Victoria was 14 when she died. Her mother fled her bedside at the hospital, shrieking as she ran into the night.
Victoria was the oldest of six children, and the latest of them to be killed by a scourge that is depriving Africa of its people.
Her father was dealt a double blow that night when his wife took a fatal dose of pesticide. Three months later, he too was dead, of tuberculosis.
Victoria was hospitalised with a fever at the Queen Elizabeth Central hospital in Blantyre, Malawi. When she arrived it was clear that she was unwell. She was thin and had malaria, which did not respond to treatment.
Her condition worsened and three days later she had convulsions and was tested for meningitis. Two days after she was diagnosed with fungal meningitis she died.
Professor Robin Broadhead, dean of the Malawi College of Medicine, specialises in children infected with HIV/Aids, and Victoria was one of his patients.
The avenue of research that he is currently pursuing is the prevention of mother-to-child infections, a task hampered by the fact that most Malawian mothers breastfeed — there simply is no alternative.
Infants infected with HIV at birth or shortly thereafter (for example through breastfeeding) have an 89% chance of dying before their third birthday, says Broadhead.
According to his research, breastfed infants have a 13% risk of contracting the virus from their HIV-positive mothers.
But bottle-feeding is only an option for the middle to upper classes of the economic structure.
Most Malawian mothers cannot afford to bottle-feed, he says. Safe water is scarce and water must be boiled before it can be used. This means using charcoal, a precious and expensive resource in a country where many are dying from malnutrition.
Because powdered milk is so costly, most mothers tend to use much less than they should, a shortcut that is more expensive in the end as 90% of infants fed artificially die.
Breastfeeding is the best method of giving children vitamins and antibodies to protect them from illness, Broadhead says.
Infants are not only susceptible to the disease through breastfeeding. Of the approximate 32% transmission risk they run, 10% are at risk while still in the womb and another 13% are at risk at the time of delivery.
The Queen Elizabeth Central hospital offers prospective mothers a chance to join a voluntary counselling and testing programme to determine if they are HIV-positive.
If they are, they receive nevirapine (a preventative drug) at the time of labour and the baby receives it within 72 hours of birth. This reduces the risk of transmission by 40%, Broadhead says.
Broadhead recommends that the preventative drug be taken and after that, the mother should breastfeed exclusively for the first four months. The reasons for this are twofold.
Infants benefit much more from vitamins contained in mother’s milk during the first four months after birth and there is no difference in either the benefits or the transmission of HIV if mothers were to breastfeed and bottle-feed simultaneously, he says.
Opportunistic illnesses such as malaria and pneumonia add to a weak immune system, making it difficult for infants to fight off infections, he says.
”Aids develops sooner in African countries as people’s immunities are suppressed. Malaria and other infections raise the viral load as much as seven times.”
A novel approach to feeding malnourished children has been implemented at the Queen Elizabeth Central hospital. Chiponde is a liquid food type that is a distant cousin of peanut butter, with added milk and sugar.
Chiponde, meaning plump nut in the native language of Chichewa, has resulted in 63% of children admitted to the hospital’s feeding programme going home at 85% of the weight that they should be at, according to their height.
This figure is up from only 45% of children reaching their goal weight during an average two-week stay.
Hospital statistics show that since the use of this food was started last year, fewer children have died in the ward from malnutrition and related illnesses.
Each year the hospital admits 1 500 severely malnourished children. This figure is at its peak during the rainy season from January to April. Before the new, tastier chiponde was implemented, the hospital had a mortality rate of 30% a year, which has been reduced to 12%.
According to hospital statistics, between 35% and 40% of the children in the ward at any given time will be HIV-positive.
Information released by the Malawian government at the announcement of its national HIV/Aids policy on Tuesday last week collaborates this.
”In the health sector, HIV/Aids patients occupy more than half of medical ward beds,” says the policy document.
The Malawian government will begin rolling out anti-retroviral treatment in June.
The trip to Malawi was courtesy of the Commonwealth Press Union, who sponsored a reporting course on HIV/Aids.