UGANDA: Home births hamper PMTCT programme
KAMPALA, 26 August 2008 (PlusNews) - The number of Ugandan children becoming infected with HIV during pregnancy, childbirth and breastfeeding remains high despite the government's ongoing rollout of services to prevent mother-to-child HIV transmission (PMTCT).
The provision of antiretroviral (ARV) drugs to pregnant women living with HIV can reduce transmission of the virus to below two percent, yet 20,000 children in Uganda become infected with HIV annually, accounting for an estimated 42 percent of all new infections in the country, according to government figures.
"The large and growing unmet need for paediatric HIV/AIDS [services] demonstrates the failure of our PMTCT programmes to avert parent-to-child transmission of HIV," said Keith McKenzie, country representative for the UN Children's Fund (UNICEF).
Of 100,000 people currently on ARV treatment in Uganda, only 10,000 are children, the Ministry of Health notes. An additional 40,000 children are thought to be in need of the drugs, but only just over half of Uganda's 310 ARV sites provide paediatric treatment.
The World Health Organisation recommends that every HIV-positive child under one year old should be put on treatment, but Uganda would need to start at least 20,000 children on ARVs every year to meet this target.
"If we prevent HIV infection in children then we do not have to take care of them when they are infected," said Dr Phillipa Musoke, chairperson of the health department's paediatric committee.
PMTCT programmes were first piloted in 2000 in the capital, Kampala, and in the northern districts of Arua and Gulu, but the services are now available at most county-level and district health centres in 76 of the country's 83 districts.
Even in northern Uganda, where conflict has severely affected health services, an estimated 70 percent of women have access to PMTCT services. The ministry of health intends to scale up services to all county-level health centres by 2010.
Although most pregnant HIV-positive women in Uganda now have access to PMTCT services, between 60 percent and 70 percent of pregnant women still give birth at home, making it impossible to administer the ARV drugs that can prevent transmission to the mother and her new infant.
Dr Dennis Tindyebwa, technical director of the Elizabeth Glaser Paediatric AIDS Foundation, noted that 98 percent of pregnant women in Uganda agreed to HIV testing and counselling, but only 67 percent returned for their results; of those who tested HIV-positive, very few came to health facilities to have their babies.
"For some women it is the distance to the health centre, or the poor quality of services and personnel, as well as lack of infrastructure," he said. "But there is also low male involvement in PMTCT, as the men deny their spouses the opportunity to participate in the programme."
Studies have also shown that knowledge of the availability of services and correct infant feeding options after birth was still low. "Many women did not know that giving food or a drink to the breastfeeding baby of an HIV-positive mother was not allowed," said Dr Deogratius Mugisa at the ministry of health in central Uganda's Kayunga district.
"Cultural beliefs, social stigma, ignorance and economic status influenced the mother's attitudes and preference for the different [feeding] alternatives."
Uganda's HIV prevalence declined from over 20 percent in the 1990s to about six percent in 2000, but has recently crept up again slightly. Dr David Apuuli Kihumuro, head of the Uganda AIDS Commission, pointed out that controlling infection levels among adults would mean fewer paediatric infections.
"If the mothers do not get infected, then the children will not," he said. "I am convinced that in this country we can reduce new infections; political will must be re-energised."
"We were born in an AIDS-free generation," he added. "We have a moral obligation to ensure that our children and grandchildren are born, and remain free from, HIV/AIDS."
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See also, UGANDA: Bwenge Kana: "People from the community were asking me why I was not breastfeeding"
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