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Objective To evaluate the effect of an intervention to improve the quality of data used to monitor the prevention of mother-to-child transmission (PMTCT) of the human immunodeficiency virus in South Africa. Methods The study involved 58 antenatal clinics and 20 delivery wards (37 urban, 21 rural and 20 semi-urban) in KwaZulu-Natal province that provided PMTCT services and reported data to the District Health Information System. The data improvement intervention, which was implemented between May 2008 and March 2009, involved training on data collection and feedback for health information personnel and programme managers, monthly data reviews and data audits at health-care facilities. Data on six data elements used to monitor PMTCT services and recorded in the information system were compared with source data from health facility registers before, during and after the intervention. Data completeness (i.e. their presence in the system) and accuracy (i.e. being within 10% of their true value) were evaluated. Findings The level of data completeness increased from 26% before to 64% after the intervention. Similarly, the proportion of data in the information system considered accurate increased from 37% to 65% (P < 0.0001). Moreover, the correlation between data in the information system and those from facility registers rose from 0.54 to 0.92. Conclusion A simple, practical data improvement intervention significantly increased the completeness and accuracy of the data used to monitor PMTCT services in South Africa. [TEXT NOT REPRODUCIBLE IN ASCII.] Objectif Evaluer l'effet d'une intervention visant a ameliorer la qualite des donnees utilisees pour controler la prevention de la transmission de la mere a l'enfant (PMTCT) du virus de l'immunodeficience humaine en Afrique du Sud. Methodes L'etude a concerne 58 cliniques prenatales et 20 salles d'accouchement (37 urbaines, 21 rurales et 20 semi-urbaines) de la province du KwaZulu-Natal, qui ont fourni des services PMTCT et reporte les donnees au systeme d'information sanitaire du district. L'intervention d'amelioration de la qualite des donnees, mise en place entre mai 2008 et mars 2009, a implique une formation a la collecte des donnees et au retour d'information du personnel d'information sanitaire et des gestionnaires de programme, ainsi que des verifications de donnees mensuelles et des audits de donnees dans les centres de soins. Les donnees de 6 elements de donnees utilises pour controler les services PMTCT et enregistres dans le systeme d'information ont ete comparees aux donnees sources des registres des centres de soins avant, pendant et apres l'intervention. Lexhaustivite des donnees (c'est-a-dire leur presence dans le systeme) et leur precision (representant 10% de leur valeur reelle) ont ete evaluees. Resultats Le niveau d'exhaustivite des donnees a augmente de 26% avant l'intervention a 64% apres celle-ci. De meme, la proportion des donnees dans le systeme d'information, qui sont considerees precises, a augmente de 37% a 65% (P < 0,0001). De plus, la correlation entre les donnees du systeme d'information et les donnees des registres des centres de soins est passee de 0,54 a 0,92. Conclusion Une intervention d'amelioration des donnees, simple et pratique, a permis d'augmenter considerablement l'exhaustivite et la precision des donnees utilisees pour controler les services PMTCT en Afrique du Sud. [TEXT NOT REPRODUCIBLE IN ASCII.] Objetivo Evaluar el efecto de una intervencion para mejorar la calidad de los datos empleados para controlar la prevencion de la transmision del virus de la inmunodeficiencia humana de la madre al hijo (TMT) en Sudafrica. Metodos El estudio incluyo 58 clinicas prenatales y 20 paritorios (37 de ellos situados en areas urbanas, 21 en areas rurales y 20 en areas parcialmente rurales) en la provincia de KwaZulu-Natal que proporcionaban servicios de prevencion de transmision de la madre al hijo y comunicaron sus datos al Sistema de Informacion Sanitaria del Distrito. La intervencion para la mejora de los datos, que se aplico entre mayo de 2008 y marzo de 2009, incluyo la formacion sobre recopilacion de datos y comunicacion de resultados dirigida al personal sanitario encargado de la informacion asi como a los gestores de programas, examenes mensuales y auditorias de los datos en las instalaciones de asistencia sanitaria. Se compararon los datos basados en seis elementos de datos utilizados para controlar los servicios de prevencion de TMT y archivados en el sistema de informacion con la fuente de datos de los registros de las instalaciones de asistencia sanitaria antes, durante y despues de la intervencion. Se evaluaron los datos en base a su exhaustividad (por ejemplo, su presencia en el sistema) y su exactitud (por ejemplo, estar situado dentro del 10% de su valor autentico). Resultados El nivel de exhaustividad de los datos aumento del 26% antes de la intervencion al 64% despues de la misma. De manera similar, la proporcion de datos en el sistema de informacion considerados exactos aumento del 37% al 65% (P Conclusion Una intervencion sencilla y practica para mejorar los datos aumento la exhaustividad y exactitud de los datos empleados para controlar los servicios de prevencion de laTMT en Sudafrica., Introduction Reliable and accurate public health information is essential for monitoring health and for evaluating and improving the delivery of health-care services and programmes. (1-4) As countries report their progress [...]

Objective To examine infant feeding intentions of HIV-infected and uninfected women and the appropriateness of their choices according to their home resources; and to determine their adherence to their intentions in the first postnatal week. Methods Feeding intentions of pregnant women were compared against four resources that facilitate replacement feeding: clean water, adequate fuel, access to a refrigerator and regular maternal income. First-week feeding practices were documented. Findings The antenatal feeding intentions of 1253 HIV-infected women were: exclusive breastfeeding 73%; replacement feeding 9%; undecided 18%. Three percent had access to all four resources, of whom 23% chose replacement feeding. Of those choosing replacement feeding, 8% had access to all four resources. A clean water supply and regular maternal income were independently associated with intention to replacement feed (adjusted odds ratio (AOR) 1.94, 95% confidence interval (CI) 1.2–3.2; AOR 2.1, 95% CI: 1.2–3.5, respectively). Significantly more HIV-infected women intending to exclusively breastfeed, rather than replacement feed, adhered to their intention in week one (exclusive breastfeeding 78%; replacement feeding 42%; P<0.001). Of 1238 HIV-uninfected women, 82% intended to exclusively breastfeed; 2% to replacement feed; and 16% were undecided. Seventy-five percent who intended to exclusively breastfeed adhered to this intention postnatally, and only 11 infants (<1%) received no breast milk. The number of antenatal home visits significantly influenced adherence to feeding intention. Conclusion Most HIV-infected women did not have the resources for safe replacement feeding, instead choosing appropriately to exclusively breastfeed. Adherence to feeding intention among HIV-infected women was higher in those who chose to exclusively breastfeed than to replacement feed. With appropriate counselling and support, spillover of suboptimal feeding practices to HIV-negative women is minimal. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Little is known about the nutritional adequacy and feasibility of breastmilk replacement options recommended by WHO/UNAIDS/UNICEF. The study aim was to explore suitability of the 2001 feeding recommendations for infants of HIV-infected mothers for a rural region in KwaZulu Natal, South Africa specifically with respect to adequacy of micronutrients and essential fatty acids, cost, and preparation times of replacement milks. METHODS: Nutritional adequacy, cost, and preparation time of home-prepared replacement milks containing powdered full cream milk (PM) and fresh full cream milk (FM) and different micronutrient supplements (2 g UNICEF micronutrient sachet, government supplement routinely available in district public health clinics, and best available liquid paediatric supplement found in local pharmacies) were compared. Costs of locally available ingredients for replacement milk were used to calculate monthly costs for infants aged one, three, and six months. Total monthly costs of ingredients of commercial and home-prepared replacement milks were compared with each other and the average monthly income of domestic or shop workers. Time needed to prepare one feed of replacement milk was simulated. FINDINGS: When mixed with water, sugar, and each micronutrient supplement, PM and FM provided

Policy-makers need to rethink the connections between the economy and health. The World Health Organization Council on the Economics of Health for All has called for human and planetary health and well-being to be moved to the core of decision-making to build economies for health. Doing so involves valuing and measuring what matters, more and better health financing, innovation for the common good and rebuilding public sector capacity. We build on this thinking to argue that breastfeeding should be recognized in food and well-being statistics, while investments in breastfeeding should be considered a carbon offset in global financing arrangements for sustainable food, health and economic systems. Breastfeeding women nourish half the world's infants and young children with immense quantities of a highly valuable milk. This care work is not counted in gross domestic product or national food balance sheets, and yet ever-increasing commercial milk formula sales are counted. Achieving global nutrition targets for breastfeeding would realize far greater reductions in greenhouse gas emissions than decarbonizing commercial milk formula manufacturing. New metrics and financing mechanisms are needed to achieve the health, sustainability and equity gains from more optimal infant and young child feeding. Properly valuing crucial care and environmental resources in global and national measurement systems would redirect international financial resources away from expanding carbon-emitting activities, and towards what really matters, that is, health for all. Doing so should start with considering breastfeeding as the highest quality, local, sustainable first-food system for generations to come., ((c) 2024 The authors; licensee World Health Organization.)

Objective: To investigate, within so-called general populations, the relationship between maternal survival and mortality of children younger than five years., Methods: We conducted a systematic review of literature published between January 1990 and November 2016 that reported maternal vital status and the corresponding mortality of children younger than five years. Seven studies were included in a qualitative analysis and four in a random-effects meta-analysis. Summary estimates of the odds of dying by maternal survival were obtained and statistical heterogeneity estimated. Quality of the included studies and evidence was assessed using a Cochrane tool for assessing risk of bias and the Grading of Recommendations Assessment, Development and Evaluation criteria, respectively., Findings: Among children younger than five years, those whose mother had died were found to be 4.09 times (95% confidence interval, CI: 2.40-6.98) more likely to die than those with surviving mothers. Due to heterogeneity (I 2 : 83%), further pooled estimates were not possible. For children that were motherless as a result of maternal mortality, the increased odds of dying ranged from 1.40 (95% CI: 0.47-4.21) to 2.92 (95% CI: 1.21-7.04) among those aged between two and four years, 6.1 (95% CI: 2.27-16.77) to 33.78 (95% CI: 24.21-47.14) for those younger than one year and 4.39 (95% CI: 3.34-5.78) to 51.68 (95% CI: 20.26-131.80) for those younger than six months., Conclusion: The loss of a mother was associated with increased mortality among children, especially when maternal death occurred in the first year of the child's life.

Objective: To report the rates of mother-to-child transmission (MTCT) of the human immunodeficiency virus (HIV), and the coverage of interventions designed to prevent such transmission, in KwaZulu-Natal., Methods: Mothers with infants aged ≤ 16 weeks and fathers or legal guardians with infants aged 4-8 weeks who, between May 2008 and April 2009, attended immunization clinics in six districts of KwaZulu-Natal were included. The mothers' uptake of interventions for the prevention of MTCT was explored. Blood samples from infants aged 4-8 weeks were tested for anti-HIV antibodies and, if antibody-positive, for HIV desoxyribonucleic acid (DNA)., Findings: Of the 19,494 mothers investigated, 89·9% reported having had an HIV test in their recent pregnancy. Of the 19,138 mothers who reported ever having had an HIV test, 34.4% reported that they had been found HIV-positive and, of these, 13.7% had started lifelong antiretroviral treatment and 67.2% had received zidovudine and nevirapine. Overall, 40.4% of the 7981 infants tested were found positive for anti-HIV antibodies, indicating HIV exposure. Just 7.1% of the infants checked for HIV DNA (equating to 2.8% of the infants tested for anti-HIV antibodies) were found positive., Conclusion: The low levels of MTCT observed among the infants indicate the rapid, successful implementation of interventions for the prevention of such transmission. Sampling at immunization clinics appears to offer a robust method of estimating the impact of interventions designed to reduce such transmission. Large-scale elimination of paediatric HIV infections appears feasible, although this goal has not yet been fully achieved in KwaZulu-Natal.