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Rapid scale-up of PMTCT programme increases the chances of survival for children born to mothers living with HIV

© UNICEF Mozambique/ Emidio Machiana
Mariana (right) and her newborn son Carlos under a mosquito net at Malahice Health Centre. They are assisted by nurse Maria Dulce (left).

CHIBUTO DISTRICT, Gaza Province (Mozambique), 2008 – Until about two years ago, there was very little hope for babies born to mothers living with HIV in the town of Malahice. Lack of adequate maternal and neonatal health services in this remote rural area meant that many children died needlessly within their first months of life.

“I lost my first child a few days after he was born, and my second child died three months after the birth,” says Mariana, as she gently strikes her newborn’s forehead in the maternity ward at the Malahice Health Centre. It is just a day since Carlos – her third child – came into the world.

Wrapped in the soft folds of a blanket, Carlos is sleeping intently at his mother’s side, oblivious to the bright sunlight shining through the large windows in the room.

“This is why I agreed to take the HIV test,” says Mariana, smiling at her son with a hopeful look. “Now I’m in the PMTCT programme, and I have been following all the recommendations that the nurses have been giving me to help Carlos from becoming infected. I am hopeful that at least this son will survive.”

Mariana has good reasons to hope for a better future for her newborn son.

As part of a nationwide scaling-up of PMTCT programme, Malahice Health Centre now offers a comprehensive package of services under one roof, helping women and children to receive all the prevention, treatment and care services they need during pregnancy and well beyond.

The introduction, at the end of 2006, of Provider-Initiated Counselling and Testing as part of the ante-natal consultation has meant that pregnant women are routinely offered HIV testing and counselling, which has led to an increase in the number of women who know their HIV status and enrol in the PMTCT programme.

Women who are found to be HIV-positive receive a course of combination therapy for antiretroviral prophylaxis during their pregnancy and during delivery. Their babies are given the medicine as syrup within 24 hours of birth.

© UNICEF Mozambique/Emidio Machiana
Mothers living with HIV and their children receive health care from trained nurses at Malahice Health Centre.

But treatment is only part of the package. PMTCT services also include psycho-social support, family planning and information on nutrition and infant feeding options to reduce the risk of transmission during breastfeeding. Babies born of HIV-positive women are enrolled in a special programme for ‘at risk’ children, which involves closer monitoring of their health status during regular vaccination and growth monitoring activities as well as referral to ART sites if the child’s conditions requires it.

The Ministry of Health’s National policy is to integrate PMTCT services into existing maternal and child health facilities and link them with other health services such as
paediatric treatment programmes, malaria control and nutritional services – an approach that has a positive impact on uptake of PMTCT services.

Marie Dulce, a maternal and child health nurse at the Malahice Health Centre, says she has seen a shift in attitudes among women who come to the clinic.

“Not long ago, few women would agree to take an HIV test or go to follow-up consultations,” says Dulce, who concedes that lack of information and fear still keep some women away.

In response, Health authorities, with support from UNICEF, began outreach activities involving traditional birth attendants and other community leaders to advise women on the importance of taking the HIV test and seeking proper treatment.

Also, Positive Mothers Groups – a support and information-sharing group within PMTCT centres – are available in each health centre offering PMTC services. The groups are open to all pregnant women and mothers with children under the age of 18 who are living with HIV.

Acceptance of HIV testing at ante-natal care consultations and adherence to the PMTCT programme [at the Malahice Health Centre] are now almost a hundred per cent, explains Dulce.

“All 124 women who came to ante-natal consultations in April this year were tested – the 39 women who tested positive for HIV are now enrolled in the PMTCT programme,” says Dulce.

And similar trends can be observed throughout the country. The number of pregnant women receiving counselling and testing in PMTCT services nationwide has increased from 4,600 in 2002 to 360,000 in 2007.

Since UNICEF started to support the Ministry of Health in the nationwide scale-up of PMTCT six years ago, the number of health centres offering PMTCT has increased to 386 by December 2007, up from only eight in 2002.

The Ministry of Health aims to expand PMTCT services in all health facilities with antenatal care and maternity wards. By the end of 2007, about half the health units in the country were offering PMTCT services.

* Not their real names.

 

 
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