Introduction: To systematically review the literature on mother-to-child transmission in breastfed infants whose mothers received antiretroviral therapy and support the process of updating the World Health Organization infant feeding guidelines in the context of HIV and ART. Methods: We reviewed experimental and observational studies; exposure was maternal HIV antiretroviral therapy (and duration) and infant feeding modality; outcomes were overall and postnatal HIV transmission rates in the infant at 6, 9, 12 and 18 months. English literature from 2005 to 2015 was systematically searched in multiple electronic databases. Papers were analysed by narrative synthesis; data were pooled in random effects meta-analyses. Postnatal transmission was assessed from four to six weeks of life. Study quality was assessed using a modified Newcastle-Ottawa Scale (NOS) and GRADE. Results and discussion: Eleven studies were identified, from 1439 citations and review of 72 abstracts. Heterogeneity in study methodology and pooled estimates was considerable. Overall pooled transmission rates at 6 months for breastfed infants with mothers on antiretroviral treatment (ART) was 3.54% (95% CI: 1.15–5.93%) and at 12 months 4.23% (95% CI: 2.97–5.49%). Postnatal transmission rates were 1.08 (95% CI: 0.32–1.85) at six and 2.93 (95% CI: 0.68–5.18) at 12 months. ART was mostly provided for PMTCT only and did not continue beyond six months postpartum. No study provided data on mixed feeding and transmission risk. Conclusions: There is evidence of substantially reduced postnatal HIV transmission risk under the cover of maternal ART. However, transmission risk increased once PMTCT ART stopped at six months, which supports the current World Health Organization recommendations of life-long ART for all.

BackgroundThe practice of Female Genital Mutilation (FGM) is common in several African countries and some parts of Asia. This practice is not only a violation of human rights, but also puts women at risk of adverse health outcomes. This paper analysed the trends in the prevalence of FGM in Burkina Faso and investigated factors that are associated with this practice following the enactment of an FGM law in 1996.MethodsThe study used the Burkina Faso Demographic and Health Survey (DHS) data sets from women aged 15 to 49 years undertaken in 1999, 2003 and 2010. Chi square tests were carried out to investigate whether there has been a change in the levels of FGM in Burkina Faso between 1999 and 2010 and multilevel logistic regression analysis were employed to identify factors that were significantly associated with undergoing FGM.ResultsThe levels of FGM in Burkina Faso declined significantly from 83.6% in 1999 to 76.1% in 2010. The percentage of women circumcised between the ages of 0 to 5 years increased from 34.2% in 1999 to 69% in 2010. Significantly more women in 2010 than in 1999 were of the opinion that FGM should stop (90.6% versus 75.1%, respectively). In 2010, the odds of getting circumcised were lowest amongst women that were born in the period 1990 to 1995 (immediately before the FGM law was enacted) compared to women born in the period 1960-1965 [OR 0.16 (0.13,0.20)]. There was significant variation of FGM across communities. Other factors that were significantly associated with being circumcised were education level, religion, ethnicity, urban residence and age at marriage.ConclusionsAlthough the prevalence of FGM has declined in Burkina Faso, the levels are still high. In order to tackle the practice of FGM in Burkina Faso, the government of Burkina Faso and its development partners need to encourage girls’ participation in education and target its sensitization campaigns against FGM towards Muslim women, women residing in rural areas and women of Mossi ethnic background.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-015-0171-1) contains supplementary material, which is available to authorized users.

BackgroundChild under nutrition is an underlying factor in millions of under-five child deaths and poor cognitive development worldwide. Whilst many studies have examined the levels and factors associated with child under nutrition in different settings, very little has been written on the variation of child under nutrition across seasons. This study explored seasonal food availability and child morbidity as influences of child nutritional status in Malawi.MethodsThe study used the 2004 Malawi Integrated Household Survey data. Graphical analysis of the variation of child under nutrition, child morbidity and food availability across the 12 months of the year was undertaken to display seasonal patterns over the year. Multivariate analysis was used to explore the importance of season after controlling for well-established factors that are known to influence a child’s nutritional status.ResultsA surprising finding is that children were less likely to be stunted and less likely to be underweight in the lean cropping season (September to February) compared to the post-harvest season (March to August). The odds ratio for stunting were 0.80 (0.72, 0.90) and the odds ratio for underweight were 0.77 (0.66, 0.90). The season when child under nutrition levels were high coincided with the period of high child morbidity in line with previous studies. Children that were ill in the two weeks prior to survey were more likely to be underweight compared to children that were not ill 1.18 (1.01, 1.38).ConclusionIn Malawi child nutritional status varies across seasons and follows a seasonal pattern of childhood illness but not that of household food availability.

Using the 2004 data from the Malawi Integrated Household Survey and the Malawi Community Survey, this study investigates the influence of community characteristics on stunting among children under five years of age in a rural context. Multilevel logistic regression modelling on 4284 children with stunting as the dependent variable shows that availability of daily markets and lineage defined in terms of patrilineal or matrilineal communities were significant community determinants of childhood stunting in Malawi. There were significant differences in socio-economic status between household heads from matrilineal and patrilineal communities. Implementation of strategies that empower communities and households economically such as supporting the establishment of community daily markets and promoting household income generating opportunities can effectively reduce the burden of childhood stunting in Malawi.