Mixed feeding confers excess risk of mother-to-child transmission (MTCT) of Human Immunodeficiency Virus (HIV) compared with exclusive breastfeeding (EBF) and exclusive formula feeding (EFF). We undertook a quantitative and qualitative cross-sectional survey to identify the social determinants of mixed feeding among a subset of HIV-infected women enrolled in a MTCT prevention program in Jos, Nigeria. Of the 91 participants, 68(75%) exclusively formula fed, 7(8%) exclusively breastfed, and 16(18%) practiced mixed feeding. Of the mixed feeding women, 7 primarily formula fed and 9 primarily breastfed. Women who primarily formula fed described family pressure as the reason for mixed feeding, whereas women who primarily breastfed indicated insufficient breast milk. In a multivariate analysis, lack of partner support of the feeding decision predicted mixed feeding behavior (OR: 4.2; 95% CI: 1.2-14.9; p=0.03). Disclosure of HIV status was significantly correlated (p<0.001) with partner support. HIV prevention interventions aimed at reducing mixed feeding should encourage supportive partner relationships that facilitate disclosure of HIV status. Attention should also be made to the differing pressures faced by women attempting to exclusively breastfeed and exclusively formula feed.

Made available in DSpace on 2014-06-11T19:28:38Z (GMT). No. of bitstreams: 0 Previous issue date: 2005-02-18Bitstream added on 2014-06-13T19:58:16Z : No. of bitstreams: 1 pita_apg_me_arafo.pdf: 1343359 bytes, checksum: 231da834e04239550cc1df3e47d0e61b (MD5) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Considerando a importância do controle de infecção cruzada nos consultórios odontológicos, a vasta utilização de fresas de aço inoxidável/carbeto de tungstênio (carbide) e o receio dos cirurgiões dentistas em esterilizar esses instrumentos devido ao risco de danificá-los, o objetivo deste trabalho foi avaliar, comparativamente, o efeito de alguns métodos de esterilização, preconizados pela literatura e pelo Ministério da Saúde, sobre a eficiência de corte de fresas carbide. Os métodos de esterilização empregados foram: estufa, autoclave e forno de microondas; as marcas comerciais das fresas foram: Komet e S.S. White; e o tempo de aplicação desses instrumentos, em esmalte dental bovino, variou de 12 a 60 minutos. Para coleta dos dados, foram realizados testes gravimétricos e acompanhamento visual das fresas, após estas terem sido submetidas às diferentes condições experimentais. A análise dos resultados permitiu observar que ocorreu perda de eficiência de corte ao longo do tempo de utilização. Observou-se também que a partir de 60 minutos de aplicação em esmalte dental bovino, a eficiência de corte reduziu a 50% dos níveis iniciais. O efeito da esterilização foi diferente entre as marcas comerciais, sendo que cada uma se comportou de maneira diversa, em relação à quantidade de ciclos aplicados. Porém, a durabilidade total dos instrumentos não diferiu entre as marcas comerciais ou entre os métodos de esterilização aplicados. Considerando-se a importância e a responsabilidade do cirurgião dentista, quanto ao controle de infecção cruzada no ambiente do consultório odontológico, e comparando-se aos resultados relativos à durabilidade, evidenciados neste trabalho, pode-se afirmar que a utilização de métodos de esterilização, pode e deve ser adotada com segurança para esterilização de fresas carbide. / Dental burs inevitably become contaminated and the rotary cutting instruments as well as other instruments used in the treatment of patients must be sterilized after use by means of techniques that assure the asepsis, without damaging the instruments and its effectiveness, thus making possible its reuse. Concerning the importance of the control of infection crossed in the deontological clinicians further than the vast use of tungsten carbide burs and the distrust of the dentists in sterilized these instruments this study evaluated the effect of time usage (60 minutes) and sterilization (dry heat, vapor under pressure and energy for microwaves) over the cutting efficiency of carbide burs of two commercial brands. Gravimetrical tests were used for evaluation of the cutting efficiency and the visual acoompaniment of the burs was made along the test. It could be observed that the sterilization influenced in the cutting efficiency of the instruments, as well as the use time. From 60 minutes of application of the burs in the bovine dental enamel the cut efficiency were reduced at levels 50% minors when compared to the initial levels. These influences were different between instruments of the two commercial brands. Based on these results, it may be concluded that the effects of sterilization on cutting efficiency of carbide burs depends upon the composition of instruments and repeated cycles.

Orientador: Regina Helena Barbosa Tavares da Silva / Banca: Lígia Antunes Pereira Pinelli / Banca: Flávia Magnani Bevilacqua / Resumo: Considerando a importância do controle de infecção cruzada nos consultórios odontológicos, a vasta utilização de fresas de aço inoxidável/carbeto de tungstênio (carbide) e o receio dos cirurgiões dentistas em esterilizar esses instrumentos devido ao risco de danificá-los, o objetivo deste trabalho foi avaliar, comparativamente, o efeito de alguns métodos de esterilização, preconizados pela literatura e pelo Ministério da Saúde, sobre a eficiência de corte de fresas carbide. Os métodos de esterilização empregados foram: estufa, autoclave e forno de microondas; as marcas comerciais das fresas foram: Komet e S.S. White; e o tempo de aplicação desses instrumentos, em esmalte dental bovino, variou de 12 a 60 minutos. Para coleta dos dados, foram realizados testes gravimétricos e acompanhamento visual das fresas, após estas terem sido submetidas às diferentes condições experimentais. A análise dos resultados permitiu observar que ocorreu perda de eficiência de corte ao longo do tempo de utilização. Observou-se também que a partir de 60 minutos de aplicação em esmalte dental bovino, a eficiência de corte reduziu a 50% dos níveis iniciais. O efeito da esterilização foi diferente entre as marcas comerciais, sendo que cada uma se comportou de maneira diversa, em relação à quantidade de ciclos aplicados. Porém, a durabilidade total dos instrumentos não diferiu entre as marcas comerciais ou entre os métodos de esterilização aplicados. Considerando-se a importância e a responsabilidade do cirurgião dentista, quanto ao controle de infecção cruzada no ambiente do consultório odontológico, e comparando-se aos resultados relativos à durabilidade, evidenciados neste trabalho, pode-se afirmar que a utilização de métodos de esterilização, pode e deve ser adotada com segurança para esterilização de fresas carbide. / Abstract: Dental burs inevitably become contaminated and the rotary cutting instruments as well as other instruments used in the treatment of patients must be sterilized after use by means of techniques that assure the asepsis, without damaging the instruments and its effectiveness, thus making possible its reuse. Concerning the importance of the control of infection crossed in the deontological clinicians further than the vast use of tungsten carbide burs and the distrust of the dentists in sterilized these instruments this study evaluated the effect of time usage (60 minutes) and sterilization (dry heat, vapor under pressure and energy for microwaves) over the cutting efficiency of carbide burs of two commercial brands. Gravimetrical tests were used for evaluation of the cutting efficiency and the visual acoompaniment of the burs was made along the test. It could be observed that the sterilization influenced in the cutting efficiency of the instruments, as well as the use time. From 60 minutes of application of the burs in the bovine dental enamel the cut efficiency were reduced at levels 50% minors when compared to the initial levels. These influences were different between instruments of the two commercial brands. Based on these results, it may be concluded that the effects of sterilization on cutting efficiency of carbide burs depends upon the composition of instruments and repeated cycles. / Mestre

Emerging multidrug-resistant tuberculosis (MDR/XDR-TB) has become a major public health problem, placing millions at risk. Further, nosocomial transmission of MDR/XDR-TB places both patients and healthcare workers at an even higher risk. Effective tuberculosis (TB) infection prevention and control (IPC) policies in high-risk settings must use evidence-based science and should be customized to the setting. However, the growing incidence of MDR/XDR-TB in some global settings raises questions about whether adequate healthcare-related TB IPC policies are in place and whether they are implemented effectively. The purpose of this systematic literature review was to catalogue healthcare-related TB IPC policy research conducted in high-prevalence settings and draw a picture of existing evidence-based TB IPC policies and their implementation, with a focus on preventing and controlling nosocomial transmission of MDR/XDR-TB. Two databases (PubMed and Embase) were searched from 1990 – 2013 and outputs were categorized by region/country, income, MDR/XDR-TB incidence, level of IC intervention, and time period. None of the 20 captured research studies were conducted in TB high-prevalence, low-income settings. Most (12/20) were implemented within the Pan American Health Organization region, followed by the African (4/20) and European (4, 20%) regions. Most studies reviewed (70%) were undertaken because of an outbreak and most (70%) were published between 1990 – 2000. This systematic literature review showed a gap in research on TB IPC policies addressing nosocomial transmission of MDR/XDR-TB in high-prevalence, low-income settings. TB IPC policy development and implementation should be routinely undertaken as a part of effective and efficient public health practice. Development of TB IPC global best practices should be guaranteed and a concerted effort to promote, distribute, train, and implement these TB IPC best practices in low-resource countries would help mitigate the growing incidence of MDR/XDR-TB worldwide.

L'évaluation économique de nouveaux vaccins exige de modéliser la transmission infectieuse au sein de la population, et donc des hypothèses sur la structure et la répartition des contacts. Les matrices de contact obtenues à partir d’enquête de population ont été déterminées pour 8 pays européens. Mais aucune donnée de ce type n'existe à ce jour pour la France. L’étude ComesF (Contact Matrix Estimation – France) vise à combler cette lacune.MéthodologieL'enquête s’est effectuée sur 3 périodes (Février-Mars, Avril, Mai-Avril) avec 278 participants communs à la première et dernière période. Les participants devaient rapporter tous leurs contacts au cours de 2 jours consécutifs dans un journal, avec l'âge, le sexe, l'endroit, la fréquence, le type et la durée du contact.En combinant des enquêtes sérologiques de 2009 et 2013 et les données de couverture vaccinales, nous avons modélisé la séroprévalence de la rougeole, des oreillons et de la rubéole; puis extrapolé la susceptibilité selon l’âge par département à l'année d'intérêt (2016) ; enfin le potentiel épidémique et l'incidence relative selon l’âge d'une future épidémie ont été estimés.Nous avons analysé l'influence de conditions météorologiques sur les variations temporelles des matrices de contact. La population de l'étude a été analysée selon le jour et la météorologie pour estimer le nombre moyen de contacts et le potentiel de transmission estimée avec le R0. Nous avons effectué une revue systématique de la littérature sur les différences selon le genre pour la grippe, la rougeole, les oreillons et la rubéole, puis exploré l'impact du genre sur les matrices de contact et la modélisation des maladies infectieuses.Résultats2033 participants ont rapporté 38881 contacts (médiane pondérée [premier quartile-troisième quartile] : 8 [5–14] par jour) et 54378 contacts avec les contacts professionnels supplémentaires (9 [5–17]). Contrairement à l'âge, le genre, la taille du foyer, les vacances scolaires, le week-end et l'activité professionnelle, la période de l'année influait peu le nombre de contacts ou les schémas de contact. Les schémas de contact étaient influencés par l'âge indépendamment du lieu de contact, et par le genre, les femmes ayant 8 % plus de contacts que les hommes. La plupart des contacts avaient lieu à la maison et à l'école, mais l'ajout des contacts professionnels modifiait la structure des schémas de contact. Les vacances scolaires et les week-ends réduisaient le nombre de contacts, et le R0 de 33 % et de 28 %, respectivement. Le risque pour les Oreillons et la Rubéole concerne surtout le Sud Est et le Centre de la France, alors que le risque pour la rougeole est plus dispersé. Le risque varie avec le genre pour la Rougeole et la Rubéole. Outre les bébés < 1 an, l’épidémie toucherait surtout les adolescents et les jeunes adultes.Les conditions météorologiques influençaient les schémas de contact différemment entre les jours de semaine ou les weekends. La correction pour analyse répétée limitait le nombre de résultats significatif, mais la tendance pour un effet de la météorologie variant entre les jours de semaine et le week-end restait.Les différences de genre dans le schéma de contact pourraient expliquer en partie les différences de genre dans l'épidémiologie des maladies infectieuses. L'utilisation de données spécifiques par genre avait un impact significatif sur le résultat de la modélisation du risque d’une épidémie.Les matrices de contact françaises partageaient de nombreux points communs avec les autres matrices européennes, notamment avec un impact substantiel des fermetures d’école en cas d’épidémie sur la progression de l’épidémie. Le risque d'une nouvelle épidémie de rougeole persiste, mais prédomine pour les oreillons. L'effet des conditions climatiques sur les schémas de contact était modeste, voire négligeable. L’utilisation des données spécifiques par genre est à considérer en modélisation. / The economic evaluation of new vaccines requires the modeling of infectious disease transmission within a population, which in turn requires some assumption of specific mixing patterns. Matrixes generated from social contact studies were determined for 8 European countries. To date, no such data exist for France. The ComesF study (Contact Matrix Estimation – France) aimed to fill this gap.MethodologyThe survey was carried out over 3 different periods (Feb-Mar, Apr, Apr-May) with 278 participants common to the first and the last periods. Participants had to list all their contacts for 2 consecutive days in a diary, with the age, sex, location, frequency, type and duration of the contact, from which we estimated French contact matrixes.Combining cross-sectional serological surveys from 2009 and 2013 and vaccine coverage information, we have determined an optimal model for the serology of measles, mumps and rubella for the year of the data collection; age-dependent susceptibility by department was then derived to the year of interest (2016), and effective reproduction number and age-dependent relative incidence of a potential outbreak were estimated using the French contact matrixes.We analysed the influence of meteorological conditions on the temporal variations in mixing patterns. The population of the study was split according to the day and the weather at the time when the diary was filled in. The mean number of contacts and the potential for transmission summarized with R0 were calculated for type and location of contact under different weather conditions.We conducted a systematic review on gender differences in infection focusing on influenza, measles, mumps and rubella. Finally, we provided an exploration of the impact of gender on mixing patterns, and eventually the potential implication for modelling.ResultsThe 2033 participants reported 38 881 contacts (weighted median [first quartile-third quartile]: 8[5–14] per day), and 54 378 contacts with supplementary professional contacts (9[5–17]). Contrary to age, gender, household size, holidays, weekend and occupation, the period of the year had little influence on the number of contacts or the mixing patterns. Contact patterns were highly assortative with age, irrespective of the location of the contact, and gender, with women having 8% more contacts than men. Although most contacts occurred at home and school, the inclusion of professional contacts modified the structure of the mixing patterns. Holidays and weekends reduced the number of contacts dramatically, and as proxies for school closure, reduced R0 by 33% and 28%, respectively.The risk for Mumps and Rubella mainly concerned southeastern and south central France, while the risk for measles was more scattered over the country. Risk differed with gender for Measles and Rubella. Besides infants under 1, the highest share of participation would concern teenagers and young adults.The weather had a differential effect on social mixing according to the type of day, notably weekdays and weekend. But correction for repeated analysis made some results no more significant, although the trend for a differential effect between weekdays and weekend remained.Gender differences in social mixing might explain some gender differences in infectious disease epidemiology. Using gender-specific susceptibility and gender-specific contact matrixes had a significant impact on the result of the modeling. Despite the differences, French contact matrixes shared many aspects with those of other European countries. Notably, school closures were likely to have a substantial impact on the spread of close contact infections in France. While the risk of a new Measles outbreak persists, it predominates for Mumps. The effect of weather on social mixing was mild, if not negligible. Gender differences in modelling should be emphasized.

Each year approximately 600 000 infants, most of them in Sub-Saharan Africa are born with HIV infection as a result of mother to child transmission of HIV. Whereas significant progress has been made in reduction of mother to child transmission of HIV in developed countries, the situation remains desperate in developing countries. Progress has been hampered by shortage of staff, facilities, limited access to voluntary counselling and testing and lack of support for women by their partners and communities. The challenge is to increase voluntary counselling and testing uptake during antenatal care. Onandjokwe district in Northern Namibia is currently introducing the Prevention of Mother to Child Transmission Program (PMTCT). It has been found the previous PMTCT programs have failed because they adopted a top down approach where there was no community consultation. This study was conducted to explore the community perceptions, knowledge and attitudes regarding mother to child transmission of HIV through focus group discussions and in-depth interviews of key community members.

Each year approximately 600 000 infants, most of them in Sub-Saharan Africa are born with HIV infection as a result of mother to child transmission of HIV. Whereas significant progress has been made in reduction of mother to child transmission of HIV in developed countries, the situation remains desperate in developing countries. Progress has been hampered by shortage of staff, facilities, limited access to voluntary counselling and testing and lack of support for women by their partners and communities. The challenge is to increase voluntary counselling and testing uptake during antenatal care. Onandjokwe district in Northern Namibia is currently introducing the Prevention of Mother to Child Transmission Program (PMTCT). It has been found the previous PMTCT programs have failed because they adopted a top down approach where there was no community consultation. This study was conducted to explore the community perceptions, knowledge and attitudes regarding mother to child transmission of HIV through focus group discussions and in-depth interviews of key community members.

PhD (Health Sciences) / Department of Advanced Nursing Science

Thesis in English, Annexure E: Consent form (leaf 81) as well as KABP Survey Questionnaire (leaves 87-91) in English and SiSwati. / The purpose of the study was to assess knowledge, explore attitudes and determine practices of breastfeeding mothers living with HIV regarding post-natal PMTCT interventions and services. The study was quantitative and descriptive in nature, utilising a retrospective cohort design. The study sample included breastfeeding mothers living with HIV, who attended the King Sobhuza II public health unit in the Manzini region of Swaziland. A written questionnaire was administered to a non-random sample of 90 consecutively selected mothers living with HIV attending the above-cited public health unit for post-natal health purposes. The overall study results revealed that the majority of breastfeeding mothers living with HIV in the afore-mentioned region (77.8%) presented high levels of knowledge on PMTCT, and 90% demonstrated a positive attitude; while a further 90% also demonstrated positive behaviour towards PMTCT. However, stigma and discrimination among family members, non-disclosure of HIV status to sexual partners; as well as poverty and fear of future drug-resistance are the cause of non-adherence to ARV prophylaxis. Furthermore, inconsistent condom use, mixed-feeding methods and wet-nursing also emerged as other contributing factors to the increase of post-natal mother-to-child transmission of HIV among breastfeeding mothers living with HIV. / Health Studies / M.A. (Nursing Science)

Thesis in English, Annexure E: Consent form (leaf 81) as well as KABP Survey Questionnaire (leaves 87-91) in English and SiSwati. / The purpose of the study was to assess knowledge, explore attitudes and determine practices of breastfeeding mothers living with HIV regarding post-natal PMTCT interventions and services. The study was quantitative and descriptive in nature, utilising a retrospective cohort design. The study sample included breastfeeding mothers living with HIV, who attended the King Sobhuza II public health unit in the Manzini region of Swaziland. A written questionnaire was administered to a non-random sample of 90 consecutively selected mothers living with HIV attending the above-cited public health unit for post-natal health purposes. The overall study results revealed that the majority of breastfeeding mothers living with HIV in the afore-mentioned region (77.8%) presented high levels of knowledge on PMTCT, and 90% demonstrated a positive attitude; while a further 90% also demonstrated positive behaviour towards PMTCT. However, stigma and discrimination among family members, non-disclosure of HIV status to sexual partners; as well as poverty and fear of future drug-resistance are the cause of non-adherence to ARV prophylaxis. Furthermore, inconsistent condom use, mixed-feeding methods and wet-nursing also emerged as other contributing factors to the increase of post-natal mother-to-child transmission of HIV among breastfeeding mothers living with HIV. / Health Studies / M.A. (Nursing Science)