Background: Pre-lacteal feeding (PLF) is a barrier to optimal breastfeeding and increases the risk of diarrhoea and acute respiratory tract infections in infants.The prevalence and predictors of PLF are not well studied in South Sudan. Understanding the predictors of PLF is crucial in designing interventions to increase exclusive breastfeeding (EBF) rates. Objective: To assess the prevalence and factors associated with PLF in Jubek State, South Sudan. Method: This was a community based cross-sectional study of 810 mothers of children under two years of age in Jubek State, South Sudan. Mothers were interviewed in their homes using a semi-structured questionnaire to collect data on PLF, socio-demographic and birth characteristics. Multivariable analysis was used to identify factors independently associated with PLF. Results: A total of 426/810 (53 %), 95% confidence interval (CI) [48 %, 59 %] mothers had given pre-lacteal feeds to their infants. The commonest pre-lacteal feeds included glucose solution (54%), water (26%), and infant formula (14%). Having received antenatal breastfeeding counselling decreased the odds of PLF [adjusted odds ratio (AOR) 0.60; 95% CI (0.43, 0.82)]; while discarding of colostrum increased the use of pre-lacteal feeds [AOR 1.57; 95% CI (1.17, 2.11)]. Conclusion: The prevalence of PLF in South Sudan is high. Predictors of PLF included lack of breastfeeding counselling and discarding of colostrum. Infant feeding counselling should be given to all pregnant women in the health facilities and communities. The counselling should emphasize the health benefits of colostrum and discourage the practice of discarding it.

Objectives: To examine the prevalence of HIV infection, neuropsychiatric disorders, psychiatric symptoms/signs, alcohol use/misuse, CD4 cell counts and risk factors in adult patients. Design: Cross-sectional study. Setting: Epworth, which is about 15km on the southeastern part of Harare, Zimbabwe. Subjects: Two hundred subjects were included in the study out of which six were excluded beacause of HIV-1 indeterminate results. Materials and Methods: A convenience sample of 200 subjects recruited in a crosssectional study in Epworth, Zimbabwe. Six subjects had indeterminate HIV-I antibody results and were excluded from the study. The remaining 194 subjects of whom 101 (52.1%) knew about their sero-status and were consecutively recruited, whereas, 93 (47.9%) did not know about their sero-status and were recruited by a systematic random sampling method (1-in-3). They were then interviewed about neuropsychiatric disorders using BPRS, MADRS, AUDIT and MINI Mental State Test, including the risk factors related to HIV infection. After ELISA tests' results, the two groups were combined and then categorised into HIV positive (n=115) and HlV negative (n=79) subjects. Main outcome measures: Prevalence, neuropsychiatric disorders, increased CD4 cell counts and risk factors associated with HIV infection.Results: The findings were that the overall point prevalence of the HIV infection was 59.3% (115/194). Comparative analyses between seropositive and seronegative HIV/AIDS subjects showed: over two thirds (71.3%) of the HIV positive subjects suffered from psychiatric disorders, more than those with HIV negative 44.3% (OR= 3.12, 95% Cl= 1.64-5.95, P=0.0002), and subjects aged 35 years and less were mostly HIV seronegatives (n= 77.2%, OR= 2.34, 95% CI= 1.18-4.75, P=0.014). The overall prevalence of alcohol use/misuse was 41(21.1%), with higher prevalence rate among HIV positive subjects, 28 (24.3%) than those who were HIV negative, 13 (16.5%). The commonest psychiatric symptoms/signs (P<0.05) were emotional withdrawal, depressed mood, suspiciousness, apparent sadness, reduced sleep and suicidal thoughts (specially among women). Conclusion: There is very high point prevalence of HIV/AIDS and psychiatric disorders, including a moderate prevalence rate of alcohol use/misuse in this less affluent community that warranted intervention.

Epilepsy is a common cause of psychosocial disability and has been perceived to have a profound impact on the social functioning of individuals with epilepsy. In Zimbabwe a combination of developing world economic priorities (with provision of social and health services for disabled people not a major goal) and culturally mediated perceptions of epilepsy as a non-medical and feared stigma may further disadvantage people with epilepsy (PWE) in this respect. In order to assess both the level of psychosocial functioning of individuals with epilepsy and their own perception of it, three groups of people were sampled: attenders at a specialized epilepsy clinic and members of two community-based support groups. All completed a brief quality-of-life questionnaire with activities of daily living added. Those carers present completed the same questionnaire at the time of sampling. The results indicated that 36 of 38 people with epilepsy sampled, and their carers, did not perceive themselves to have sufficient cognitive impairment to interfere with social functioning, work performance or relationships with other as assessed by a subsection of the WHO SIDAM (objective evaluation of cognitive performance) interview. However, an adapted activities of daily Living Questionnaire (ADLQ) showed that three-quarters of carers (and two-thirds of PWE) felt that functioning was mildly to moderately reduced, particularly in the areas of solving daily problems and speed of thinking. One-quarter of PWE experienced problems with relationships to others, just less than one-fifth of PWE reported more than four areas of reduced functioning. Of special interest was the fact that 25 (66%) reported sexual functioning as not applicable, although only four of these were of an age group which is not sexually active (less than 15 years old). In addition one-third of the central Hospital Group reported difficulties with using public transport, but none of the Community Support Group members, implying that the use of Public transport becomes an issue when it is necessary to travel long distances and that PWE curtail their travel but do not necessarily view this as a restriction. The samples chosen were from groups which, compared with PWE as a whole, are likely to include more disabled individuals, because attenders at a specialized epilepsy clinic and members of support groups self-select for more symptomatic epilepsy and a visibility. Therefore the proportion of PWE perceived to have difficulties with ADL in this project is not representative for PWE as a whole. The implications of our study are firstly that there is a significant need for selected groups of PWE in Zimbabwe to receive attention to psychosocial abilities and secondly that there are certain specific areas such as sexual functioning and the use of transport which deserve special attention. A much more detailed inventory of neuro-psychological tests will be of value to plan treatment strategies for those selected by the crude screening instruments used in this project. An important fut...

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