Immunisation and Vitamin A Capsule Coverage in a Semi-Urban Area of KwaZulu-Natal Province; South Africa

Background. The Expanded Programme on Immunisation (EPI) in South Africa (SA) has had a large effect on vaccine-preventable illnesses; yet there is little in the literature describing access to and utilisation of the programme beyond 1 year of age. Coverage of vitamin A supplementation is examined through District Health Information System data; but this does not give a fair assessment of the lifetime coverage in a child or provide any correlation with the immunisation status of the child. Objectives. To describe utilisation and dropout rate with the vitamin A and immunisation programmes over the first 6 years of life among children aged 6 - 8 years in a semi-urban population in KwaZulu-Natal (KZN) Province; SA. A secondary objective was to investigate whether access and dropout rates are associated between these two programmes. Methods. A retrospective cohort analysis was performed on 923 anonymised Road-to-Health cards; extracting information on immunisation and vitamin A coverage. Results. Overall; 92.9% (95% confidence interval (CI) 91.2 - 94.6) and 88.5% (95% CI 86.4 - 90.5) of children were fully immunised by 12 months and 18 months of age; respectively. The percentage of children fully immunised by 6 years of age dropped to 44% (95% CI 41.2 - 47.6). The dropout rates for measles; and diphtheria; pertussis and tetanus 1 - 3 vaccination were 2.4% and 1.2%; respectively. Vitamin A had an overall coverage of 34.9% during 6 - 60 months of life for this population; with children receiving; on average; three doses (interquartile range 2 - 5). Conclusion. Despite good immunisation coverage in the first 18 months of life; there was relatively poor vitamin A coverage; suggesting a need for re-evaluation of the current vitamin A capsule distribution programme

How to change perceptions on feeding in neonatal care

The transmission of HIV through breastmilk; with the potential to infect the newborn; has had a major impact on child health worldwide. Although South African studies confirmed that exclusive breastfeeding reduced rates of mother-to-child transmission of HIV; the recommendation of formula feeding for HIV-exposed newborn infants; provided their mothers had the facilities for safe preparation of formula milk and complied with the AFASS criteria (formula feeding to be Acceptable; Feasible; Affordable; Sustainable; Safe); was introduced. Observations made by the nursing staff; fully aware of the risks of formula feeding; in the neonatal unit at King Edward VIII Hospital in 2009 showed that an increasing number of small; sick newborns were being formula fed.By conducting focus group discussions with nurses; mothers and counsellors and teasing out the confusions and misconceptions; relevant information was imparted to the groups to allow them to re-consider their misconceptions. Within a period of 2 months nurses were confident about re-counselling mothers with respect to appropriate feeding choices. HIV-positive mothers were trained to flash-heat their milk. Subsequently; policies for the unit were derived from the focus group discussions. In addition; regional hospitals in the Durban area (eThekweni) considered the introduction of flash-heating to their units. The South African Department of Health opted for infants to receive prophylaxis with daily nevirapine as long as they are breastfed; and the Nutrition Directorate decided to withdraw the issue of free replacement feeds in HIV-exposed babies. KZN was the first province to institute this policy. The Department of Health has recommended that neonatal units no longer encourage HIV-infected mothers to flash-heat their breastmilk unless the infant is not receiving ARV prophylaxis or the mother is not on treatment

Messages about Dual Contraception in Areas of High HIV Prevalence are not Heeded

Background : Dual protection is recommended for prevention of unwanted pregnancies and protection against sexually transmitted infections; including HIV. It is critical for HIV-negative women to prevent sero-conversion and HIV transmission to their infants during pregnancy and breastfeeding. Methods: Women were followed post-partum; monthly to 9 months and 3-monthly to 24 months; in a cohort study investigating postnatal HIV transmission. Study nurses discussed family planning; including condom use; at each visit. Contraceptive methods used since the last visit were recorded. All women knew their HIV status; most women breastfed for a minimum of six months.Results : of 1137 HIV-positive and 1220 HIV-negative women the most common contraceptive method was the hormonal injectable; few women used condoms alone or as dual contraception (0-3 months 6.8; 7-12 months 16.3; 19-24 months 14.4). HIV-positive women were more likely to use condoms in years one and two post-partum (AOR 1.72; 95CI 1.38-2.14; pp=0.040). Conclusions. More creative ways of promoting condoms and dual contraception need to be found if new HIV infections; in women and children; are to be prevented

Effects of vitamin A supplementation during pregnancy and early lactation on body weight of South African HIV-infected women.

Effects of vitamin A supplementation during pregnancy and early lactation on maternal weight among HIV-1-seropositive South African women were examined. Three hundred twelve HIV-seropositive pregnant women between 28 and 32 weeks gestation were studied as part of a randomized, double-blind, placebo-controlled trial at the King Edward VIII Hospital in Durban, South Africa. Patients were randomized to receive placebo or 5,000 IU of retinyl palmitate and 30 mg of beta-carotene daily during pregnancy. At delivery, patients received placebo or 200,000 IU of retinyl palmitate. The main outcome measures were prenatal and postnatal maternal weight and weight loss at three months after delivery as measured in body mass index (BMI). Supplementation of vitamin A was not associated with improvements in prepartum weight gain but was significantly associated with improved weight retention three to six months after delivery (p = 0.02). The benefit of vitamin A supplementation appeared to be confined to subgroups with baseline CD4+ count < 200 cells/microL and serum retinol 0-20 micrograms/dL. Similar trends were observed in maintenance of postpartum BMI. However, no statistically significant associations were observed. Although there was no benefit of vitamin A supplementation on prepartum weight gain, a benefit on maintenance of postnatal weight was observed. The benefit was highest among those who were vitamin A-deficient or whose CD4+ count was < 200 cells/microL presupplementation. In populations for whom antiretroviral therapy is not readily available or accessible, the finding that vitamin A may improve postpartum weight lends some hope to a relatively inexpensive treatment which could be used for helping ameliorate some weight loss which is common during HIV infection.