maternal and infant interactive behaviors. We recruited 83 mother-infant dyads (27 early-preterm, 29 late-preterm, and 27 full-term dyads). Mothers of early-preterm infants looked at and rocked their infants less, and their infants looked at their mothers less, than mothers of either late-preterm infants or full-term infants. The infants in all groups were asleep most of the time, which contributed to low levels of interactive behaviors. Factors that were related to infant behaviors included marital status, maternal occupation, maternal education, infant medical complications, infant gender, history of neonatal deaths, and multiple births. Our findings provide evidence about the need to encourage mothers to engage interactive behaviors with their infants. Future studies of factors that contribute to positive interactions in Malawi are needed.

Maternal Experience of Intimate Partner Violence Is Associated with Suboptimal Breastfeeding in Malawi, Tanzania, and Zambia: Insights from DHS Analyses (P10-059-19)

ObjectivesMaternal experience of intimate partner violence (IPV) remains an overlooked variable in the context of breastfeeding in East Africa. Therefore, this study investigated the association between maternal experience of different forms of intimate partner violence (IPV) and frequency of IPV and suboptimal breastfeeding practices in Malawi, Tanzania, and Zambia. MethodsData were obtained from the most recent Demographic and Health Surveys for Malawi (n = 1878), Tanzania (n = 3184), and Zambia (n = 3879) and included mother-infant dyads. Outcomes were early initiation of breastfeeding, exclusive breastfeeding, and continued breastfeeding. IPV was maternal reported experience of physical, sexual, or emotional violence or controlling behaviors and frequency of IPV. Significant bivariate results (P < 0.05) were included in the adjusted models in multivariate logistic regression. ResultsMost (80.4%) Malawian mothers initiated early breastfeeding, compared to mothers in Tanzania (53.4%) and Zambia (67.7%). Just over half (55.0%) of Tanzanian infants were exclusively breastfed while 60.1% and 70.6% of Malawian and Zambia infants were. Continued breastfeeding at 1 year was high in all countries; Malawi (91.0%), Tanzania (92.4%), Zambia (95.0%). In Zambia, 78.8% of mothers reported experiencing any form of IPV compared to 76.6% and 73.4% of Tanzanian and Malawian mothers who reported experiencing IPV. In all three countries, mothers who experienced emotional IPV were more likely not to initiate breastfeeding in the first hour after birth (Malawi [AOR = 1.37(1.05–1.79)]; Tanzania [AOR = 1.43(1.22–1.68)]; Zambia [AOR = 1.28(1.06–1.54)]). In Malawi and Zambia, women who frequently experienced any form of IPV were more likely not to have exclusively breastfed (Malawi [AOR = 1.88(1.17–3.04)]; Zambia [AOR = 1.96(1.35–2.85)]). Tanzanian mothers who experienced emotional IPV were nearly two times more likely not to continue breastfeeding until the child’s first birthday [AOR = 1.94(1.03–3.66)]. ConclusionsIn all three countries, maternal experience of IPV was associated with suboptimal breastfeeding practices. The potential effects of maternal experience of IPV on breastfeeding should be considered when planning interventions and designing policies to improve breastfeeding in Malawi, Tanzania, and Zambia. Funding SourcesNone.

Periapical infection may affect birth outcomes via systemic inflammation.

Maternal dental periapical infections are associated with preterm birth and intrauterine growth restriction. This study investigates whether the association is mediated through bacterial spread from periapical lesions to placenta (direct pathway) or systemic inflammatory reaction (indirect pathway). We compared birth outcomes in Malawian mothers with and without periapical infection. As markers of a direct pathway, we identified placental bacteria using a 16S rDNA approach and assessed histological evidence of inflammation in the placenta and amniotic membranes. We measured C-reactive protein, alpha-1-acid glycoprotein, and salivary cortisol as markers of an indirect pathway. We used regression models to associate the predictor variables with duration of pregnancy and newborn size. Of 1,024 women, 23.5% had periapical infection. There was no association of periapical infection with either bacterial DNA or histological inflammation in placenta or membranes. Periapical infection was associated with C-reactive protein, alpha-1-acid glycoprotein, and cortisol concentrations in a dose-dependent manner at 36weeks. Addition of alpha-1-acid glycoprotein or cortisol concentration into regression models attenuated the association between periapical infection and pregnancy outcomes. There was no evidence of direct spread of periapical bacteria to the placenta. Periapical infections and adverse pregnancy outcomes are in part mediated through systemic inflammation.

Validation of the Chichewa Perinatal PTSD Questionnaire and Chichewa Child Health Worry Scale

Malawian mothers regardless of gestation at birth find pregnancy to be a stressful period that triggers worry due to a fear of maternal death. Research has mostly focused on maternal depressive symptoms regardless of gestation. Limited literature exists on posttraumatic stress symptoms and maternal worry. The purpose of this study was to translate and validate the Perinatal PTSD Questionnaire and Child Health Worry Scale for assessment of posttraumatic stress symptoms and worry about child’s health, respectively, among Malawian women. The process of assuring the accuracy of the translation involved having five native English-speaking nurse researchers and eight Malawian nurse-midwives in a focus group review the translations. We then psychometrically tested the instruments with 30 postpartum mothers at Kamuzu College of Nursing and Queen Elizabeth Central Hospital. Findings from the nurse researchers and the nurse-midwives agreed with most of the translations and modifications were done to improve the adaptations. The instruments were administered to the postpartum mothers. The Chichewa Self Reporting Questionnaire was used as the standard for assessment of perinatal emotional distress symptoms. Both the Chichewa Perinatal PTSD Questionnaire and Chichewa Child Health Worry Scale had high internal consistency and showed strong to moderate correlations with the Chichewa Self Reporting Questionnaire. The mothers agreed that the questions were easy to understand and culturally sensitive, although a few questions were seen as distressing. Future adaptations need to consider testing the instruments in mothers throughout infancy and utilizing other gold standard instruments for validation.

The effects of a lipid-based nutrient supplement and antiretroviral therapy in a randomized controlled trial on iron, copper, and zinc in milk from HIV-infected Malawian mothers and associations with maternal and infant biomarkers.

We evaluated effects of antiretroviral (ARV) therapy and lipid‐based nutrient supplements (LNSs) on iron, copper, and zinc in milk of exclusively breastfeeding HIV‐infected Malawian mothers and their correlations with maternal and infant biomarkers. Human milk and blood at 2, 6, and 24 weeks post‐partum and blood during pregnancy (≤30 weeks gestation) were collected from 535 mothers/infant‐pairs in the Breastfeeding, Antiretrovirals, and Nutrition study. The participants received ARV, LNS, ARV and LNS, or no intervention from 0 to 28 weeks post‐partum. ARVs negatively affected copper and zinc milk concentrations, but only at 2 weeks, whereas LNS had no effect. Among all treatment groups, approximately 80–90% of copper and zinc and <50% of iron concentrations met the current adequate intake for infants at 2 weeks and only 1–19% at 24 weeks. Pregnancy haemoglobin was negatively correlated with milk iron at 2 and 6 weeks (r = −.18, p < .02 for both). The associations of the milk minerals with each other were the strongest correlations observed (r = .11–.47, p < .05 for all); none were found with infant biomarkers. At 2 weeks, moderately anaemic women produced milk higher in iron when ferritin was higher or TfR lower. At 6 weeks, higher maternal α‐1‐acid glycoprotein and C‐reactive protein were associated with higher milk minerals in mildly anaemic women. Infant TfR was lower when milk mineral concentrations were higher at 6 weeks and when mothers were moderately anaemic during pregnancy. ARV affects copper and zinc milk concentrations in early lactation, and maternal haemoglobin during pregnancy and lactation could influence the association between milk minerals and maternal and infant iron status and biomarkers of inflammation.

Infant and Young Child Feeding Decision Making and Practices: Malawian Mothers' and Fathers' Roles in the Context of HIV.

Few studies in low- and middle-income countries have examined the roles of couples in infant and young child feeding decision making and practices, and there is no corresponding data in the context of human immunodeficiency virus (HIV). Research aim: This study aimed to explore mothers' and fathers' perceptions of their roles in feeding decision making and practices. The authors conducted in-depth interviews with 15 mothers and their male partners, recruited from the catchment areas of two urban and two rural government clinics in Lilongwe District, Malawi. The mothers were ≥ 18 years of age, were HIV positive, and had a child < 24 months of age. Twelve of the 15 fathers were also HIV positive. The interviews were analyzed using content analysis. Mothers were responsible for child care, including breastfeeding and complementary feeding. Fathers provided monetary support for purchasing food and offered verbal support to encourage mothers to implement recommended feeding practices. Many fathers found it difficult to support adequate complementary feeding because of household food insecurity. Mothers were advised on child feeding during prevention of mother-to-child transmission clinic visits. No fathers in this study accompanied women to clinic appointments, so they were less well-informed about feeding than mothers. Fathers usually deferred to mothers in feeding decision making. One-third of mothers wanted fathers to be more involved in child feeding. Malawian mothers' and fathers' roles in feeding decision making in the context of HIV align with local gender norms. Strategies are needed to improve fathers' knowledge of and involvement in child feeding, as desired by mothers.

Maternity waiting homes—a solution for Malawian mothers?

Background: The maternal mortality rate in Malawi remains unacceptably high, and maternity waiting homes might offer an effective solution. The current and previous Malawian Governments both stated that they were committed to improving the maternal mortality rate, and pledged to increase the numbers of maternity waiting homes (MWH). However, it seems that little was documented about the existing maternity waiting homes. Aims: To gather information about one Malawian MWH and the women who attended. Methods: Interviews with a random sample of pregnant women in a waiting home at a local district hospital outside Lilongwe indicated why women choose to use the homes and the challenges they faced. Findings: Of the seven women in the study, six lived between 5 and 10 km from the MWH, and one lived more than 10 km away. Six of the women were primiparous and therefore potentially at risk of prolonged labour. Six women presented late into their pregnancy for antenatal care, and one did not present for antenatal care at all. None of the women knew their expected date of delivery, and all women in the study believed that it was better to deliver a baby in a hospital than in the village or on the way to hospital. Conclusions: More information about more maternity waiting homes throughout the country is needed, in order to make informed decisions about whether maternity waiting homes are useful at all and if so, how they might be optimally effective.

Factors associated with delayed Antenatal Care attendance in Malawi: Results from a Qualitative study

Background: Antenatal care has been identified as pivotal to improving maternal and child health in Malawi. Though Malawian women consistently seek antenatal care, they rarely do so during their first trimester. The purpose of this study was to identify barriers to antenatal care uptake among Malawian women. This article adds to the literature by identifying common sociocultural barriers and their impact on ANC attendance.&#x0D; Methods: Two large tertiary care hospitals in the central and southern regions of Malawi were selected as study sites. Twenty pregnant mothers and eight health workers were recruited and interviewed. The interviews were transcribed verbatim and analyzed to identify themes. Posters in health facilities were also analyzed.&#x0D; Results: Results revealed many contributors to delayed antenatal attendance among Malawian mothers including: attitudes toward pregnancy, hospital inefficiencies, ANC promotion at the health facilities/communities, and spousal/significant other involvement all contributed to delayed antenatal attendance among urban Malawian women. &#x0D; Conclusions: Incorporating spouses/significant others in antenatal care activities, providing a consistent message in promotion materials used with the women and addressing the inefficiencies within the health system could be targets to improve early antenatal attendance in Malawi.

Factors associated with delayed antenatal care attendance in Malawi: results from a qualitative study

Background: Antenatal care has been identified as pivotal to improving maternal and child health in Malawi. Though Malawian women consistently seek antenatal care, they rarely do so during their first trimester. The purpose of this study was to identify barriers to antenatal care uptake among Malawian women. This article adds to the literature by identifying common sociocultural barriers and their impact on ANC attendance.&#x0D; Methods: Two large tertiary care hospitals in the central and southern regions of Malawi were selected as study sites. Twenty pregnant mothers and eight health workers were recruited and interviewed. The interviews were transcribed verbatim and analyzed to identify themes. Posters in health facilities were also analyzed.&#x0D; Results: Results revealed many contributors to delayed antenatal attendance among Malawian mothers including: attitudes toward pregnancy, hospital inefficiencies, ANC promotion at the health facilities/communities, and spousal/significant other involvement all contributed to delayed antenatal attendance among urban Malawian women.&#x0D; Conclusions: Incorporating spouses/significant others in antenatal care activities, providing a consistent message in promotion materials used with the women and addressing the inefficiencies within the health system could be targets to improve early antenatal attendance in Malawi.

Thiamin and Riboflavin in Human Milk: Effects of Lipid-Based Nutrient Supplementation and Stage of Lactation on Vitamer Secretion and Contributions to Total Vitamin Content.

While thiamin and riboflavin in breast milk have been analyzed for over 50 years, less attention has been given to the different forms of each vitamin. Thiamin-monophosphate (TMP) and free thiamin contribute to total thiamin content; flavin adenine-dinucleotide (FAD) and free riboflavin are the main contributors to total riboflavin. We analyzed milk collected at 2 (n = 258) or 6 (n = 104), and 24 weeks (n = 362) from HIV-infected Malawian mothers within the Breastfeeding, Antiretrovirals and Nutrition (BAN) study, randomly assigned at delivery to lipid-based nutrient supplements (LNS) or a control group, to investigate each vitamer’s contribution to total milk vitamin content and the effects of supplementation on the different thiamin and riboflavin vitamers at early and later stages of lactation, and obtain insight into the transport and distribution of these vitamers in human milk. Thiamin vitamers were derivatized into thiochrome-esters and analyzed by high-performance liquid-chromatography-fluorescence-detection (HPLC-FLD). Riboflavin and FAD were analyzed by ultra-performance liquid-chromatography-tandem-mass-spectrometry (ULPC-MS/MS). Thiamin-pyrophosphate (TPP), identified here for the first time in breast milk, contributed 1.9–4.5% to total thiamin. Free thiamin increased significantly from 2/6 to 24 weeks regardless of treatment indicating an active transport of this vitamer in milk. LNS significantly increased TMP and free thiamin only at 2 weeks compared to the control: median 170 versus 151μg/L (TMP), 13.3 versus 10.5μg/L (free thiamin, p<0.05 for both, suggesting an up-regulated active mechanism for TMP and free thiamin accumulation at early stages of lactation. Free riboflavin was consistently and significantly increased with LNS (range: 14.8–19.6μg/L (LNS) versus 5.0–7.4μg/L (control), p<0.001), shifting FAD:riboflavin relative amounts from 92–94:6–8% to 85:15%, indicating a preferred secretion of the free form into breast milk. The continuous presence of FAD in breast milk suggests an active transport and secretion system for this vitamer or possibly formation of this co-enymatic form in the mammary gland.

The Role of Cultural Beliefs in Accessing Antenatal care in Malawi: A Qualitative Study.

The World Health Organization in 2002 recommended a focused antenatal care model of four visits for women in low-income countries. Despite the high percentage of mothers (95%) who see a skilled attendant and the adaptation of the recommended antenatal model, only 46% of Malawian mothers meet the recommendation. The purpose of this study was to identify the cultural beliefs that influence women's antenatal care or pregnancy-related health care decisions. Twenty pregnant mothers and eight health workers from two urban tertiary care hospitals in Malawi were recruited to participate in a qualitative study assessing barriers to antenatal care. Data were collected between September and December 2014 through face-face, audio-recorded interviews, and a demographic survey. Identified maternal cultural beliefs included: seeking advice from village elders, spousal fidelity, and disclosing pregnancy. Health workers mentioned that providers often held the same cultural beliefs and, therefore, turned women away if they tried to go against cultural norms. Cultural beliefs play an integral role in the decision-making process of antenatal care. Specifically, the belief and practice of when to disclose pregnancy prohibits women from seeking antenatal care in the first trimester.

Antibodies against pneumococcal capsular polysaccharide in Malawian HIV-positive mothers and their HIV-exposed uninfected children

Background HIV-exposed uninfected children have a higher risk of infection and mortality compared to HIV-unexposed children and the reasons for this vulnerability are still under investigation. Aim: This study aimed to evaluate the influence of maternal HIV parameters on the passive transfer of anti-pneumococcal capsular polysaccharide (PCP) IgG and to determine whether the concentrations of specific IgG might be related to the morbidity and mortality in HIV-exposed uninfected children. Methods One hundred and twenty-six Malawian HIV-infected pregnant women and their uninfected children were studied. Antiretroviral treatment-naive women started a nevirapine-based triple combination regimen from the third trimester of pregnancy until at least 6 months of exclusive breastfeeding. Mother/child pairs were followed until 2 years after delivery. Plasma anti-PCP IgG titers (in mothers at 26 weeks of gestation and in infants at 1 and 6 months) were determined by an enzyme-linked immunosorbent assay. None of these women and children had received any vaccination against pneumococcal polysaccharides. Results Maternal anti-PCP IgG concentration was independent from viral load (p = 0.848), CD4 count (p = 0.740) and WHO stage (p = 0.450). However, the child/mother ratio of anti-PCP IgG measured at 1 month among infants was significantly reduced in pairs whose mothers had HIV-RNA > 10 000 copies/ml (p = 0.043) and CD4 < 350 cells/μl (p = 0.090) before antiretroviral therapy (ART). No clear associations between anti-PCP IgG and respiratory-related deaths were found, but respiratory infection episodes were more frequent among children with lower anti-PCP IgG ratio (p = 0.046). Conclusion This study indicates that HIV pre-ART conditions in mothers may influence the rate of specific immunoglobulins transfer, increasing infants vulnerability to respiratory infections.

Malawian Mothers Consider Lipid-Based Nutrient Supplements Acceptable for Children throughout a 1-Year Intervention, but Deviation from User Recommendations Is Common1–3

Background: Lipid-based nutrient supplements (LNSs) offer a vehicle to improve children’s diets in low-income countries where complementary foods are typically deficient in essential nutrients. Sustained acceptability by the intended users is essential for achieving growth-promoting effects.Objective: We aimed to determine the sustained acceptability of LNSs among 6- to 18-mo-old children in Malawi.Methods: In the context of a trial testing the growth-promoting effect of different formulations and doses of LNSs, we delivered LNSs to the homes of the children biweekly according to the randomization protocol. We defined acceptability to include adherence to feeding recommendations and mothers’ experiences of feeding LNSs to their child. We conducted brief interviews each week with the mothers. At 2 time points we conducted knowledge, attitudes, and practices (KAP) interviews. In addition, we conducted repeated in-depth interviews with a subset of mothers.Results: Of the 1612 children who received the LNS intervention, we analyzed adherence data from 1478 (91.7%) children and KAP data at 2 time points (child’s age of 12 and 18 mo) from 839 (52.1%) of the children. The mean ± SD overall adherence (proportion of days when the study child reportedly consumed LNSs considering only those weeks when the supplement had been successfully delivered to the home) was 92.4 ± 9.6%, and there was no difference between children receiving milk-containing or milk-free LNSs. There was also no increasing or decreasing trend over time in any of the groups. Sharing and deviation from other feeding recommendations were common. Maternal experiences were mostly very positive.Conclusions: The acceptability of LNS products was good and was sustained for 12 mo in this rural Malawian population. However, sharing of the products with family members and deviation from other feeding recommendations were frequent, which means that individually targeted children were likely to receive less than the intended dose of the LNS. This trial was registered at clinicaltrials.gov as NCT00945698.