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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 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.

Abstract Background There is a high burden of depression globally, including in South Africa. Maternal depression is associated with poverty, unstable income, food insecurity, and lack of partner support, and may lead to poor outcomes for mothers and children. In South Africa one-third of working women are in informal work, which is associated with socioeconomic vulnerability. Methods A cross sectional survey explored work setting and conditions, food security and risk of depression among informal working women with young children (0–3 years). Depression risk was assessed using the Edinburgh Postnatal Depression Score (EPDS) and Whooley score. Food insecurity was evaluated using Household Food Insecurity Access Scale. Data was analysed using SPSS and Stata. Results Interviews were conducted with 265 informal women workers. Types of work included domestic work, home-based work, informal employees and own account workers, most of whom were informal traders. Most participants (149/265; 56.2%) earned between US$70–200 per month, but some participants (79/265; 29.8%) earned US$200 per month (37/265; 14.0%). Many participants experienced mild (38/267; 14.3%), moderate (72/265; 27.2%) or severe (43/265; 16%) food insecurity. Severe food insecurity was significantly higher among participants with the lowest income compared to those with the highest income (p = 0.027). Women who received financial support from the baby’s father were less likely to be food insecure (p = 0.03). Using EPDS scores, 22/265 (8.3%) women were designated as being at risk of depression. This was similar among postnatal women and women with older children. Household food insecurity was significantly associated with depression risk (p

The article discusses the Africa Centre Vertical Transmission Study which aims to identify the impact of infant feeding practices on HIV infection rates of infants at 6 and 22 weeks of age. Conducted in the rural Umkhanyakude district of northern KwaZulu Natal in August 2001, the study analyzed a group of 3,445 pregnant women. Researchers found that HIV positive women are at a significantly increased risk of pregnancy complications.

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

Abstract Background Integrated Management of Childhood Illness (IMCI) is a strategy to reduce mortality and morbidity in children under-5 years by improving management of common illnesses at primary level. IMCI has been shown to improve health worker performance, but constraints have been identified in achieving sufficient coverage to improve child survival, and implementation remains sub-optimal. At the core of the IMCI strategy is a clinical guideline whereby health workers use a series of algorithms to assess and manage a sick child, and give counselling to carers. IMCI is taught using a structured 11-day training course that combines classroom work with clinical practise; a variety of training techniques are used, supported by comprehensive training materials and detailed instructions for facilitators. Methods We conducted focus group discussions with IMCI trained health workers to explore their experiences of the methodology and content of the IMCI training course, whether they thought they gained the skills required for implementation, and their experiences of follow-up visits. Results Health workers found the training interesting, informative and empowering, and there was consensus that it improved their skills in managing sick children. They appreciated the variety of learning methods employed, and felt that repetition was important to reinforce knowledge and skills. Facilitators were rated highly for their knowledge and commitment, as well as their ability to identify problems and help participants as required. However, health workers felt strongly that the training time was too short to acquire skills in all areas of IMCI. Their increased confidence in managing sick children was identified by health workers as an enabling factor for IMCI implementation in the workplace, but additional time required for IMCI consultations was expressed as a major barrier. Although follow-up visits were described as very helpful, these were often delayed and there was no ongoing clinical supervision. Conclusion The IMCI training course was reported to be an effective method of acquiring skills, but more time is required, either during the course, or with follow-up, to improve IMCI implementation. Innovative solutions may be required to ensure that adequate skills are acquired and maintained.

Abstract Background Integrated Management of Childhood Illness (IMCI) is a WHO/UNICEF strategy to improve child survival in resource poor settings. South Africa adopted IMCI in 1997, and IMCI guidelines were adapted to include identification and management of HIV infected and exposed children. This study describes the validity of the IMCI/HIV algorithm when used by IMCI experts, the use of IMCI/HIV guidelines by IMCI trained health workers in routine clinical practice, and the burden of HIV among children under 5 years attending first level health facilities. Methods Seventy seven randomly selected IMCI trained health workers were observed in 74 health facilities in two provinces of South Africa. Consultations were observed with 1357 sick children; each child was reassessed by an IMCI expert to confirm the correct findings. Consent was requested for HIV testing of all children who attended with a parent or legal guardian. Positive rapid HIV tests were confirmed with HIV PCR in children aged less than 18 months. HIV positive children had a CD4 count and HIV clinical staging done. Results Of 1064 children with HIV results available, 76 (7.1% CI: 5.7% - 8.9%) children were confirmed HIV positive. IMCI experts using the HIV algorithm classified 54/76 (71.1% CI: 59.5%-80.9%) HIV positive children as suspected symptomatic HIV, and 15/22 remaining HIV positive children were identified as HIV exposed. Therefore, 69/76 (90.8% CI: 81.9-96.2) HIV infected children were identified by IMCI experts. No classification was made for HIV by observed health workers in 899/1357(66.2%) children. 906/1243(72.9%) mothers had been tested previously for HIV, of whom 221(24.4%) reported testing positive. Of 221 children therefore identified as HIV exposed, only 78(35.3%) had been tested for HIV within routine services. Conclusion The HIV algorithm is a valid tool for identifying HIV infected and exposed children when correctly and comprehensively implemented. However, it is not being used by IMCI trained health workers in routine practise, leading to a failure to implement life saving interventions.

Abstract Background Few studies address the use of paediatric highly active antiretroviral therapy (HAART) in Africa. Methods We performed a retrospective cohort study to investigate preliminary outcomes of all children eligible for HAART at Sinikithemba HIV/AIDS clinic in KwaZulu-Natal, South Africa. Immunologic, virologic, clinical, mortality, primary caregiver, and psychosocial variables were collected and analyzed. Results From August 31, 2003 until October 31, 2005, 151 children initiated HAART. The median age at HAART initiation was 5.7 years (range 0.3–15.4). Median follow-up time of the cohort after HAART initiation was 8 months (IQR 3.5–13.5). The median change in CD4% from baseline (p < 0.001) was 10.2 (IQR 5.0–13.8) at 6 months (n = 90), and 16.2 (IQR 9.6–20.3) at 12 months (n = 59). Viral loads (VLs) were available for 100 children at 6 months of which 84% had HIV-1 RNA levels ≤ 50 copies/mL. At 12 months, 80.3% (n = 61) had undetectable VLs. Sixty-five out of 88 children (73.8%) reported a significant increase (p < 0.001) in weight after the first month. Eighty-nine percent of the cohort (n = 132) reported ≤ 2 missed doses during any given treatment month (> 95%adherence). Seventeen patients (11.3%) had a regimen change; two (1.3%) were due to antiretroviral toxicity. The Kaplan-Meier one year survival estimate was 90.9% (95%confidence interval (CI) 84.8–94.6). Thirteen children died during follow-up (8.6%), one changed service provider, and no children were lost to follow-up. All 13 deaths occurred in children with advanced HIV disease within 5 months of treatment initiation. In multivariate analysis of baseline variables against mortality using Cox proportional-hazards model, chronic gastroenteritis was associated with death [hazard ratio (HR), 12.34; 95%CI, 1.27–119.71) and an HIV-positive primary caregiver was found to be protective against mortality [HR, 0.12; 95%CI, 0.02–0.88). Age, orphanhood, baseline CD4%, and hemoglobin were not predicators of mortality in our cohort. Fifty-two percent of the cohort had at least one HIV-positive primary caregiver, and 38.4% had at least one primary caregiver also on HAART at Sinikithemba clinic. Conclusion This report suggests that paediatric HAART can be effective despite the challenges of a resource-limited setting.

Background: Integrated Management of Childhood Illness (IMCI) is a strategy to reduce mortality and morbidity in children under-5 years by improving management of common illnesses at primary level. IMCI has been shown to improve health worker performance, but constraints have been identified in achieving sufficient coverage to improve child survival, and implementation remains sub-optimal. At the core of the IMCI strategy is a clinical guideline whereby health workers use a series of algorithms to assess and manage a sick child, and give counselling to carers. IMCI is taught using a structured 11-day training course that combines classroom work with clinical practise; a variety of training techniques are used, supported by comprehensive training materials and detailed instructions for facilitators.Methods: We conducted focus group discussions with IMCI trained health workers to explore their experiences of the methodology and content of the IMCI training course, whether they thought they gained the skills required for implementation, and their experiences of follow-up visits.Results: Health workers found the training interesting, informative and empowering, and there was consensus that it improved their skills in managing sick children. They appreciated the variety of learning methods employed, and felt that repetition was important to reinforce knowledge and skills. Facilitators were rated highly for their knowledge and commitment, as well as their ability to identify problems and help participants as required. However, health workers felt strongly that the training time was too short to acquire skills in all areas of IMCI. Their increased confidence in managing sick children was identified by health workers as an enabling factor for IMCI implementation in the workplace, but additional time required for IMCI consultations was expressed as a major barrier. Although follow-up visits were described as very helpful, these were often delayed and there was no ongoing clinical supervision.Conclusion: The IMCI training course was reported to be an effective method of acquiring skills, but more time is required, either during the course, or with follow-up, to improve IMCI implementation. Innovative solutions may be required to ensure that adequate skills are acquired and maintained. [ABSTRACT FROM AUTHOR]

Background: Marketing of commercial milk formula (CMF) is well resourced and has influenced societal beliefs and practices that have undermined breastfeeding. This has occurred despite legislation in many countries largely reflecting the provisions of the International Code of Marketing of Breast-milk Substitutes., Methods: A cross-sectional survey was conducted in seven countries: Bangladesh, Mexico, Morocco, Nigeria, South Africa, United Kingdom and Viet Nam to explore the scope and nature of CMF marketing among pregnant women and mothers. A marketing-research methodology was adopted using convenience sampling of women stratified according to infant feeding practices and the infant's age. Participants were identified in hospitals and clinics, as well as in the street, markets and shopping malls. In each country the sample size comprised 300 pregnant women, 150 mothers of children aged > 18 months who were breastfeeding without giving CMF and 600 women feeding their children with CMF. Data were collected using a questionnaire administered on tablets by trained field workers., Results: Interviews were conducted with 8528 women between October 2019 and March 2021. Overall, 3095/7480 (41.3%) of women reported exposure to CMF marketing ranging from 3% in Morocco to 92% in Viet Nam. The commonest marketing site in all countries was television, but advertising in-store and in magazines and newspapers was also common. In most countries, CMF advertising on social media, websites and YouTube was less compared to traditional media. Reports of receiving free CMF samples varied from 3.1% in Nigeria to 34.6% in Viet Nam. Health professionals were the most common source of advice to mothers about starting CMF and which CMF brand to use., Conclusions: The study provides quantitative data about CMF marketing and insights on how marketing companies develop effective messages, helping to explain how individual vulnerabilities or aspirations are integrated into marketing strategies. The findings reaffirm the need for action across political and health domains to counter actions of CMF companies. This will require effective national legislation fully reflecting the Code and action by professional bodies to protect health professionals from targeting by CMF marketing. Marketing-research methods could be employed to develop messaging in support of breastfeeding and breastfeeding-friendly policies., Competing Interests: Declarations. Ethics approval and consent to participate: The study was approved by the WHO Ethics Review Committee (ERC 003235); and the respective research ethics committees or Institutional Review Boards of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B); Instituto Nacional de Salud Publica, Mexico City, Mexico; Université Mohammed V de Rabat, Morocco; National Health Research Ethics Committee of Nigeria (NHREC), Abuja, Nigeria; Human Sciences Research Council (HSRC), Pretoria, South Africa; Queen Mary University of London, UK; and, the Center for Creative Initiatives in Health and Population (CCIHP), Hanoi, Vietnam. All participants provided informed consent. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)