Objectives:International guidelines on infant feeding for HIV- positive mothers promote Exclusive Replacement Feeding (ERF) (infant formula or animal milk) or exclusive breastfeeding (with no supplements of any kind). A mixed feeding pattern, where breastfeeding is combined with other milks, liquid foods or solids, has been shown to increase the risk of transmission of HIV and is strongly discouraged. However, little is known about the ability of women to adhere to recommended feeding strategies to prevent mother-to-child transmission (MTCT) of HIV from breast milk. The objective of this study was to assess the individual and community-level factors that affect perspectives, attitudes and practices of HIV-positive mothers on MTCT and infant feeding in sub-Saharan Africa as documented in peer-reviewed and grey literature.Methods:This work is based on an extensive review of peer-reviewed articles and grey literature from the period 2000-2012. The literature search was carried out using electronic databases like Medline Ovid, Google Scholar, PubMed and EBSCOhost. Both quantitative and qualitative studies written in English language on HIV and infant feeding with particular emphasis on Sub-Saharan Africa were included.Results:The review found low adherence to the chosen infant feeding method by HIV-positive mothers. The following factors emerged as influencing infant feeding decisions: cultural and social norms; economic conditions; inadequate counselling; and mother’s level of education.Conclusions and Public Health Implications:Unless local beliefs and customs surrounding infant feeding is understood by policy makers and program implementers, Prevention of Mother-to-Child Transmission (PMTCT) programs will only be partially successful in influencing feeding practices of HIV-positive women. Hence programs should provide affordable, acceptable, feasible, safe and sustainable feeding recommendations that do not erode strong cultural practices. Advice to HIV-positive mothers should be based on local conditions that are acceptable to the community.
BACKGROUND: Rehabilitation therapists are expected to manage upper extremities difficulties following stroke by using effective treatment approaches. Constraint-induced movement therapy (CIMT) facilitates upper extremity functional recovery in patients after stroke; however, in South Africa, its application is not well documented. AIM: To assess and compare the knowledge and perception of occupational therapists and physiotherapists on the use of CIMT for stroke rehabilitation in South Africa. METHODS: A descriptive cross-sectional design using a self-administered online questionnaire was distributed via the two national professional societies. Data were analysed descriptively and the Mann-Whitney U and Kruskal Wallis tests were used to make inferences RESULTS: Of 108 respondents, 49.1% (n=53) were occupational therapists, and 50.9% (n=55) physiotherapists. A higher level of education (p=0.037) and working specifically with stroke patients (p=0.050) are significantly associated with better CIMT knowledge and perception. The profession of the participants was not significantly associated with their knowledge and perception of CIMT. CONCLUSION: This study demonstrates gaps in the knowledge of CIMT as a treatment technique for upper extremity impairment following stroke. Although most respondents knew about CIMT, improved guidance and knowledge of CIMT are required to remediate knowledge gaps. This may assist in improving the feasibility of CIMT and thus promote its clinical application, given the prevalence of UE impairment in stroke patients managed by therapists.
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