By Francis Lwanga
An increasing number of children born to HIV+ mothers are born HIV-free. This is possible because of an intervention known as virtual elimination of Mother to Child Transmission of HIV (eMTCT).
In this intervention, HIV positive expectant mothers are given Antiretroviral drugs (ARVs) during pregnancy.
The newly born babies are also given a dose of ARVs. These two strategies are helping the babies survive HIV infection. However, as these children escape the virus, they are confronted by another silent killer, malnutrition.
In most cases, these children are born too small because their mothers’ nutritional status was poor before and during pregnancy. The mothers’ HIV and nutritional status is not poor by choice but because of overriding poverty and limited opportunities available to them.
The HIV infections together with the ARVs they take on a daily basis have serious implications on the nutritional status of these mothers. The desire to have an HIV-free child, commits them to take daily ARVs which require good nutrition for the body to cope.
Furthermore, pregnancy itself causes stress that also impacts on the nutritional status of mothers.
Malnourished and stressed pregnant mothers usually enter into labour when they are too weak, with low blood levels, a condition that can lead even to their death. Death of a mother further complicates the life of a baby, most of whom also die within a few days or months.
For the mothers who survive child birth, they come out too weak to provide for the nutritional needs of their children. The resultant effects is succumbing to malnutrition related complications or even death.
The big question is why do the children who survive being infected by the deadly virus end up dying of poor nutrition in a country with plenty of food? The answers remain a puzzle.
The fact is that, in Uganda, maternal and child nutrition remains a serious concern not only among HIV infected mothers and their children but generally, among the entire community. As a country, we have not put to good use the nutrition data we collect.
According to the Uganda demographic and Health surveys of 2006 and 2011, 38%, 6% and 16% of Uganda’s children were stunted (a child whose weight is too short for his/her weight), underweight (a child whose weight is below what is expected of his/her age) and wasted (too thin) in 2006 as compared to 33%, 5% and 14% in 2011 respectively. This constitutes to 1%, 0.2% and 0.4% reduction of stunting, underweight and wasting respectively per year. Is this an achievement worthy cerebrating? Have we taken time to analyse who of these are born to HIV positive mothers?
The other problem that is contributing to child deaths is poor breastfeeding practices. Currently, only 62% of Uganda’s mothers exclusively breastfeed (giving only breast milk to a child up to a time the he/she is aged 6 months) their children as compared to 60% recorded in 2006; a minimal increase of only 2% .
According to the World Health Organisation, exclusive breastfeeding plays a big role in reducing child deaths. Inadequate exclusive breastfeeding is responsible for 45% of the early infant deaths, 30% of diarrhoeal deaths and 18% of abrupt respiratory tract deaths that occur among children aged under five years.
According to the above facts, close to 40% of Uganda’s mothers do not exclusively breastfeed their children. Could it be that majority of these mothers are those who are HIV positive? Yes, some HIV positive mothers still have a thinking that breastfeeding would result in infecting their children with the virus. This thinking, however, should be excommunicated from the public.
The World Health Organisation currently recommends that every pregnant mother who tests HIV positive is started on ARVs for life. This strategy aims at preventing early progress of the virus, thus promoting the healthy well-being of the mother at the same time preventing the mother-to-child transmission of HIV.
Mothers who are on treatment have very limited chances of transmitting the virus to their babies. It is, therefore, advised that, mothers who are on treatment exclusively breastfeed their babies up to six months and there after gradually but progressively add soft nutritious locally available foods (complementary foods).
My call is let us encourage all pregnant mothers to go to the health facilities and attend antenatal care. To fellow health workers, handle with care these pregnant mothers and screen them for poor nutrition as well as providing nutrition assessment, counseling and support.
How then do we help our children born to HIV positive mothers stay free from HIV and at the same time stay alive? Helping them necessitates a collaboration right from the homes, the community to the health facility.
All of us should ensure that; every mother attends antenatal care and takes and HIV test. Those who test HIV positive ought to be enrolled on eMTCT and upon delivery, mothers should be supported to breastfeed exclusively from 0-6 months, give complementary foods from six months and continue breastfeeding up to one year, if the baby is proved to be HIV negative.
For those who are tested and are HIV positive, breastfeeding should be continued up to two years and beyond.
The writer is a Makerere University School of Public Health-CDC Fellow attached to TASO-Uganda