Addressing social barriers and closing the gender knowledge gap: exposure to road shows is associated with more knowledge and more positive beliefs, attitudes and social norms regarding exclusive breastfeeding in rural Zimbabwe.

Exclusive breastfeeding (EBF) is rarely practiced despite its significant child survival benefits. A key constraint to increasing EBF rates in Zimbabwe and most of the developing world is that key decision makers (fathers/partners and other family members) are often poorly informed about EBF and do not attend antenatal clinics where health information is routinely provided. Informed by formative research, a district-wide campaign was conducted in rural Zimbabwe to encourage EBF and expressing and heat treating (EHT) breast milk as a means to maintain EBF. The campaign combined traditional strategies of education, counselling and outreach through health service delivery with a novel road show 'edutainment' intervention to reach men and other community members. A post campaign evaluation measured the association of road show exposure with 20 knowledge items and summative scores of social norms, beliefs and attitudes obtained through exploratory factor analysis. In adjusted models, road show exposure was associated with correct EBF knowledge (ß=1.0, 0.001), EHT knowledge (ß=1.3, P<0.001) and greater perceived benefits of condom use during pregnancy and breastfeeding (ß=0.5, P<0.001), and more positive EBF social norms (ß=0.6, P<0.001), EBF beliefs and attitudes (ß=1.0, P<0.001) and attitudes towards condom use during breastfeeding (ß=0.6, P<0.001). Road show exposure was more strongly associated with EBF knowledge among men (P-value for gender×exposure group interaction=0.03), suggesting that it also closed the knowledge gap between men and women. Longitudinal studies will determine whether road shows were associated with changes in EBF practices.

HIV-positive poor women may stop breast-feeding early to protect their infants from HIV infection although available replacement diets are grossly inadequate.

Little is known about mothers' perspectives and experiences of early breast-feeding cessation as a strategy to reduce postnatal HIV transmission in rural, resource-constrained settings. We conducted in-depth interviews (IDI) with 15 HIV-positive breast-feeding mothers of infants aged 3-5 mo about their plans for feeding their infants after age 6 mo. We also conducted IDI with 12 HIV-positive mothers who intended to stop breast-feeding after receiving their infant's HIV-PCR negative test result at age 6 mo. Twenty-four-hour dietary recalls were conducted with the same 12 mothers and 16 HIV-negative or status unknown mothers who were breast-feeding their 6- to 9-mo-old infants. Of the 12 mothers who intended to stop breast-feeding, 11 did so by 9 mo. Median energy intake (percent requirement) was 1382 kJ (54%) among weaned infants compared with 2234 kJ (87%) among breast-feeding infants. Median intakes were <67% of the recommended levels for 9 and 7 of the 12 micronutrients assessed for weaned and breast-feeding infants, respectively. Factors facilitating early breast-feeding cessation were mothers' knowledge about HIV transmission, family support, and disclosure of their HIV status; food unavailability was the primary barrier. HIV-positive mothers in resource-constrained settings may be so motivated to protect their child from HIV that they stop breast-feeding early even when they cannot provide an adequate replacement diet. As reflected in the new World Health Organization guidance, HIV-positive mothers should continue breastfeeding their infants beyond 6 mo if replacement feeding is still not acceptable, feasible, affordable, sustainable, and safe.

Risk factors for hospitalization and infection in Canadian Inuit infants over the first year of life--a pilot study.

OBJECTIVES: Inuit infants experience higher mortality and poorer health than other Canadian infants, and suffer disproportionately from bacterial and viral infections. A wide range of inter-related factors affect their health and susceptibility to infection. The objective of the study was to describe hospitalization and morbidity patterns in a cohort of 46 healthy Inuit infants from Iqaluit, Nunavut, over their first year of life. STUDY DESIGN: Risk factors for hospitalization and infections were assessed using multiple linear regression. RESULTS: Infants experienced an average of four respiratory tract infections (RTIs) annually, which accounted for half of the hospitalizations in the cohort. Some interesting trends were evident from the assessment of risk factors using multiple linear regression. Adoption was associated with adverse health effects in addition to those that would be expected due to lack of breast-freeding alone; among infants who were not breast-fed, adopted infants had three more RTIs per year than non-adopted infants. CONCLUSION: The results of this pilot study provide support for undertaking larger epidemiological studies in order to clarify the role of these risk factors, so that future preventive efforts can be informed and effective.

An overview of factors influencing the health of Canadian Inuit infants.

BACKGROUND: Inuit infants throughout the Arctic experience higher mortality and poorer health than their non-Inuit counterparts, and suffer disproportionately from bacterial and viral infections. STUDY DESIGN: This review examines the health status of these infants, with a focus on Canadian Inuit communities and reference to other circumpolar regions, as appropriate. It is based on a Medline search (1965 to present), special analyses of the 1996 Canadian Census and various national surveys, and selected government reports and documents. RESULTS: A wide range of inter-related factors affect the health of Inuit infants: their demographic, social, economic and physical environment, as well as personal health practices and the availability of high quality, culturally appropriate health services. Some of these factors may influence the susceptibility of Inuit infants to infection. Smoking is highly prevalent in Inuit communities, and its indisputable negative effects on health, including increased risk of respiratory tract infection in infants, represent an urgent public health challenge. CONCLUSION: Locally driven, focused and methodologically sound epidemiological research that addresses key gaps in knowledge could lead to more appropriate and effective preventive strategies to improve health in northern communities.