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'Unstoppable wave of child mortality'
HIV is the main driving force behind South Africa's high child death rates and unless there is a concerted effort to put child survival strategies in place the country faces an "unstoppable wave of child mortality”,’ paediatricians have warned.
Speaking at the national AIDS conference in Durban, Professor Nigel Rollins head of the Department of Paediatrics and Child Health at the University of KwaZulu-Natal, said South Africa was one of nine countries where child mortality was increasing.
Rollins had already warned earlier this year that "PMTCT fatigue” had set in and that multitudes of children were getting needlessly infected.
His comments at the time were in response to the health department announcing with great fanfare that it would soon have "100% coverage for Prevention of Mother to Child Transmission of HIV (PMTCT)".
Rollins revealed that a study conducted among 2 470 infants (6 weeks of age) who attended up to 11 different immunization clinics around KwaZulu Natal - over 7 percent of all these infants were already HIV infected by the time they reached the clinic and that "the story was only going to get worse in that more children were going to get infected through mixed breastfeeding".
"This equates to a 20,8% vertical transmission rate (the number of children born to HIV infected mothers who become infected). In other parts of South Africa it is 7% and in other parts of the world it is 2%,” said Rollins.
He added that while there may be some centres of relative excellence within the country, the overall picture was poor. "Transmission of HIV to infants is one area of HIV that genuinely falls within the sphere of influence as more than 90% of HIV infected pregnant women attend ante-natal clinics and could therefore be reached with preventive interventions. Avoiding transmission would be possible with concerted and focused actions,” said Rollins.
'Even at sites where PMTCT is delivered the story is generally pretty dismal. Between 40 and 80 percent of women at ante-natal clinics accept voluntary counseling and testing while only between 10 and 60 percent of HIV infected women get nevirapine and less than half of their babies get tested after birth,” he said.
Rollins said the quality of counseling offered to women was also often poor.
Dr Harry Moultrie of the Harriet Shezi Children&rsquos Clinic at Chris Hani Baragwanath Hospital said it was critical for the PMTCT programme to function optimally as the health system would not cope with the rising number of HIV positive children.
'Unless we cope with basic paediatric care, we are not going to cope with (dispensing) paediatric ARVs,” Moultrie cautioned.
He said one third of children were dying by the time they reached 12 months, "We are facing an unstoppable wave of child mortality,” he said.
Given the high mortality rate, Moultrie said it was critical to introduce mandatory HIV testing of all children at their six week immunisation visit at the clinics.
Dr Tanya Doherty, Senior Scientist at the Medical Research Council and Health Systems Trust said there was room for improvement (of the PMTCT programme).
She said results from the District Health Barometer suggested that greater attention needed to be paid to the quality of the services currently being provided.
The overall rate of HIV testing uptake amongst antenatal clients for the country in 2005/2006 was 45,2% and there has been virtually no improvement since 2004/2005.
"This highlights the need for HIV testing to be integrated as a routine part of antenatal care, specifically with the introduction of a routine offer testing strategy,” said Doherty.
This strategy has been shown in other African countries, most notably Botswana, to dramatically increase uptake of antenatal HIV testing.
The Barometer also found that only half of the women who tested HIV positive were recorded as having received nevirapine. Doherty said this low uptake would significantly impact on programme effectiveness.
The health department statement said at the time that more than 80% of government clinics were currently providing a PMTCT service and the target was to have these services available in all clinics by December 2007.