Scaling-Up Exclusive Breastfeeding Support Programmes The Example of KwaZulu-Natal 英文参考文献.docVIP

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Scaling-Up Exclusive Breastfeeding Support Programmes The Example of KwaZulu-Natal 英文参考文献.doc

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Scaling-Up Exclusive Breastfeeding Support Programmes The Example of KwaZulu-Natal 英文参考文献

Scaling-UpExclusiveBreastfeedingSupport Programmes:TheExampleofKwaZulu-Natal ChrisDesmond1,RuthM.Bland2,3*,GerardBoyce1,HoosenM.Coovadia4,AnnaCoutsoudis5 ,Nigel Rollins5,Marie-LouiseNewell2,6 1Human Sciences Research Council, Durban, South Africa, 2Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa, 3DivisionofDevelopmentalMedicine,GlasgowUniversity,Glasgow,UnitedKingdom,4CentreforHIV/AIDSNetworking,UniversityofKwaZulu-Natal,Somkhele,South Africa,5DepartmentofPaediatricsandChildHealth,UniversityofKwaZulu-Natal,Somkhele,SouthAfrica,6CentreforPaediatricEpidemiologyandBiostatistics,Institute ofChildHealth,UniversityCollege,London,UnitedKingdom Abstract Background:Exclusivebreastfeeding(EBF)forsixmonthsisthemainstayofglobalchildhealthandthepreferredfeeding option for HIV-infected mothers for whom replacement feeding is inappropriate. Promotion of community-level EBF requireseffectivepersonnelandmanagementtoensurequalitycounsellingandsupportforwomen.Wepresentacosting andcosteffectivenessanalysisofasuccessfulinterventiontopromoteEBFinhighHIVprevalenceareainSouthAfrica,and implicationsforscale-upintheprovinceofKwaZulu-Natal. MethodsandFindings:Thecostingoftheinterventionasimplementedwascalculated,inadditiontothemodellingofthe costs and outcomes associated with running the intervention at provincial level under three different scenarios: full intervention (per protocol), simplified version (half the number of visits compared to the full intervention; more clinic comparedtohomevisits)andbasicversion(onethirdthenumberofvisitscomparedtothefullintervention;allclinicand nohomevisits).ImplementationofthefullscenariocostsR95million($14million)perannum;thesimplifiedversionR47 million($7million)andthebasicversionR4million($2million).Althoughthecostofthebasicscenarioislessthanone tenthofthecostofthesimplifiedscenario,modelledeffectivenessofthefullandsimplifiedversionssuggesttheywouldbe 10timesmoreeffectivecomparedtothebasicintervent