Progress and challenges
AIDS-related diseases are fast emerging as a major cause of mortality among children in Mozambique. A growing proportion of all child deaths are a result of HIV-related illnesses. In 2010, it is estimated that about 19,000 children under the age of 15 will die as a result of the disease.
The number of children receiving antiretroviral treatment (ART) increased significantly over the past five years, from 500 in 2004 to12,647 children in 2009. This represents 27 per cent of eligible children requiring treatment.
Children have a much quicker rate of progression from HIV infection to AIDS than adults – months in comparison to years for adults. Over 50 per cent of children infected with HIV die before reaching their first birthday.
Impact on child health
Many children with HIV infection do not gain weight or grow normally. Severe malnutrition, especially wasting, is highly associated with HIV, and current mortality rates for severely malnourished patients in most health facilities are high in Mozambique.
Children living with HIV suffer the usual childhood bacterial infections more frequently and more severely than uninfected children. These illnesses can cause seizures, fever, pneumonia, recurrent colds, diarrhea, dehydration and other problems that need urgent medical attention.
Food insecurity and insufficient knowledge of nutrition as well as low coverage of water and sanitation facilities and insufficient knowledge on hygiene practices put the health of HIV infected children further at risk.
In developing countries such as Mozambique, the difficulties in treating children with HIV or AIDS are compounded by the lack of medical facilities and technologies for early diagnosis of HIV, poor healthcare infrastructure and systems and insufficient skilled health staff.
The provision of ARV syrups to infants requires specific skills. In addition, the parents or caregivers are often affected by HIV and AIDS themselves, which reduces their capability to take care of their children.
What is being done
The Ministry of Health is supported by UNICEF and its partners to expand treatment, care and support for children living with HIV across the country.
Over the past few years, the number of sites providing one or more of the elements of care, treatment and nutrition package required by children exposed to and/or infected with HIV has increased significantly.
As of 2008, UNICEF supports 146 of the 215 paediatric treatment sites for children living with HIV. The treatment sites are integrated into health facilities to ensure that children can receive a package of services including screening, voluntary testing and counselling, treatment for opportunistic diseases, nutritional counseling and support and home-based care.
The Ministry of Health is taking a public health approach to paediatric treatment, promoted through linkages to other child survival interventions such as vitamin A supplementation, immunisation, safe infant and young child feeding practises and insecticide-treated mosquito nets.
HIV prevention and treatment are incorporated into the Integrated Management of Childhood Illness approach, in order to detect and treat children living with HIV at an early stage.
The way forward
Between 2010 and 2011, UNICEF and its partners will continue to support the Ministry of Health in the existing 146 UNICEF supported sites and will support the creation of 10 new sites, bringing the number of UNICEF-supported sites to 170.
The strategy over the next three years is to strengthen the quality of services in existing sites across the country and create stronger linkages with PMTCT services, early infant diagnosis and community activities.
UNICEF will focus on three main areas, ranging from capacity building of health personnel and communities to stronger delivery of services in the districts to community mobilisation.
Strengthening of policies and protocols, and capacity building
Communication and social mobilisation