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Background: A substantive number of People Living with HIV (PLHIV) develop Opportunistic Infections (OIs). The introduction of Anti-Retroviral Therapy (ART) in Tanzania led to a significant decline in opportunistic infections and a slower progression to AIDS, but OIs are still prevalent. This study was set to determine the magnitude of OIs and associated factors among HIV/AIDS patients on Anti-Retroviral Therapy (ART) attending care and treatment clinic at Bombo Regional Referral hospital, Tanga region. Materials And Methods: A crosssectional descriptive study was conducted on HIV/AIDS patients on ART attending Bombo Hospital in Tanga from July to October 2019. A non-probability, consecutive sampling technique was employed to obtain study participants. Data were collected using available data obtained from the patients' files, hospital record books and interviews of study participants by using semi-structured questionnaires. Data were entered into the computer using Excel 2013, cleaned and analysed using Epi Info version 7.2.2.6. Any p-value of < 0.05, at a 95% confidence interval was regarded as statistically significant. Results : The study showed that out of the 360 participants, 126 cases (35.0%) of OIs were reported. Pulmonary Tuberculosis had the highest prevalence of 18.0% among PLHIV while other opportunistic Infections altogether contributed 17.0%. Late ART initiation (OR=10.9, 95% CI: 6.5 18.3, p-value <0.001), Poor drug adherence (OR=19, 95% CI: 9.0 39.7, p-value <0.001), female gender (69% vs. 31%), which was however, not statistically significant (p-value 0.904), Informal and Primary School education (OR = 1.6, 95% CI: 1.1 1.6, p-value 0.04) being married (OR=2.1, 95% CI: 1.3 3.4, p value 0.004) and widowed/widower (OR=7.7, 95% CI: 1.7 33.7, p value 0.007) respectively were found to be associated with OIs to PLHIV.CONCLUSION : The rate of OIs still high among PLHIV, Pulmonary Tuberculosis is the leading disease with 18.0% of all OIs symptomatic patients. Delay in ART initiation after positive test results, poor drug adherence and moderate malnutrition have been identified as major risk factors affecting 66.0%, 70.0%, 71%of PLWHA with OIs. We recommend early initiation of ART, Education on ART adherence and refilling of large quantities of ARV drugs to individuals working far from their homes.
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Humans , Male , Female , Opportunistic Infections , HIV Infections , Acquired Immunodeficiency Syndrome , Anti-Retroviral Agents , Medication Adherence , Referral and ConsultationABSTRACT
Background@#Breastfeeding is the ideal food source for all newborns globally. Proper feeding of infants and young children promotes optimal growth and development, especially in the critical window from birth to 2 years of age. Exclusive breastfeeding for 6 months and continued breastfeeding for the first 2 years of life protects children from infection, provides an ideal source of nutrients, and is economical and safe.@*Objective@#To assess the indicators of infant feeding practices among 0- 23 months old children.@*Materials and Methods@#The NNS V was implemented in 21 aimags (provinces) in 4 economic regions (Central, Eastern, Khangai, Western) and the capital city of Ulaanbaatar. Given the regional differences in lifestyle and nutrition status, target populations were stratified into 5 strata based on economic region and Ulaanbaatar with equal samples drawn from each stratum using a cluster-randomized sampling design [1]. The infant and young child feeding indicators assessed in the NNS V were based on the mother’s or caretaker’s report of breastfeeding and consumption of foods and fluids by the child during the day or night prior to being interviewed.@*Results@#83.7% of children under 2 years started breastfeeding within 1 hour of birth and though almost all children were ever breastfed (97.9%), a slightly higher percentage of girls were ever breastfed overall and within 1 hour of birth. Children 0-5 months were categorized according to whether they were exclusively breastfed or predominantly breastfed, with the former only allowing vitamins, mineral supplements, and medicine and the latter also including plain water and non-milk liquids. Among children 0-5 months of age, 58.3% were exclusively breastfed and 65.3% were predominantly breastfed, having received other liquids or foods in addition to breast milk. The prevalence of exclusive breastfeeding was lowest in the 4th wealth index quintile (46.5%) and wealthiest quintile (54.0%) households.@*Conclusions@#Exclusive breastfeeding and early initiation of breastfeeding practices are unacceptably low in Mongolia; 20% of newborns are not breastfed within 1 hour of birth and more than 40% of infants under 6 months of age are not exclusively breastfed and therefore, not receiving optimum nutritional and immunity benefits from breast milk. Strengthening IYCF counselling in all regions and wealth quintiles to support women to practice optimal breastfeeding, along with counselling and awareness of timely and adequate complementary feeding for children under 2 years of age, should be a top priority for public health and as it is a key strategy to reduce malnutrition in children.
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Background:Considering the poor practices of optimal breastfeeding, a cross-sectional study with the objective to ascertain the disparity in knowledge, attitude and practice (KAP) pertaining to early initiation, exclusive and continued breastfeeding behaviours was conducted among the mothers of children below 3 years of age.Methods:400 mothers of children ≤6 months from 52 villages of Rajasthan were included in the analysis for EBF. The data collection was analysed using statistical software SPSS version 23.0. All characteristics were summarized descriptively. Chi-square (χ2) test was performed to study the association between two categorical variables. Three points liket scale was administered to assess the attitude of mothers.Results:72.8 % mothers initiated early breastfeeding, 22.5% continued breastfeeding, and exclusively breastfeeding was practiced by none. 34.3% mothers had knowledge on early initiation of breastfeeding, 34.6% on exclusive breastfeeding and 65.5% had knowledge on continued breastfeeding. 73.8% mothers had positive attitude towards early initiation of breastfeeding, 13.5 % on exclusive breastfeeding and 79.5% had positive attitude towards continued breastfeeding up to 2 years.Conclusions:Though the attitude and knowledge on breastfeeding is good yet exclusive breastfeeding practice was observed very poor. These findings indicate that despite of having good knowledge and a positive attitude towards breastfeeding, there are certain myths and social determinants which hinder optimal breastfeeding. Identification of such barriers will be extremely useful, since counselling and behaviour change strategies will focus and address them, resulting in the practice of good behaviours.
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Background: Breastfeeding is a well-established key of success to improve the outcome in neonates. Early initiation of breastfeeding in neonates refers to the provision of mother's milk to their own babies as early as possible after delivery. Despite the established benefits of breastfeeding, early initiation of breastfeeding is found to be suboptimal in our country. Early initiation of breastfeeding has many challenges like no bedding in, availability of lactation counsellors and staff nurses, procedural delay (episiotomy, skin suture) and shifting from the recovery room. Objective of the study was to improve the rate of initiation of breastfeeding stable term and preterm neonates within 1 hour of life in both normal vaginal delivery and caesarean section conducted in our hospital from baseline to 95% over 3 months period by Quality improvement approach.Methods: Eligible inborn mother-infant dyads were enrolled in this study. A team formed, baseline data and rate of early initiation of breastfeeding collected and factors for delayed initiation analysed by Flowchart process, Fishbone analysis and 5 why's, 3 PDSA cycles were done.Results: Total 50 mother-infant dyads assessed. Rate of early initiation of breastfeeding within 1 hour of life increased from 25% to 100% over 3 months.Conclusions: This quality improvement study was able to accomplish sustained improvement in the rate of breastfeeding the neonates in the first hour of life.
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Background: Breastfeeding remains the simplest, healthiest, and least expensive feeding method that fulfills the infant’s needs and it is also important for reducing child morbidity and mortality. It has nutritional, immunological, behavioral, and economic benefits and also provides desirable mother-infant bonding. Objectives: The objectives of this study were (1) to assess the awareness and practices regarding breastfeeding of rural mothers and (2) to find out the influence of sociodemographic variables on breastfeeding practices. Materials and Methods: A community-based cross-sectional study was conducted in the field practice area of Rural Health Training Centre, Integral Institute of Medical Sciences and Research, Lucknow. Mothers having children between 0 and 2 years age group were included in the study. A pre-designed, semi-structured questionnaire was used as a study tool. Data were compiled in MS Excel and statistical analysis was done using SPSS version 20. Results: About 54.8% were aware that breastfeeding should be initiated within 1–24 h after birth, but 66.7% initiated breastfeeding within 1–24 h after birth, 73.9% were aware and feed their infant on demand, and 46.2% were aware that exclusive breastfeeding (EBF) should be continued up to 6 months of age, but only 37.6% practiced EBF. Factors such as literacy status, place of delivery, and mode of delivery were found to be associated with breastfeeding practices. Conclusion: It is seen in the study that practice of EBF and early initiation of breastfeeding are still low.
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Background: Early initiation of breastfeeding defined by World Health Organization as initiation of breastfeeding within one hour of birth, provides new-borns the best chance for survival, growth and development. Yet the rates of early initiation are still low (41.5%), varying widely in different parts of India. Present study was done to find the proportion of early initiation of breastfeeding and associated factors in a rural area.Methods: This cross-sectional study was conducted among 73 recently delivered mothers residing in a rural area of Moradabad, who were interviewed using a semi structured questionnaire with early initiation of breastfeeding as outcome variable. For statistical analysis Chi-square and Fisher’s exact tests were used.Results: 61.64% recently delivered mothers responded that they had initiated breastfeeding within one hour of delivery. Early initiation was significantly lower among working mothers as compared to housewives. No significant differences in timely initiation have been found with mother age, religion and type of family. However significant association of early initiation was found between full antenatal care (ANC) and breastfeeding counselling.Conclusions: More than sixty percent mothers initiated breastfeeding within an hour of delivery. Full ANC and breastfeeding counselling can help in improving rates of early initiation.
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Background: Breast milk is the best nutrition to every new born baby. WHO recommends that all new-borns should be breastfed within one hour of birth and then on demand. Exclusive breast feeding i.e. avoiding any other feeds till 6 months of age, is best for the baby. Despite these guidelines, our national average of initiating breastfeeding within the first hour is less than 50% as per NFHS 2015-2016. The objective was to study the existing rate of early initiation of breast feeding in the study hospital.Methods: Retrospective data collection from 2015 to 2017 was used for this study. Mothers were educated about colostrum and benefits of early initiation of breastfeeding in their third trimester and during their baby shower.Results: Early initiation of breast feeding was successful among 2624 babies out of 2835 babies who were born in the study period.Conclusions: As compared to national averages, the study hospital had a superior percentage of babies being initiated early on breastfeeding. We need to educate and motivate the society to encourage exclusive breast feeding for all babies. Professional help in the form of dedicated lactation consultants of guidelines will help mothers to breast feed their babies sooner and for longer. Busting local myths and harmful practices is the need of the hour.
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Background: The benefits of breastfeeding for the health and wellbeing of the mother and babies are well documented. A recent trial has shown that early initiation of breastfeeding could reduce neonatal mortality, which would contribute to the achievement of the Millennium development goals. The positive effects of breastfeeding on the new-born’s health can be attributed to the components of breast milk, as well as the contact between mother and baby.Methods: This is a hospital based, cross sectional study conducted in the Department of Pediatrics and Department of Obstetrics and Gynaecology, at a tertiary care hospital in North Coastal Andhra Pradesh. Study period was one year between March 2018 to February 2019. 310 healthy term new-born babies of singleton pregnancy were included.Results: The prevalence of initiation of breast breastfeeding within one hour in this study is 48.7% (151 neonates). Hindu religion, literacy, urban residence, vaginal delivery, male child, breast feeding advice during antenatal period, birth spacing <2 years, not giving prelacteal feeds, absence of breast-feeding problems and maternal illness were found to have a significant association with initiation of breast feeding within 1 hour after delivery (p value <0.05).Conclusions: Innovative strategies like provision of breastfeeding counsellors in the hospital setup; constant counselling to mothers and their immediate relatives who take care of baby and mothers can increase early initiation of breast feeding.
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Background: Early initiation of breastfeeding (EIBF) and exclusive breastfeeding for the first 6 months of life prevents around 20% newborn deaths and 13% under-five deaths. EIBF is predominately associated with socioeconomic, health related, and individual factors. Very few studies in Gujarat and probably none in Jamnagar district have been conducted to know factors related to the timing of initiation of breastfeeding. Objectives: This study was carried out with the objective to find out the prevalence of EIBF and association of demographic, antenatal, and intranatal factors with prelacteal feeding practice in Jamnagar district of Gujarat. Materials and Methods: This study was carried out in 2015–2016 in four talukas of Jamnagar district with a sample size of 426 mother-infant pairs calculated with appropriate formula using prevalence of EIBF. Out of this, 400 samples with adequate response were analyzed. Multistage sampling was done and mothers who gave valid consent were taken as respondent. Chi-square, Fisher exact, and Pearson correlation tests were used for statistical analysis. Results: The prevalence of EIBF was 62% in Jamnagar district. About 94.8% newborn of 15–19 years aged mothers, 96.4% newborns of mothers of Class-V socio-economic class, 87.5% newborns of illiterate mothers, 96.5% newborns of farmer mothers, and 77.4% of 1st birth order newborns received breastfeeding within 1 h of their birth. The proportion of newborn receiving breastfeeding within 1–4 h after birth increased significantly with increasing number of antenatal care (ANC) visits (P < 0.01). Among mothers with prolonged labor, 43.5% could initiate breastfeeding early. Mode of delivery and health facility for delivery were a significant determinant for the time of initiation of breastfeeding. Conclusion: EIBF decreased with increasing age of mothers, increasing socio-economic class and increasing the education level of mothers. The practice of EIBF is also low among employed mothers, among newborn with high birth order and among mothers of general caste. EIBF is high in mothers with fewer ANC visits, among mothers with prolonged labor, in case of normal delivery, delivery at primary health care, and delivery assisted by female health staff.
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Background: The WHO recommends that mothers worldwide to initiate breastfeeding within an hour of delivery to achieve optimal growth, development and health but the breastfeeding rates remain far below the recommended standards. The aim of this study was to find the prevalence of delay in initiation of breast feeding, to identify various factors which determine the initiation of breastfeeding and to correlate their association with delayed onset of breast feeding.Methods: Hundred and thirty six postnatal women, who delivered in Santosh Medical College and Hospital, Ghaziabad, were recruited in the study. They were interviewed after their informed consent using a pretested structured questionnaire. Socio-demographic and obstetric factors were compared between subjects who initiated breast feeding in less than and more than 1 hours. Frequencies were calculated for different variables. Data was statistically analyzed and p value of <0.05 was taken significant.Results: The prevalence of delay in initiation of breast feeding in our study was found to be 74.2% (n=101).The mean time of initiation of breast feeding was 18.43 hours. Significant association (p <0.05) was found in various sociodemographic, obstetrical and social factors.Conclusions: Identifying mothers at risk of delayed breastfeeding initiation should be the target for breastfeeding promotion during prenatal, antenatal as well as postnatal period. Public health officials and health care providers should consider interventions to promote and support early initiation of breast feeding.
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Background: Early or timely initiation of breastfeeding, specifically within 1 hour of birth has benefits for survival and beyond and it is recommended by the World Health Organization. Breastfeeding initiation after the first hour of birth doubles the risk of neonatal mortality. The present study has been conducted to estimate the prevalence and determine the factors affecting early initiation of breastfeeding in rural areas of Dibrugarh, district, Assam. Methods: Community based cross sectional study from May 2017 to April 2018 among mothers having children in the age group 0 to 23 months in the rural areas of Dibrugarh district. The sample size calculated for the study was 360 children. Results: The results were analyzed for 334 children. Prevalence of early initiation of breastfeeding was found to be 54.8%. On multivariate regression analysis the occupation and education of mothers, number of antenatal checkup visits, type of delivery and religion were found to be independently associated with early initiation of breastfeeding. Conclusions: This study reveals that the early initiation of breast feeding is lower in rural areas of Dibrugarh district. The findings clearly highlight the importance of imparting health education to family members and mothers right from antenatal period on infant and child feeding practices.
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Background: Breastfeeding is the corner stone of child survival, nutrition and development and maternal health. The World Health Organization recommends that all neonates be breastfed within one hour of birth. Early initiation of breast feeding (EIBF) is a sentinel indicator for successful breastfeeding. The aim of this study is to assess the practice of early initiation of breastfeeding among babies delivered in our tertiary care teaching unit and to list out the reasons for delay in implementation.Methods: This study is done on 409 postnatal mothers who delivered in our hospital. All the mother-baby dyads enrolled were interviewed within 12 hours of delivery. Data was collected through clinical records and interview of mothers.Results: EIBF is seen only in 19.8% of babies. Median time of initiation of breast feed is 110 minutes. Primiparous mothers had a delay in initiation of feed (p<0.01). The mothers who received practical support from health care providers had successful EIBF(p< 0.01). The main reasons for delay in feeding were lack of early, uninterrupted skin to skin contact between baby and mother and the separation of mother - baby dyads immediately after delivery.Conclusions: EIBF rate in our centre is extremely low compared to the national standards of 44.6%. Several gaps in EIBF need to be addressed and a strict institutional protocol need to be followed. Periodic review of EIBF rates needs to be done by every institute to achieve a global target of > 90%.
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Background: Breastfeeding is the healthiest way to feed a baby. Like mothers love there is no substitute for breast milk. Despite of benefits of breast feeding, the breast feeding incidence and the duration of exclusive breast feeding all over world is not satisfactory. In India though breastfeeding is almost universal, the prevalence of exclusive breastfeeding as per WHO recommendation is not up to the expectations. Over one million infants worldwide die every year because they are not breastfed or because they are given other foods too early. The determination of indicators and variables related to exclusive or overall breastfeeding duration can be a valuable instrument when planning local actions and policies aimed at improving breast feeding rates. Aim: To assess the knowledge, attitude and practices of mothers regarding breast feeding and to determine the impact of lactation counseling to mothers around the time of delivery on breast feeding practices. Material and Methods: Our study was a single center cross sectional questionnaire based study conducted in a Teaching Hospital in Telangana state in India. Duration of study was from October 2016 to September 2018. It was conducted upon 600 (n=600) women i.e. Expectant mothers admitted in antenatal wards and mothers in labour room and postnatal wards of our hospital, who were otherwise healthy. These women were randomly divided in to two groups Group A and Group B. Group A (n=300), Women interviewed after delivery with a preset questionnaire which included 22 questions pertaining to knowledge, attitude and practices of breastfeeding. For Group B (n=300), women brief counseling was given just before delivery in the antenatal wards or in the labour room. Counseling was done by women who were appointed as support staffs under NRHM. These women were given basic training on ideal breastfeeding practices as per Infant and Young Child Feeding Kannaiah B, Radha Mohan M, Snigdha, Sharada. Impact of Lactation Counseling To Mothers on Breast Feeding Practices. IAIM, 2019; 6(2): 13-22. Page 14 (IYCF) guidelines by SNCU pediatricians in our hospital. Mothers in Group B were also interviewed with the same questionnaire by the same interviewer after delivery. The data from the questionnaire of the two groups were analyzed and compared using open EPI INFO statistical methods. Results: Early initiation of breast feeding was observed in 88 % (252-mothers) of Group B compared to 67 % (201-mothers) in Group A. Among the literate women 75% (98-mothers) of Group A and 94% (138-mothers) of Group B women followed early initiation of breast feeding where as in illiterate women early initiation was noticed in 31% (92-mothers) of group A and 41%(114-mothers) of group B mothers. Media played minimal role 16% (48 mothers) of group A and 9% (12 mothers) in group B in encouraging breast feeding. Support from family members & hospital staff had positive influencing on breastfeeding in the groups. 71% (213) of Group A and 89 % (254) of Group B mothers felt breast feeding should be continued for two years and beyond. Conclusion: It revealed that mothers, in virtually all cultures and communities, have considerable knowledge and experience related to all aspects of maternal and child development, and that they have a strong commitment to promoting the well-being of children, their mothers, and families. ‘To have enduring effects, interventions must have an impact on social norms’. In particular, in households in traditional societies around the world, older women or grandmothers play a leading role in decision. They also serve as the primary caregivers of women and children and will continue to play-important role in mother and child health. Thus early initiation of breast feeding, antenatal counseling, educating other family members and support of media etc. will have major role in promoting exclusive breast feeding.
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Justification: Shaping up the post-2015 development agenda is of crucial importance in the development process around the Globe as 2015 was the last year of milllionium development goals. It is the right time to asses our own progress vis-a-vis the Millennium Development Goals and these Guidelines are an attempt in that regard. Process: The Infant and Young Child Feeding (IYCF) chapter of Indian Academy of Pediatrics invited a group of experts for National Consultative Meet for discussing and contributing on latest scientific advances and developments. Various partners from WHO, UNICEF, Ministry of Child Welfare Department, Ministry of Health and Family Welfare, Ministry of Chemical and Fertilizers of Govt of India, Human Milk Banking Association (of India), Indian Medico-Legal and Ethics Association (IMLEA), non-governmental organizations and academicians from various states of India contributed to these guidelines. The guidelines were finalized during the IYCNCON 2015 at New Delhi in August 2015. Objectives: To formulate, endorse, adopt and disseminate guidelines related to Infant and Young Child feeding from an Indian perspective (including human milk banking, infant feeding in the HIV situation, and micro-nutrients). Recommendations: Early initiation of breastfeeding within first hour of birth, exclusive breastfeeding for the first six months followed by continued breastfeeding for up to two years and beyond with appropriate complementary foods after completion of 6 months is the most appropriate feeding strategy. Micro-nutrient supplementation in infants, and adequate nutrition and anemia control for adolescent girls, pregnant and lactating mothers is advocated. Concepts and need for human milk banks in India has also been incorporated.
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Objective To investigate the impact of early initiation of continuous renal replacement therapy (CRRT) based on Kidney Disease: Improving Global Outcomes (KDIGO) classification on the prognosis of critically ill patients with acute kidney injury (AKI). Methods A retrospective analysis of clinical data of patients diagnosed as AKI in Department of Critical Care Medicine of Zhejiang Provincial People's Hospital from January 2011 to January 2015 was conducted. All patients included should be 18 years old or older, having stayed in intensive care unit (ICU) for more than 48 hours, and received CRRT. All subjects were divided into three groups according to their renal function before CRRT according to the KDIGO-AKI guideline: AKI-stage 1 group, AKI-stage 2 group and AKI-stage 3 group. The general condition, original disease, severity of disease, duration of mechanical ventilation, the length of ICU or hospital stay, 28-day survival rate and in-hospital mortality rate were compared among these three groups. Additionally, risk factors for the 28-day survival rate and hospital mortality of critically ill patients with AKI were screened by logistic regression analysis. Results A total of 258 critically ill patients with AKI were enrolled, with 64 cases in AKI-stage 1 group, 62 cases in AKI-stage 2 group, and 132 cases in AKI-stage 3 group. 116 patients survived with 28-day survival rate of 44.96%. 154 patients died with hospital mortality 59.69%. The precipitating factors of AKI in all three groups (stage 1, stage 2, and stage 3) were similar, with sepsis, heart failure and poisoning (drugs or poison) being the main triggers for AKI, accounting for 35.66%, 19.38% and 13.18%, respectively. There were significant differences in the rate of vasoactive agent usage (31.25%, 41.94%, 50.00%, χ2 = 6.241, P = 0.044), acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score (20.87±7.37, 17.19±7.02, 22.58±7.95, F = 5.292, P = 0.006) and sequential organ failure assessment (SOFA) score (8.41±3.46, 6.22±2.43, 9.58±3.71, F = 10.328, P = 0.000), while there was no significant difference in gender, age, primary disease, time from ICU admission to the beginning of CRRT, mean arterial pressure (MAP), lactate level or 24-hour lactate clearance rate (LCR), mechanical ventilation time, the length of ICU or hospital stay, 28-day survival rate or hospital mortality among these three groups (all P > 0.05). According to the logistic regression analysis, time from ICU admission to start of CRRT and lactate level were the independent risk factors for 28-day survival rate or hospital mortality of critically ill patients with AKI [odds ratio (OR) for 28-day survival rate was 0.850 and 0.774, 95% confidence interval (95%CI) was 0.752-0.960 and 0.638-0.940, P value was 0.009 and 0.010, respectively; OR for hospital mortality was 0.884 and 0.756, 95%CI was 0.781-1.000 and 0.610-0.939, P value was 0.049 and 0.011, respectively]. Conclusion Early initiation of CRRT based on KDIGO-AKI classification could not improve the prognosis of critically ill patients with AKI, the optimal timing of RRT for such patients remains to be further explored.
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Cesarean section is considered as a barrier for early initiation of breastfeeding. We found that 65.2% of mothers initiated breastfeeding within 1 hour of delivery. We found that there is no significant difference between vaginal delivery and cesarean section in early initiation of breastfeeding, (P = 0.35). We were successful in overcoming this barrier by involving a lactation management counsellor in supporting mothers in early initiation of breastfeeding following cesarean section.
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Justification: The first National Guidelines on Infant and Young Child Feeding (IYCF) were formulated by Ministry of Women and Child Development (Food & Nutrition Board) in 2004, and the same guidelines were revised in 2006. India is committed to halving the prevalence of under weight children by 2015 as one of the key indicators of progress towards the Millennium Development Goals (MDG). By the end of 2009 nutritional achievement goals did not make for happy reading. So there was need to revise the existing guidelines and to have more viable and scientifically accepted national guidelines on Infant and Young child feeding. Process: A National Consultative Meet was organized by Indian Academy of Pediatrics at Gurgaon in 2009 where members of IYCF and Nutrition Chapters of IAP, BPNI, WHO, UNICEF, USAID, WFP were present. Each group made detailed presentations after reviewing recent literature on the subject. After extensive discussions a consensus was reached and the guidelines were formulated. Objectives: To formulate, endorse, adopt and disseminate guidelines related to Infant & Young Child feeding from an Indian perspective (including infant feeding in the context of HIV infection). Recommendations: Optimal infant and young child feeding: Early initiation of breastfeeding, exclusive breastfeeding for the first six month of life followed by continued breastfeeding for up to two years and beyond with adequate complementary foods is the most appropriate feeding strategy for infants and young children. Adequate nutrition and anemia control for adolescent girls, pregnant and lactating mother is also advocated.
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After menopause, estrogen deficiency from the loss of ovarian function results in various symptoms and metabolic changes, which lead to an increased risk of chronic diseases. Troublesome menopausal symptoms, vasomotor and/or psychological, are the first to develop, and various kinds of disorders related to estrogen deficiency such as genitourinary atrophy, involutional osteoporosis, cardiovascular, and Alzheimer's diseases follow. Among these, two major long-term consequences of ovarian failure are osteoporosis and cardiovascular disease, which are also the major causes of morbidity, mortality and financial costs. Hormone therapy by using estrogen with or without progesterone, is most consistently effective for the treatment of acute and some intermediate menopause-related symptoms such as vasomotor symptoms and vaginal dryness, and therefore has been recommended as the first-line measure to prevent and treat the acute symptoms of estrogen deficiency. It also has been reported that hormone therapy reduces the risks of some long-term sequelaes, suggesting both therapeutic and preventive roles in postmenopausal women. However, it is clear that hormone therapy is not a panacea and is not suitable for all postmenopausal women because of side effects and some concerns about cancer risks. The rate of long-term compliance is also low at present. Recent RCTs showed that hormone therapy does not seem to be effective in improving cognition and preventing CHD and dementia. However, there is a growing consensus that the early initiation of hormone therapy provides protection from CVS and CNS, the two most important areas, whereas RCTs have disagreed with observational data. This means that in young women at early menopause, "a window of therapeutic opportunity" exists for hormone therapy, since treatment during this period may provide cardio- and neuroprotection. More studies are urgently needed on this controversy. Current recommendations suggest treatment with the lowest effective dose for the shortest period of time and individualized treatment based on patient's risk and benefit ratio.