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Background Intimate partner violence (IPV) against women is a major global health issue, particularly in low- and middle-income countries (LMICs), that is associated with poor physical and mental health, but its association with breastfeeding practices is understudied. Both the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) recommend that children initiate breastfeeding within the first hour of birth and be exclusively breastfed for the first 6 months of life. Breastfeeding within the first hour of birth is critical to newborn survival, and exclusive breastfeeding for 6 months is recognised to offer significant health benefits to mothers and their infants. We examined the association of maternal exposure to IPV with early initiation of breastfeeding (within 1 hour of birth) and exclusive breastfeeding in the first 6 months. Methods and findings We assessed population-based cross-sectional Demographic and Health Surveys (DHS) from 51 LMICs. Data from the most recent DHS in each country (conducted between January 2000 and January 2019) with data available on IPV and breastfeeding practices were used. By WHO region, 52.9% (27/51) were from Africa, 11.8% (6/51) from the Americas, 7.8% (4/51) from the Eastern Mediterranean, 11.8% (6/51) from Europe, 11.8% (6/51) from South-East Asia, and 3.9% (2/51) from the Western Pacific. We estimated multilevel logistic regression models for any IPV and each type of IPV separately (physical violence, sexual violence, and emotional violence), accounting for demographic and socioeconomic factors. Depending on specification, the sample size varied between 95,320 and 102,318 mother-infant dyads. The mean age of mothers was 27.5 years, and the prevalence of any lifetime exposure to IPV among mothers was 33.3% (27.6% for physical violence, 8.4% for sexual violence, and 16.4% for emotional violence). Mothers exposed to any IPV were less likely to initiate breastfeeding early (adjusted odds ratio [AOR]: 0.88 [95% CI 0.85-0.97], p < 0.001) and breastfeed exclusively in the first 6 months (AOR: 0.87 [95% CI 0.82-0.92], p < 0.001). The associations were similar for each type of IPV and were overall consistent across infant's sex and WHO regions. After simultaneously adjusting for all 3 types of IPV, all 3 types of IPV were independently associated with decreased likelihood of early breastfeeding initiation, but only exposure to physical violence was independently associated with a decreased likelihood of exclusively breastfeeding in the first 6 months. The main limitations of this study included the use of cross-sectional datasets, the possibility of residual confounding of the observed associations by household wealth, and the possibility of underreporting of IPV experiences attenuating the magnitude of observed associations. Conclusions Our study indicates that mothers exposed to any form of IPV (physical, sexual, or emotional violence) were less likely to initiate breastfeeding early and breastfeed exclusively in the first 6 months. These findings may inform the argument for antenatal screening for IPV in LMICs and the provision of services to not only improve mothers' safety and well-being, but also support them in adopting recommended breastfeeding practices., Author(s): Rishi Caleyachetty 1,*, Olalekan A. Uthman 1, Hana Nekatebeb Bekele 2, Rocio Martín-Cañavate 3, Debbie Marais 1, Jennifer Coles 1, Briony Steele 1, Ricardo Uauy 4, Peggy Koniz-Booher 5 [...]

Objective To assess the association between the employment status of human immunodeficiency virus (HIV)-infected individuals and adherence to antiretroviral therapy (ART). Methods We searched the Medline, Embase and Cochrane Central Register of Controlled Trials databases for studies reporting ART adherence and employment status published between January 1980 and September 2014. Information from a wide range of other sources, including the grey literature, was also analysed. Two independent reviewers extracted data on treatment adherence and study characteristics. Study data on the association between being employed and adhering to ART were pooled using a random-effects model. Between- study heterogeneity and sources of bias were evaluated. Findings The meta-analysis included 28 studies published between 1996 and 2014 that together involved 8743 HIV-Infected individuals from 14 countries. The overall pooled odds ratio (OR) for the association between being employed and adhering to ART was 1.27 (95% confidence interval, CI: 1.04-1,55).The association was significant for studies from low-income countries (OR: 1.85, 95% CI: 1.582.18) and high-income countries (OR: 1.33,95% CI: 1.02-1.74) but not middle-income countries (OR:0.94, 95% CI: 0.62-1.42). In addition, studies published after 2011 and larger studies showed less association between employment and adherence than earlier and small studies, respectively. Conclusion Employed HIV-Infected individuals, particularly those in low- and high-income countries, were more likely to adhere to ART than unemployed individuals. Further research is needed on the mechanisms by which employment and ART adherence affect each other and on whether employment-creation interventions can positively influence ART adherence, HIV disease progression and quality of life. Objectif Evaluer le lien entre le statut professionnel des personnes infectees par le virus de l'immunodeficience humaine (VIH) et le suivi de la therapie antiretrovirale (TAR). Methodes Nous avons effectue des recherches dans les bases de donnees de Medline, d'Embase et du registre central de Cochrane des essais controles (Cochrane Central Register of Controlled Trials) pour trouver les etudes relatives au suivi de la TAR et aux statuts professionnels qui ont ete publiees entre janvier 1980 et septembre 2014. Des informations provenant d'un large eventail de sources alternatives, y compris la litterature grise, ont egalement ete analysees. Deux examinateurs independants ont extrait les donnees sur le suivi du traitement et les caracteristiques de l'etude. Les donnees de l'etude sur le lien existant entre le fait d'avoir un emploi et le suivi de laTAR ont ete regroupees en utilisant un modele a effets aleatoires. L'heterogeneite entre les etudes et les sources de biais ont ete evaluees. Resultats La meta-analysea Inclus 28 etudes publiees entre 1996 et 2014, qui, ensemble, ont implique 8743 personnes infectees par le VIH dans 14 pays. Le rapport des cotes (RC) regroupe global pour le lien entre le fait d'avoir un emploi et le suivi de la TAR etait de 1,27 (Intervalle de confiance a 95%, IC: 1,04-1,55). Ce lien etait significatif pour les etudes dans les pays a revenu faible (RC: 1,85; IC 95%: 1,58-2,18) et dans les pays a revenu eleve (RC: 1,33; IC 95%: 1,02-1,74) mais il ne l'etait pas dans les pays a revenu intermediaire (RC:0,94; IC 95%: 0,62-1,42). En outre, les etudes publiees apres 2011 et les etudes plus vastes ont montre un lien moins fort entre le statut professionnel et le suivi therapeutique que dans les etudes precedentes et les etudes plus restreintes, respectivement. Conclusion Les personnes infectees par le VIH et ayant un emploi, en particulier dans les pays a revenu faible et les pays a revenu eleve, etaient plus susceptibles de suivre laTARque les personnes sans emploi. Des recherches plus approfondies sont necessaires pour etudier les mecanismes par lesquels le fait d'avoir un emploi et le fait de suivre la TARs'affectentmutuellementetpoursavoirsi les interventions favorisant la creation d'emplois peuvent influencer positivement le suivi de laTAR, la progression de la maladie due au VIH et la qualite de vie. Objetivo Evaluar la relacion entre la situacion laboral de personas Infectadas por el virus de la inmunodeficlencla humana (VIH) y la adherencia a la terapia antirretroviral (TAR). Metodos Se realizaron busquedas de estudios publicados entre enero de 1980 y septiembre de 2014 que informaran acerca de la adherencia a la TAR y la situacion laboral en las bases de datos Medline, Embase y el Registro Cochrane Central de Ensayos Controlados. Tambien se analizo la informacion de una amplia gama de fuentes, entre ellas, la literatura gris. Dos revisores independientes extrajeron los datos sobre la adherencia al tratamiento y las caracteristicas del estudio. Los datos de los estudios sobre la asociacion entre el empleo y la adherencia a la TAR se agruparon por medio de un modelo de efectos aleatorios y se evaluo la heterogeneidad entre los estudios y las fuentes de sesgo. Resultados El metanalisis Incluyo 28 estudios publicados entre 1996 y el 2014 que Incluyeron 8743 Individuos Infectados por el VIH provenientes de 14 paises. La razon de posibilidades agrupada general situacion laboral: examen sistematico y metaanalisis (OR) para la asociacion entre estar empleado y la adherencia a la TAR fue 1,27 (intervalo de confianza del 95%, IC: 1,04-1,55). La asociacion fue significativa en los estudios en paises con ingresos bajos (OR: 1,85, IC del 95%: 1,58-2,18) ycon Ingresos altos (OR: 1,33, IC del 95%: 1,02-1,74), pero no en los paises con ingresos medios (OR:0,94, IC del 95%: 0,621,42). Ademas, los estudios publicados despues de 2011 y los de mayor tamano mostraron una relacion menor entre el empleo y la adherencia que, respectivamente, los estudios anteriores y mas pequenos. Conclusion Las personas infectadas por el VIH con un empleo, en particular en los paises con Ingresos bajos y altos, tenian mas probabilidades de adherirse a la TAR que las personas desempleadas. Se necesitan Investigaciones adicionales sobre los mecanismos por los que el empleo y la adherencia a la TAR se influyen mutuamente y sobre si las intervenciones de creacion de empleo pueden influir positivamente la adherencia a la TAR, la progresion de la enfermedad del VIH y la calidad de vida., Introduction Recent data from the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) indicate that access to human immunodeficiency virus (HIV) treatment and care services [...]

Background The implementation of publicly funded health insurance schemes (PFHIS) is the major strategy to drive progress and achievement of universal health coverage (UHC) by 2030. We appraised evidence on the equity of insurance schemes across Africa. Methods We conducted a systematic review of published studies that assessed equity in health insurance schemes implemented under the UHC agenda in Africa. Seven databases, Web of Science, Medline, CINAHL, Scopus, Cochrane Library, EMBASE and World Bank eLibrary, were searched; we operationalized the PROGRESS-Plus (p lace of r esidence; r ace/ethnicity/culture/language; o ccupation; g ender/sex r eligion; e ducation; s ocioeconomic status; s ocial capital) equity framework to assess equity areas. Results Forty-five studies met the inclusion criteria and were included in the study, in which 90% assessed equity by socioeconomic status. Evidence showed that rural residents, those self-employed or working in the informal sector, men, those with lower educational attainment, and the poor were less likely to be covered by health insurance schemes. Broadly, the insurance schemes, especially, community-based health insurance (CBI) schemes improved utilization by disadvantaged groups, however, the same groups were less likely to benefit from health services. Conclusions Evidence on equity of PFHIS is mixed, however, CBI schemes seem to offer more equitable coverage and utilization of essential health services in Africa. [ABSTRACT FROM AUTHOR]