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Henjum S.,Akershus University College | Barikmo I.,Akershus University College | Gjerlaug A.K.,Akershus University College | Mohamed-Lehabib A.,Saharawi Ministry of Health Tindouf | And 3 more authors.
Public Health Nutrition | Year: 2010

Objective: To assess the prevalence of enlarged thyroid volume (Tvol) in Saharawi refugee children, and their urinary iodine concentration (UIC), and to identify possible sources of excess iodine intake. Design: A cross-sectional survey was performed during January-February 2007. Tvol was measured by ultrasound and iodine concentration was analysed in casual urine samples, in household drinking water and in milk samples from household livestock.Setting The study was undertaken in four refugee camps in the Algerian desert.Subjects The subjects were 421 Saharawi children, 6-14 years old. Results: Enlarged Tvol was found in 56 % (Tvol-for-age) and 86 % (Tvol-for-body-surface-area) of the children. The median (25th percentile-75th percentile, P25-P 75) UIC was 565 (357-887) μg/l. The median (P25-P75) iodine concentration in household drinking water was 108 (77-297) μg/l. None of the children had UIC below 100 μg/l, 16 % had UIC between 100 and 299 μg/l, and 84 % had UIC above 300 μg/l. There was a positive association between Tvol and whether the household possessed livestock. Conclusions: The children are suffering from endemic goitre and high UIC caused probably by an excessive intake of iodine. The excessive iodine intakes probably originate from drinking water and milk. Copyright © 2010 The Authors.

Henjum S.,Oslo University College | Barikmo I.,Oslo University College | Strand T.A.,University of Bergen | Oshaug A.,Oslo University College | Torheim L.E.,Fafo Institute for Applied International Studies
Public Health Nutrition | Year: 2012

Objective: The main objective was to assess iodine status (thyroid volume (Tvol) and urinary iodine concentration (UIC)) and their determinants in Saharawi refugee women. Design: A cross-sectional survey was performed during January-February 2007. Tvol was measured by ultrasound and iodine concentration was analysed in spot urine samples and in household drinking water. Anthropometry and Hb concentration were measured and background variables were collected using pre-coded questionnaires. Setting: The survey was undertaken in four long-term refugee camps in the Algerian desert. Subjects: Non-pregnant women (n 394), 15-45 years old, randomly selected. Results: Median (25th percentile-75th percentile (P25-P75)) UIC was 466 (294-725)μg/l. Seventy-four per cent had UIC above 300mg/l and 46% above 500mg/l. Median (P25-P75) Tvol was 9.4 (7.4-12.0) ml and the goitre prevalence was 22 %. UIC was positively associated with iodine in drinking water and negatively associated with breast-feeding, and these two variables explained 28% of the variation in UIC. The mean (SD) Hb level was 11.8 (2.4) g/dl. In total 46% were anaemic with 14 %, 25% and 7%, classified with respectively mild, moderate and severe anaemia. Conclusions: The Saharawi women had high UIC, high levels of iodine in drinking water and increased Tvol and probably suffered from iodine-induced goitre. The high prevalence of anaemia is considered to be a severe public health concern. To what extent the excessive iodine intake and the anaemia have affected thyroid function is unknown and should be addressed in future studies. © 2012 The Authors.

Falnes E.F.,University of Bergen | Moland K.M.,Bergen University College | Tylleskar T.,University of Bergen | De Paoli M.M.,Fafo Institute for Applied International Studies | And 2 more authors.
Journal of the International AIDS Society | Year: 2011

Background: Partner involvement has been deemed fundamental in prevention of mother to child transmission (PMTCT) programmes, but is difficult to achieve. This study aimed to explore acceptability of the PMTCT programme components and to identify structural and cultural challenges to male involvement. Methods. The study was conducted during 2007-2008 in rural and urban areas of Moshi in the Kilimanjaro region of Tanzania. Mixed methods were used, and included focus group discussions with fathers and mothers, in-depth interviews with fathers, mothers and health personnel, and a survey of 426 mothers bringing their four-week-old infants for immunization at five reproductive and child health clinics. Results: Routine testing for HIV of women at the antenatal clinic was highly acceptable and appreciated by men, while other programme components, notably partner testing, condom use and the infant feeding recommendations, were met with continued resistance. Very few men joined their wives for testing and thus missed out on PMTCT counselling. The main barriers reported were that women did not have the authority to request their husbands to test for HIV and that the arena for testing, the antenatal clinic, was defined as a typical female domain where men were out of place. Conclusions: Deep-seated ideas about gender roles and hierarchy are major obstacles to male participation in the PMTCT programme. Empowering women remains a huge challenge. Empowering men to participate by creating a space within the PMTCT programme that is male friendly should be feasible and should be highly prioritized for the PMTCT programme to achieve its potential. © 2011 Falnes et al; licensee BioMed Central Ltd.

Chinkonde J.R.,University of Oslo | Sundby J.,University of Oslo | de Paoli M.,Fafo Institute for Applied International Studies | Thorsen V.C.,University of Oslo
International Breastfeeding Journal | Year: 2010

Background: When and how to wean breastfed infants exposed to HIV infection has provoked extensive debate, particularly in low-income countries where safe alternatives to breastfeeding are rarely available. Although there is global consensus on optimal infant-feeding practices in the form of guidelines, practices are sub-optimal in much of sub-Saharan Africa. Policy-makers and health workers face many challenges in adapting and implementing these guidelines.Methods: This paper is based on in-depth interviews with five policy-makers and 11 providers of interventions to prevent mother-to-child transmission (PMTCT) of HIV, participant observations during clinic sessions and site visits.Results: The difficulties with adapting the global infant-feeding guidelines in Malawi have affected the provision of services. There was a lack of consensus on HIV and infant-feeding at all levels and general confusion about the 2006 guidelines, particularly those recommending continued breastfeeding after six months if replacement feeding is not acceptable, feasible, affordable, sustainable and safe. Health workers found it particularly difficult to advise women to continue breastfeeding after six months. They worried that they would lose the trust of the PMTCT clients and the population at large, and they feared that continued breastfeeding was unsafe. Optimal support for HIV-infected women was noted in programmes where health workers were multi-skilled; coordinated their efforts and had functional, multidisciplinary task forces and engaged communities. The recent 2009 recommendations are the first to support antiretroviral (ARV) use by mothers or children during breastfeeding. Besides promoting maternal health and providing protection against HIV infection in children, the new Rapid Advice has the potential to resolve the difficulties and confusion experienced by health workers in Malawi.Conclusions: The process of integrating new evidence into institutionalised actions takes time. The challenge of keeping programmes, and especially health workers, up-to-standard is a dynamic process. Effective programmes require more than basic resources. Along with up-to-date information, health workers need contextualized, easy-to-follow guidelines in order to effectively provide services. They also require supportive supervision during the processes of change. Policy-makers should ensure that consensus is carefully considered and that comprehensive perspectives are incorporated when adapting the global guidelines. © 2010 Chinkonde et al; licensee BioMed Central Ltd.

Kamudoni P.,University of Oslo | Maleta K.,University of Malawi | Shi Z.,University of Oslo | Shi Z.,U.S. Center for Disease Control and Prevention | And 3 more authors.
Acta Paediatrica, International Journal of Paediatrics | Year: 2010

Aim: To investigate mothers' perceptions of breastfeeding and influences from their social network. Methods: A cross-sectional survey was carried out in Mangochi district, Malawi where questionnaire data from 157 rural and 192 semi-urban mother-infant pairs were obtained. Results: The proportion of mothers who thought that exclusive breastfeeding should last for 6 months and those who reported to have actually exclusively breastfed were 40.1% and 7.5% respectively. Of those who reported practising exclusive breastfeeding for 6 months, 77.5% stated that exclusive breastfeeding should last for 6 months. This opinion was independently associated with giving birth in a Baby-Friendly facility, OR = 5.22; 95% CI (1.92-14.16). Among the mothers who thought that exclusive breastfeeding should last for less than 6 months, 43.9% reported having been influenced in their opinion by health workers. Infant crying was the most common (62.4%) reason for stopping exclusive breastfeeding. Conclusion: The findings illustrate the positive impact health workers can have, as well as the need to raise awareness of the benefits of exclusive breastfeeding among both health workers and mothers. Furthermore, continued counselling of mothers on how to deal with stressful infant behaviour such as crying may assist to prolong exclusive breastfeeding. © 2009 Foundation Acta Pædiatrica.

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