± SD (mmHg) Pregnancy (n=30) Systolic BP Diastolic BP A A 63 81 86 93 96 99 -2.9 ± 7.4 0.3 ± 5.0 Pregnancy (including pre-eclampsia) (n=45) Systolic BP Diastolic BP B A 58 70 82 90 95 97 -3.8 ± 7.3 -1.5 ± 6.2 SD – standard deviation Figure 1 Mean against difference plot for systolic pressure in pregnancy and pre-eclampsia (n=45) Figure 2. Mean against difference plot for diastolic pressure in pregnancy and pre-eclampsia (n=45)
prospective study. S Afr Med J 2013;103(8):552-556.) The phenotypic classification should therefore be expanded to include all low birth weight babies. The placental pathology category of the phenotypic classification was not useful as very few placentas were sent for histology. Conclusion Consideration should be given to expanding the “significant maternal condition” to include the clinical conditions in the placental pathology category, namely abruption placenta and placenta praevia into the maternal conditions group and excluding the placenta category altogether.
Supply of DBS kits During our visit 20% of the sampled facilities in EC, MP and LP reported stock-outs of DBS kits in the past month. 10% Sampled facilities in LP and NC were out of stock during the visit. 17% facilities in LP and 28% in NC had expired DBS kits. Blood Specimens Storage More than 60% facilities in KZN, EC and GP stored blood specimens in the consulting room where they were collected. The other sampled facilities in WC (44%), LP (52%) and MP (44%) used fridges, cooler boxes or special boxes to store specimens when collected Barriers to EID The health workers in sampled facilities reported barriers to the provision of early Infant Diagnosis. Some of these barriers are related to staff shortages, time and budget shortages for training, high volume of work at immunization service points. Others were personal factors like maternal fear of disclosure, maternal denial of HIV status and infant coming to the facilities with caregivers. Figure 1 Barriers to EID Discussion Our findings reveal that lay counsellors outnumber the ENAs and staff nurses in general. Proper utilisation of lay counsellors at primary care facilities does not only alleviate the workload from other cadres allowing timely early infant diagnosis but could also leverage their skills in terms of weighing babies, performing anthropometry, feeding practises, addressing mothers on issues relating to safer sex, disclosure, stigma reduction, HIV and how to prevent it. The shortages and expiration of DBS kits leads to interrupted service thereby denying HIV exposed babies an opportunity to access care on time. This can be overcome by establishing functional inventory control systems that are monitored regularly. DBS cards are designed in such a way that specimens can withstand temperature variation better than other specimens. However, the ideal storage temperature to
Among mothers of HIV-unexposed infants, a significant increase in exclusive breastfeeding was measured in 2011, 43.6% (41.6%-45.7%) compared to 31.3% (31.3% (29.-33.0%) in 2010, Limpopo, Northern Cape and North West were the only three provinces not reporting significant increases in exclusive breastfeeding. The lowest prevalence of EBF was reported in Eastern Cape and Limpopo. This is especially worrying as these are both rural provinces. The prevalence of exclusive breastfeeding was highest in the KwaZulu-Natal and Mpumalanga provinces. Mixed feeding among HIV–unexposed infants Data showed a reduction in mixed feeding amongst HIV-unexposed infants from 57.4% (55.5-59.2%) in 2010 to 46.2% (44.2-48.3) in 2011. Discussion Infant feeding per caregiver recall for the past 8 days suggests a substantial increase in infant feeding counseling, increase in exclusive breastfeeding and reduction in mixed breastfeeding amongst HIV exposed and unexposed infants. The Tshwane Declaration of Support for Breastfeeding was adopted in August 2011 just as the survey started. Its effects are likely to have been measured over the duration of the survey. This survey also provides data on uptake of the PMTCT programme and infant feeding. Limitations Infant feeding practices were documented from recall over the previous 24 hours and seven days prior to these 24 hours; infant feeding counseling data also relied on recall from the antenatal period; thus information bias was likely. The survey excluded infants who do not come for immunization, those seen in mobile facilities, sick infants seen in hospital and infants who have already died Conclusions Following the adoption of The Tshwane Declaration of Support for Breastfeeding data show that reported infant feeding counseling and infant feeding practices improved between 2010 and 2011. Recommendations More work is needed to provide appropriate infant feeding counseling and improve feeding practices. Also more research needs to be done assessed late infant feeding practices among HIV exposed and unexposed infants.
Table 1 Comparison of demographic, maternal and newborn characteristics between CMV- infected and uninfected newborns exposed to HIV. Abbreviation: Intrapartum AZT/sdNVP: intrapartum zidovudine with single dose nevirapine Finding CMV infected infants (n=22) CMV uninfected infants (n=726) OR (95%CI) P value Mean ± SD Maternal age 27.1 ± 5.1 28.5 ± 5.3 0.95 0.23 Length of Maternal ART prophylaxis (days) 344 ± 526 383 ± 652 0.99 0.78 Maternal CD4 count 312 ± 211 395 ± 205 0.99 0.06 Gestational age (weeks) 36.8 ± 2.7 37.5 ± 1.8 0.86 0.25 Birth weight (kg) 2.8 ± 0.7 3.0 ± 0.6 0.99 0.06 Type of maternal ART prophylaxis Positive (%) 0.89 None 1 (4.5) 15 (2.1) Intrapartum AZT/ sdNVP 0 (0) 10 (1.4) Prenatal AZT 9 (40.9) 319 (43.9) HAART 12 (54.5) 378 (52.1) Length of ARV prophylaxis <120days 11 (50) 262(36) 1.8 (0.8-4.4) 0.18 Maternal CD4 count <200 8 (36.4) 118 (16.3) 2.9 (1.2-7) 0.01 Prematurity (<37 weeks) 5 (22.7) 104 (17) 1.7 (0.6-4.6) 0.35 Small for gestational age 2 (9.1) 67 (9.3) 1.0 (0.2-4.4) 0.98 Infant feeding choice: Breastfeeding Formula 14 (63.6) 7 (31.8) 476 (65.6) 236 (32.5) 0.69