Malawi

Early infant HIV diagnosis helps save lives in Malawi

© UNICEF video/2008

Mothers with their infants at the Bwaila maternal and child health clinic in Lilongwe, Malawi.

By Shantha Bloemen

LILONGWE, Malawi, 1 December 2008 – With a prick in the heel of her tiny foot, six-week-old Daudi is the having a test to see if she, like her mother, is living with the HIV virus.
 
At Bwaila maternal and child health clinic in downtown Lilongwe, Malawi’s capital city, the nurse carefully collects small samples of blood on a piece of cardboard that will be dried and then sent to a nearby lab for testing.

Across Southern Africa, HIV has had a devastating toll on every aspect of life. In Malawi, for the estimated 30,000 children infected every year, almost half will die before they reach their second birthday.

After being counselled by nurses on the implications of the test, Daudi's mother promises to return in a month to collect her results. In the meantime, she is given an antibiotic to prevent any opportunistic infections.

A dramatic change

Previously in many poor countries like Malawi, the average age at which children begin treatment is between five- and nine-years-old, by which time their immune systems can already be compromised.

With the introduction of a new sophisticated test that screens an infant’s DNA for HIV, this situation is dramatically changing. Instead of waiting till a child is 18-months-old, this new technology means a child can be diagnosed as early as six-weeks and immediately receive life-saving treatment.

“I am very proud that this test now exists in Malawi and that we are saving children’s lives,” said senior laboratory technician, Lloyd Nyangulu, who has been part of the team trained and paid for through Howard University’s technical support project. For him, early infant diagnosis is extremely rewarding work. 

“Eighteen months is a long time for a child to not know their status and by then many children have complications and get sick.” 

Saving children’s lives

UNICEF, along with an array off technical partners including Center for Disease Control, Baylor School of Medicine, and Howard University, have helped the Ministry of Health purchase lab equipment, chemicals and supplies, train nurses and laboratory technicians, and support the private courier services that transport samples from health facilities to labs as well as deliver results.

Since the tests began in 2007, more than 5000 infants have been tested.  It is hoped that with the introduction of a new drug regime for pregnant mothers, the number of children who test positive could drop to two per cent. 

Routine testing

The acceptance of early infant diagnosis is linked in many ways to the success in the last two years of scaling up the prevention of mother-to-child transmission (PMTCT) and identifying more mothers who are in need of treatment.
 
“Previously, with voluntary counselling and testing, the mother would have to volunteer to get tested,” said UNICEF Malawi PMTCT and Paediatric HIV Care Specialist Dr. Kondwani, Ng’oma. “Now, the Government has embarked on routine testing, which has resulted in wide spread acceptance of getting testing as part of a package of services offered at antenatal clinics.”

The  challenge now for the Ministry of Health and its partners is to expand early infant diagnosis testing to link to the country’s prevention of mother to child services already provided at nearly all health facilities. The first priority is to make the services available at all 28 district hospitals and then to roll out to more remote rural areas.