Coovadia Paediatrics And Child Health Free Pdf Download !!HOT!!
Coovadia Paediatrics And Child Health Free Pdf Download
the world health organization (who) recommends that pregnant women living with hiv receive a multidisciplinary approach with regards to hiv and obstetric care [ 41 ]. this includes care and treatment of medical conditions common to both pregnancy and hiv, optimal nutrition for mother and baby, and the prevention of vertical transmission of hiv [ 42 ]. the uptake of maternal antiretroviral therapy (art) was high in our study, but not sustained after delivery. morbidity and mortality rates were found to be higher among children born to mothers with aids. who recommends that hiv-infected women who wish to breastfeed their babies should receive art throughout breastfeeding and until six weeks postpartum. most clinical trials have shown a lower risk of vertical transmission among women on art for more than six months, compared to women on art for less than six months, and a lower risk of transmission with regimens that contain two nucleoside reverse transcriptase inhibitors (nrti) [ 43 ]. in a study conducted in zambia, znkessi et al [ 44 ] compared the risk of mother-to-child transmission of hiv between women on antiretroviral therapy and women receiving no antiretroviral therapy throughout pregnancy and immediately after delivery. a significantly lower risk of vertical transmission was observed in the antiretroviral therapy group (rr= 0.38, 95% ci=0.14-0.92). in addition, two randomized controlled trials have been conducted to determine the effect of antiretroviral therapy initiated during pregnancy on vertical transmission [ 45, 46 ]. both trials showed that initiation of maternal art therapy in early pregnancy substantially reduced the risk of mother to child transmission of hiv.
The Coovadia paediatric care model has been shown to be effective in identifying and referring children requiring specialist interventions from within the communities. Referral to hospital is more efficient and cost-effective and the service retains the quality of care received in the community. Given the high costs and inaccessibility of tertiary hospitals, and given that such services are not always available in rural areas, the uptake of services offered through this pilot model could be seen as a significant intervention in reducing health disparities in the future. Given the resources available, the proposed model could be easily scaled up through provincial, district and local health authorities.
Cumulatively, the proposed model offers a robust option for combating child illness and promoting optimal health in the KZN province of South Africa. Although the importance of access to maternal health services in promoting infant and child health has been well established, this has not always been the case in poorer countries, many of which are either still in a state of emergency or are in a state of rapid economic growth. This model is a significant investment in addressing inequities in health and it will be of interest to learn to what extent it will have longer-term impacts on the health and development of children, and to the extent that it will positively impact on health services.
Given the risk and lack of evidence regarding HIV transmission, in 2001 a massive campaign of media and advocacy was launched in South Africa to promote exclusive breastfeeding. This included increasing the number of counsellors in all medical facilities to provide infant feeding counselling. Further, messages about the risks of HIV transmission via breast milk and formula milk were widely disseminated through the media in South Africa. A new national advocacy campaign was started to use posters, radio and print media to make the messages of exclusive breastfeeding as safe, cheap, efficient and effective for both mother and child [ 11 ]. The Ministry of Health also launched a new health policy, the National Directives on Infant Feeding and Nutrition [ 12 ], which clearly stated that exclusively breastfeeding until six months was the best approach to PMTCT and recommended that feeding babies anything other than mother’s milk for six months was unacceptable, with mixed feeding or bottle feeding expressly forbidden. However, when the National Directives were published there was no guideline provided for free provision of formula milk in the public health sector. Although the National Directives recommended counselling and support for mothers who chose not to breastfeed, there was no enforcement of this policy, and hence this was not implemented.