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'Mother-Baby Pack' model helps prevent mother-to-child HIV transmission in Lesotho

One mother's story: Malekena George sees hopeful results

By Roderick Huntress

Here is one is a series of stories on HIV/AIDS and children, presented in tandem with the XVIII International AIDS Conference now under way in Vienna, Austria.

LESOTHO, 19 July 2010 – Malekena George lives in a rural area in the southern African kingdom of Lesotho. Four months ago, she set out on a trip to a distant clinic, determined to protect the health of her unborn child.

VIDEO: In March, UNICEF's Shantha Bloemen reported from Lesotho on Malekena George's efforts to prevent transmission of HIV to her unborn child with the help of a package of pre-measured medicines. Her baby has since been born and so far has tested negative for the virus.


Ms. George travelled for five hours across steep gravel roads and rocky mountain trails. She was eight months pregnant at the time, and had already seen her first baby die.

What she learned on that trip changed not only her own life, but the life of the baby she carried. And only now, long after her return home, are the rewards of her journey becoming clear for them both.

Two lives in danger

At the clinic, Ms. George had her first antenatal examination, including a routine HIV test. The results showed that she was living with the virus. Her own health was at risk – and without intervention, she would transmit HIV to her child during pregnancy, delivery or breastfeeding.

© UNICEF Lesotho/2010
When she was eight months pregnant with her daughter, Malekena George travelled to the Pilot Health Clinic in Lesotho's Berea District for antenatal care and received take-home treatment to prevent mother-to-child HIV transmission.

The news was a shock. But there was also reason for hope, because the clinic offers a treatment that allows mothers living with HIV to protect their babies from the virus.

This medical intervention – prevention of mother-to-child transmission, or PMTCT – uses anti-retroviral drugs and an antibiotic to safeguard the health of both mother and child. But it usually requires a series of visits to a clinic over many months for new drugs and monitoring.

Ms. George lived too far from the clinic to make the long, difficult journey over and over, and she couldn’t afford the cost of repeated visits. Without preventive treatment, however, her baby’s health and survival were in jeopardy.

Overcoming obstacles

The clinic’s health workers used a technique pioneered in their own country to overcome the obstacles Ms. George faced. They bundled pre-measured doses of PMTCT drugs together in a plain paper bag, and gave the young mother instructions in administering them to herself and the baby she was about to bear.

© UNICEF/NYHQ2010-1057/Markisz
UNICEF's Mother-Baby Pack can make HIV-prevention treatment available to mothers and infants who might not otherwise have access to it.

Ms. George gave birth at home after a long and painful delivery. Her circumstances were not unusual; nearly half of pregnant women in Lesotho have their babies at home. Many live in rural areas far from a clinic, and reaching a health care facility in time for delivery is often not an option.

“When I saw my baby for the first time and held her in my arms,” says Ms. George, “I knew immediately that she would be fine. From that moment, I felt at peace.”

Access to treatment

Ms. George named her little girl Mankhube. Her confidence in Mankhube’s good health was borne out when mother and daughter returned to the clinic for the infant’s first HIV test. It showed that so far, she is free of the virus.

This mother and child were fortunate. Sub-Saharan Africa is the region hit hardest by the global HIV/AIDS epidemic, and many of its pregnant women have no access to PMTCT treatment. 

© UNICEF Lesotho/2010
Malekena George and her infant daughter Mankhube at their home at Ha Lejone, in Lesotho's Berea District. Mankhube is now three months old, and her first HIV test was negative.

Lesotho offers services in nearly all of its clinics to prevent mother-to-child HIV transmission. In fact, a majority of the country’s pregnant women living with the virus received treatment from the PMTCT programme last year. But many still do not, often because they, like Ms. George, live too far from a health facility – or because the costs of repeated travel are too great for them to bear.

Access to preventive care

To help these women gain access to preventive care, UNICEF and its partners have developed a product, the ‘Mother-Baby Pack’, which is inspired by the very innovation that benefitted Ms. George and Mankhube: the package of pre-measured PMTCT medicines pioneered by Lesotho’s health workers. The Mother-Baby Pack is a take-home box containing anti-retroviral drugs and antibiotics needed to protect the health of one mother and child.

Today, Ms. George looks back on her difficult trek and marvels at the outcome. “She is my miracle baby,” she says of Mankhube. “I am so happy to have made the trip to the clinic. My first baby died when he was just over a year old, and it was terrible. Now I want to make sure my little girl grows up healthy.”



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