Women In Low-resource Settings Research Articles

High Uptake of Exclusive Breastfeeding and Reduced Early Post-Natal HIV Transmission

BackgroundEmpirical data showing the clear benefits of exclusive breastfeeding (EBF) for HIV prevention are needed to encourage implementation of lactation support programs for HIV-infected women in low resource settings among whom replacement feeding is unsafe. We conducted a prospective, observational study in Lusaka, Zambia, to test the hypothesis that EBF is associated with a lower risk of postnatal HIV transmission than non-EBF.Methods and ResultsAs part of a randomized trial of early weaning, 958 HIV-infected women and their infants were recruited and all were encouraged to breastfeed exclusively to 4 months. Single-dose nevirapine was provided to prevent transmission. Regular samples were collected from infants to 24 months of age and tested by PCR. Detailed measurements of actual feeding behaviors were collected to examine, in an observational analysis, associations between feeding practices and postnatal HIV transmission. Uptake of EBF was high with 84% of women reporting only EBF cumulatively to 4 months. Post-natal HIV transmission before 4 months was significantly lower (p = 0.004) among EBF (0.040 95% CI: 0.024–0.055) than non-EBF infants (0.102 95% CI: 0.047–0.157); time-dependent Relative Hazard (RH) of transmission due to non-EBF = 3.48 (95% CI: 1.71–7.08). There were no significant differences in the severity of disease between EBF and non-EBF mothers and the association remained significant (RH = 2.68 95% CI: 1.28–5.62) after adjusting for maternal CD4 count, plasma viral load, syphilis screening results and low birth weight.ConclusionsNon-EBF more than doubles the risk of early postnatal HIV transmission. Programs to support EBF should be expanded universally in low resource settings. EBF is an affordable, feasible, acceptable, safe and sustainable practice that also reduces HIV transmission providing HIV-infected women with a means to protect their children's lives.Trial RegistrationClinicalTrials.gov NCT00310726

The Changing Face of Preterm Birth

The Changing Face of Preterm Birth

Scan-and-treat methodology using Azure A fast stain as a cost-effective cervical cancer screening alternative to visual inspection with acetic acid

Most cases of invasive cervical cancer arise in the developing world, where few resources exist for large-scale screening programs. Sankaranarayanan [1–5] has advanced visual inspection with acetic acid (VIA) as a method to screen women in low resource settings. While VIA has been extensively investigated, most studies rely on a gold standard of colposcopically directed biopsy. In our studies [6], the sensitivity of colposcopy is 96% and the specificity is 48% when discriminating between normal and abnormal cervical tissue.

Pregnancy and childbirth care following conflict and displacement: care for refugee women in low-resource settings

Pregnancy and childbirth care following conflict and displacement: care for refugee women in low-resource settings

Pregnancy and childbirth care following conflict and displacement: care for refugee women in low-resource settings

Women in developing countries experience the same problems during pregnancy and childbirth and die of the same complications, regardless of whether they live in stable situations or in situations of conflict and displacement. They need services and/or care during pregnancy and childbirth wherever they are and in whatever circumstances prevail. This article provides an overview of the Safe Motherhood Initiative, including the recent directions taken to prevent maternal and neonatal mortality and morbidity. In addition, pregnancy and childbirth care in complex humanitarian emergencies is examined, highlighting the experiences in refugee settings. In some of these settings, pregnancy outcomes have been better than in host or home countries. The challenge remains to ensure that good-quality pregnancy and childbirth care, in line with the global standards set for achieving safe motherhood, is consistently available and accessible to women affected by complex humanitarian emergencies. J Midwifery Womens Health 2004;49(suppl 1):14–18 © 2004 by the American College of Nurse-Midwives.