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A study was conducted to evaluate and investigate the coverage of nevirapine-based services to help prevent the spread of mother-to-child HIV transmission in 4 African countries. Results indicated that only 51% of HIV-exposed infants received the required dosage of nevirapine in these countries.

The release of the new WHO guidelines on HIV and infant feeding, in a global context of widespread impoverishment, requires countries to re-examine their infant-feeding policies in relation to broader socioeconomic issues. This widening scope is necessitated by compelling new reports on the scale of global underdevelopment in developing countries. This paper explores these issues by addressing feeding choices made by HIV-infected mothers and programmes supplying free formula milks within a global environment of persistent poverty. Accumulating evidence on the increase in malnutrition, morbidity and mortality associated with the avoidance or early cessation of breastfeeding by HIV-infected mothers, and the unanticipated hazards of formula feeding, demand a deeper assessment of the measures necessary for optimum policies on infant and child nutrition and for the amelioration of poverty. Piecemeal interventions that increase resources directed at only a fraction of a family's impoverishment, such as basic materials for preparation of hygienic formula feeds and making flawed decisions on choice of infant feeding, are bound to fail. These are not alternatives to taking fundamental steps to alleviate poverty. The economic opportunity costs of such programmes, the equity costs of providing resources to some and not others, and the leakages due to temptation to sell capital goods require careful evaluation. Providing formula to poor populations with high HIV prevalence cannot be justified by the evidence, by humanitarian considerations, by respect for local traditions or by economic outcomes. Exclusive breastfeeding, which is threatened by the HIV epidemic, remains an unfailing anchor of child survival, Bulletin of the World Health Organization 2008;86:210-214. Resume Dans le contexte mondial actuel d'appauvrissement generalise, les nouvelles directives de I'OMS sur le VIH et l'alimentation du nourrisson recemment publies demandent aux pays de reexaminer leurs politiques d'alimentation du nourrisson en tenant compte d'aspects socioeconomiques plus larges. Cet elargissement de la perspective est motive par de nouveaux rapports convaincants sur l'ampleur a l'echelle mondiale du sous-developpement dans les pays en developpement. Le present article etudie ces aspects en examinant les choix en matiere d'alimentation du nourrisson faits par les meres infectees par le VIH et les programmes fournissant gratuitement du lait pour nourrisson dans un contexte mondial de pauvrete persistante. Les preuves qui s'accumulent d'une augmentation de la malnutrition, de la morbidite et de la mortalite liee a l'abstention ou a l'arret precoce de l'alimentation au sein par les meres infectees et les dangers imprevus de l'alimentation artificielle exigent une evaluation plus approfondie des mesures necessaires pour optimiser les politiques en matiere d'alimentation du nourrisson et de l'enfant et pour faire reculer la pauvrete. Les interventions fragmentaires pour augmenter les ressources qui ne compensent qu'une partie de l'appauvrissement familial (fourniture de matieres de base pour preparer des aliments pour nourrissons conformes a l'hygiene par exemple) et prennent de mauvaises decisions concernant l'alimentation du nourrisson, sont condamnees a echouer. Il n'existe pas d'alternative a la prise de mesures fondamentales pour attenuer la pauvrete. Les couts d'opportunite de tels programmes, les couts en matiere d'equite de la fourniture selective de ressources et les pertes dues aux tentations de vendre des biens en capital doivent etre soigneusement evalues. La fourniture de preparations pour nourrissons a des populations pauvres subissant une forte prevalence du VIH ne peut se justifier par des elements factuels, des considerations humanitaires, le respect des traditions locales ou des resultats economiques. L'alimentation exclusivement au sein, menacee par l'epidemie de VIH, reste la base inebranlable de la survie de l'enfant. Resumen La publicacion de las nuevas directrices de la OMS sobre el VIH y la alimentacion del lactante, en un contexto mundial de empobrecimiento generalizado, obliga a los paises a revisar sus politicas de alimentacion del lactante en relacion con algunos aspectos socioeconomicos mas amplios. Esta perspectiva mas amplia es imprescindible a la vista de la contundencia de los ultimos datos sobre la magnitud del subdesarrollo global en los paises en desarrollo. En este articulo se analizan esas cuestiones centrando la atencion en las decisiones de alimentacion de sus hijos que toman las madres infectadas por el VIH y en los programas que suministran leche artificial gratuita en un contexto mundial de pobreza persistente. La creciente evidencia de un aumento de la malnutricion, la morbilidad y la mortalidad asociadas a la evitacion o la interrupcion temprana de la lactancia materna por las madres infectadas por el VIH y los riesgos imprevisibles de las preparaciones para lactantes exigen una evaluacion mas profunda de las medidas necesarias para formular politicas optimas sobre la nutricion del lactante y del nino y para mitigar la pobreza. Las intervenciones fragmentarias de incremento de los recursos con miras a paliar solo una parte del empobrecimiento de las familias, como productos basicos para la elaboracion higienica de las preparaciones y algunas decisiones desacertadas en materia de alimentacion del lactante, estan destinadas a fracasar. No son esas alternativas que puedan suplir medidas fundamentales de mitigacion de la pobreza. Los cestos de oportunidad economicos de esos programas, la inequidad que supone proporcionar recursos a unos y no a otros, y las perdidas debidas a la tentacion de vender los bienes de capital exigen una detenida evaluacion. El suministro de preparaciones a las poblaciones pobres con alta prevalencia de infeccion por VIH no puede justificarse aduciendo la evidencia disponible, consideraciones humanitarias, el respeto de las tradiciones locales o los erectos economicos. La lactancia materna exclusiva, amenazada por la epidemia de VIH, sigue siendo un arma fundamental para la supervivencia infantil., WHO Consensus Statement on HIV and Infant Feeding The new WHO Consensus Statement on HIV and Infant Feeding (1) highlights critical issues in the continuing debate on whether the HIV [...]

Ambitious goals for paediatric AIDS control have been set by various international bodies, including a 50% reduction in new paediatric infections by 2010. While these goals are clearly appropriate in their scope, the lack of clarity and consensus around how to monitor the effectiveness of programmes to prevent mother-to-child HIV transmission (PMTCT) makes it difficult for policy-makers to mount a coordinated response. In this paper, we develop the case for using population HIV-free child survival as a gold standard metric to measure the effectiveness of PMTCT programmes, and go on to consider multiple study designs anal source populations. Finally, we propose a novel community survey-based approach that could be implemented widely throughout the developing world with minor modifications to ongoing Demographic and Health Surveys. Resume Des objectifs ambitieux en matiere de lutte contre le VIH/sida en milieu pediatrique ont ete fixes par divers organismes internationaux, et notamment la reduction de moitie du nombre de nouveaux cas d'infection pediatrique d'ici 2010. Meme si ces objectifs sont tout a fait pertinents dans leur contexte, le manque de clarte et de consensus quant aux personnes devant surveiller I'efficacite des programmes de prevention de la transmission mere-enfant du VIH (PMTCT) s'oppose a I'obtention d'une reponse coordonnee de la part des decideurs. Cet article presente les arguments en faveur de I'utilisation du taux de survie des enfants sans contamination par le VIH dans la population comme instrument de mesure cle de I'efficacite des programmes de PMTCT et examine divers types d'etude et plusieurs populations sources. II propose en conclusion une approche novatrice, reposant sur des enquetes en communaute, qui pourrait etre mise en oeuvre a grande echelle dans le monde en developpement, moyennant I'apport de modifications mineures aux enquetes demographiques et sanitaires en cours. Resumen Diversos organos internacionales han fijado metas ambiciosas para la lucha contra el SIDA pediatrico, en particular una reduccion del 50% de las nuevas infecciones pediatricas para 2010. Aunque se trata de metas indudablemente acertadas en cuanto a su alcance, la falta de claridad y consenso respecto a la manera de vigilar la eficacia de los programas de prevencion de la transmision del VIH de la madre al nino (PTMN) es un obstaculo para que las instancias normativas articulen una respuesta coordinada. Se aportan aqui argumentos para utilizar la supervivencia infantil sin infeccion por VIH en la poblacion como criterio de referencia para medir la eficacia de los programas de PTMN, y se examinan luego varios disenos de estudio y poblaciones de diverso origen. Por ultimo, proponemos un nuevo enfoque basado en encuestas comunitarias que podria implementarse ampliamente en todo el mundo en desarrollo introduciendo pequenos cambios en las actuales Encuestas de Demografia y Salud. [TEXT NOT REPRODUCIBLE IN ASCII.], Introduction Despite the availability of proven interventions for the prevention of mother-to-child HIV transmission (PMTCT) and substantial donor investments for implementing them in developing countries, paediatric AIDS remains a largely [...]

A study examines early clinical and immunologic outcomes of children enrolled in the pediatric treatment program. The results conclude that good care provided by care providers improves the outcome of HIV-infected children in primary health care settings in Zambia.

The human immunodeficiency virus (HIV) is the causative agent of AIDS. Clinical drug trials have shown that zidovudine (formerly called azidothymidine, or AZT) is effective for the treatment of HIV infection in adults. In order to evaluate the safety, tolerance and effectiveness of zidovudine in children, 88 children (mean age of 4 years) with advanced HIV disease were treated with zidovudine. The first phase of the study included 24 weeks of drug treatment (180 milligrams per square meter of body surface area given every six hours), and those who completed the first phase were allowed to continue receiving zidovudine. During the course of the study, 14 children died due to either pneumonia, lung failure, tuberculosis or heart failure. Sixty-one of the children completed the first phase and 49 of these children continued receiving zidovudine for up to 90 weeks. Sixty-one percent of the children experienced some form of blood toxicity, occurring as anemia (low red blood cell count) in 26 percent of the cases, or neutropenia (low white blood cell count) in 48 percent. Most of these conditions disappeared by themselves. However, 30 children had to have the dose of the drug reduced or required blood transfusions. There were only three cases where drug treatment was stopped because of blood toxicity. Drug treatment with zidovudine resulted in an improvement in mental function and weight gain, and in increase in the number of cerebrospinal fluid cultures that tested negative for HIV. It is concluded that the dose of zidovudine used in this study is can be used safely in children with advanced HIV disease. The clinical improvements observed in this study are similar to those reported previously for zidovudine drug trials in adults infected with HIV. (Consumer Summary produced by Reliance Medical Information, Inc.)

Haemophilus influenzae type b is a bacteria that causes severe illnesses that can be fatal in 1 of every 200 American children under the age of five. Meningitis (inflammation of the membrane surrounding the brain), epiglottitis (swelling of the throat and airway), and pneumonia are among the illnesses caused by the bacteria, and of the 95% of children who survive, many are left with neurologic and learning disabilities. In the past, antibiotics have been effective in reducing death rates from the disease, but the emergence of many bacteria with resistance to common antibiotics means that such therapy may not be as effective as before. Vaccination of children against the bacteria is now possible, but to ensure maximum effectiveness of such a program, planners must know which children are at most risk, which can be determined by epidemiologic studies. Studies of the annual incidence of H. influenzae type b infection in the United States show wide variance, with 67 to 129 children per 100,000 being infected. Up to three-fourths of the bacterial infections occur in children younger than three months old, and in populations where the disease rate is much higher or lower, the differences in incidence occur in that same age group. In the United States, native Americans, Eskimos, blacks, and Hispanics are at higher risk than the general population for developing H. influenzae type b infections, although studies have not been able to separate genetic influences from those of socioeconomic factors. Attendance at a day-care center, presence in the home of a school-age sibling, and crowding in the home are other risk factors which have been identified. Breast-feeding protects against the infection. Based upon these data, an effective immunization program would seek to immunize children by two weeks of age, but since multiple risk factors make it difficult to predict accurately which children are at risk, universal immunization is the desirable goal. (Consumer Summary produced by Reliance Medical Information, Inc.)

Pertussis (whooping cough) is a bacterial infection characterized by a cough that makes a deep whooping-like sound during inspiration. Although children entering school are legally required to be immunized against pertussis, there has been a recent increase in the number of reported cases, particularly in children under one year of age. Between 1984 and 1987 the number of reported cases of pertussis tripled in North Carolina. It is estimated that fewer than 66 percent of all two-year-old children living in North Carolina have received the required immunization schedule, namely three doses of the combined diphtheria, tetanus, pertussis (DPT) vaccine by the eight month of life. The immunization status of eight-month-old children residing in North Carolina was studied for three one-year intervals, 1984-1985, 1985-1986 and 1986-1987. The percentages of children immunized correctly were 58.1 percent, 58.6 percent and 56.7 percent for the three study years. Of the 117 cases of pertussis reported in the 9- to 36-month-old age group between 1978-1987, 20.5 percent had been immunized appropriately. It is unclear whether it is the extremely low immunization rate among school-aged children, particularly during the years 1984 and 1987, that is responsible for the increased incidence of pertussis, or the increased reporting of cases. The failure to immunize is not likely to explain the high number of cases in children under five months of age. However, younger siblings may be exposed to pertussis if their school-aged siblings are not adequately immunized. The reasons that families fail to immunize or keep recommended immunization schedules can be useful in guiding future immunization strategies. (Consumer Summary produced by Reliance Medical Information, Inc.)