GLOBAL: PMTCT could be key to cutting child mortality

Fewer child deaths
JOHANNESBURG, 25 May 2010 (PlusNews) - Sub-Saharan Africa is struggling to meet the Millennium Development Goal (MDG) of reducing child mortality but with greater access to prevention of mother-to-child HIV transmission (PMTCT) services, some countries are slowly catching up.

A new study by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in Seattle, US, published on 24 May in the online edition of British medical journal The Lancet, compared mortality in children younger than five from 1970 to 2010 in 187 countries to chart progress towards reaching the goal.

Worldwide child mortality had declined by 52 percent since 1970, but only 31 developing countries were on track to meet the MDG target of reducing under-five mortality by two-thirds by 2015; African countries hit hard by HIV were conspicuously absent from the list.

Sub-Saharan Africa accounted for about half the global figure for child mortality under the age of five, and the region also had the slowest rates of decline in child deaths, which might be partly due to high HIV prevalence levels.

"We can see the effects of HIV in sub-Saharan Africa in the way that the declines in child mortality throughout the [19]70s and '80s stop, and start to reverse in the 1990s. This coincides with the rise of the HIV epidemic there," Dr Christopher Murray, director of the IHME, told IRIN/PlusNews.

According to UNAIDS, sub-Saharan Africa still has most of the world's HIV infections, while a regional prevalence of about 5 percent accounted for almost 70 percent of all new HIV infections in 2008.

The good news

Yet there was compelling evidence that some African countries were making significant strides in reducing child mortality, and the report's authors suggested that this could be explained by improved access to antiretroviral (ARV) drugs and PMTCT services.

"There has been a tremendous scale-up in ARV programmes over the past decade, and an increased emphasis on preventing mother-to-child transmission. We think both of these efforts are starting to show an effect on child mortality, and are helping to drive the child mortality rate lower," Murray noted.

"Since 2005, though, we are starting to see declines [in child mortality] again, including in countries that have been hit very hard by HIV, such as Swaziland, Botswana, and Lesotho."

The study also pointed out that southern African countries with relatively strong ARV and PMTCT programmes had notably lower under-five mortality rates than those in other regions of Africa.

Malawi, which has made substantial gains in ARV and PMTCT services, has been charting yearly declines in child mortality of more than three percent. Today, 45 percent of pregnant, HIV-positive women access PMTCT, up from just three percent five years ago, according to a recent report by the International Treatment Preparedness Coalition, a support group for people living with HIV and AIDS.

''Globally, the trend is clear - child mortality rates are going down faster than anyone anticipated''
Studies like this may point way forward

Dr Ashraf Coovadia, chair of the South African National AIDS Council's treatment and care support task team, and head of paediatric HIV services at the Rahima Moosa Mother and Child Hospital in Johannesburg, told IRIN/PlusNews that the results of improved PMTCT regimens and access were becoming evident.

"We are seeing less [HIV]-infected infants, and those that are infected we are seeing at an earlier stage," said Coovadia. Infants brought to the hospital in later stages of HIV infection tended to come from areas outside Johannesburg, where access to PMTCT services was often still problematic.

The study's authors suggested that comprehensive and accurate studies, such as this one, should be conducted more often because decreased funding levels would make the data they provided crucial to guiding aid and national health priorities.

"We need to spend more time looking in depth at what is working and what isn't working in countries where we have seen substantial progress ... What are the lessons to be learned from these countries?" Murray said.

"Globally, the trend is clear - child mortality rates are going down faster than anyone anticipated," he said. "Now, for governments and non-governmental organizations, the real work begins of identifying the best policies to build on that momentum."

Coovadia agreed, noting that further studies were needed, not only to lobby governments and funders for extended services, but also to understand why not all countries with PMTCT programmes had charted gains, like Malawi.

"We need to know where we're getting bang for our buck, especially when funding is dwindling; we need to take an evidenced-based approach to prioritising [health] interventions," he told IRIN/PlusNews.

"We also need to look at the challenges of why, in places where programmes are in place, we may not be getting the same benefits ... in many cases this is related to [weak] health systems and issues of access."


Theme (s): Care/Treatment - PlusNews, Children, Health & Nutrition, HIV/AIDS (PlusNews), Prevention - PlusNews,

[This report does not necessarily reflect the views of the United Nations]

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