title: Use of nutritional and water hygiene packages for diarrhoeal prevention among HIV-exposed infants in Lilongwe, Malawi: an evaluation of a pilot prevention of mother-to-child transmission post-natal care service.
abstract: OBJECTIVE
  To evaluate a pilot prevention of mother-to-child transmission post-natal programme in Lilongwe, Malawi, through observed retention and infant diarrhoeal rates.
  
  
  METHODS
  Free fortified porridge and water hygiene packages were offered to mothers to encourage frequent post-natal visits and to reduce diarrhoeal rates in infants on replacement feeding. Participant retention and infant health outcome were assessed.
  
  
  RESULTS
  Of 474 patients enrolled, 357 (75.3%) completed 3-month follow-up visits. Ninety-nine percent of women reported hygiene package use, and only 17.7% (95% CI 13.8-22.0%) of the infants had diarrhoea at least once over the 3-month period. Being 12 months or younger, confirmed HIV positive, access to tap water, and having a mother with diarrhoea were all associated with increased risk of infant diarrhoea.
  
  
  CONCLUSIONS
  The majority of participants adhered to their scheduled visits and retention was favourable, possibly because of the introduction of hygiene and nutrition incentives. The infant diarrhoeal rate was low, suggesting benefits of regular medical care with hygiene package usage and reliable replacement feeding options. Continuation and expansion of the programme would allow further studies and improve the post-natal care of HIV-exposed infants in Malawi and in other resource-constrained countries.
authors.affiliation: The University of North Carolina School of Medicine, Chapel Hill, NC, USA.
authors.forename: Jiayin
authors.initials: J
authors.lastname: Xue
authors.forename: Zenabu
authors.initials: Z
authors.lastname: Mhango
authors.forename: Irving F
authors.initials: IF
authors.lastname: Hoffman
authors.forename: Innocent
authors.initials: I
authors.lastname: Mofolo
authors.forename: Esmie
authors.initials: E
authors.lastname: Kamanga
authors.forename: James
authors.initials: J
authors.lastname: Campbell
authors.forename: Greg
authors.initials: G
authors.lastname: Allgood
authors.forename: Myron S
authors.initials: MS
authors.lastname: Cohen
authors.forename: Francis E A
authors.initials: FE
authors.lastname: Martinson
authors.forename: William C
authors.initials: WC
authors.lastname: Miller
authors.forename: Mina C
authors.initials: MC
authors.lastname: Hosseinipour
mesh_terms: D003968:Diarrhea, Infantile / Q000517:prevention & control*; D005260:Female; D005527:Food, Fortified; D006679:HIV Seropositivity / Q000635:transmission*; D006801:Humans; D007223:Infant; D007224:Infant Care; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008295:Malawi; D017063:Outcome Assessment, Health Care; D010342:Patient Acceptance of Health Care; D010865:Pilot Projects; D011181:Postnatal Care / Q000379:methods*; D011446:Prospective Studies; D012307:Risk Factors; D012423:Rural Health; D014867:Water
chemical_list: D014867:Water