/ 14 June 2007

A looming ‘wave of child mortality’

HIV is the driving force behind South Africa’s high child death rates. 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. The knock-on effects for the future of South Africa’s youth, and therefore the economy, could be dire.

Speaking at the national Aids conference in Durban two weeks ago, Professor Nigel Rollins, head of the department of paediatrics and child health at the University of KwaZulu-Natal, said South Africa is one of nine countries where child mortality is increasing.

Rollins had warned earlier this year that fatigue over prevention of mother-to-child transmission (PMTCT) of HIV had set in and that multitudes of children were getting infected needlessly.

His comments were in response to the Health Department announcing with great fanfare that it would soon have “100% coverage for PMTCT”.

Rollins reported that a study of 2 470 infants (all six weeks old), who attended up to 11 different immunisation clinics around KwaZulu-Natal, revealed that more than 7% were HIV-infected by the time they reached the clinic and that “the story was only going to get worse because more children were going to get infected” through a mix of formula and breastfeeding.

This means that in KwaZulu-Natal the rate of children born to HIV-infected mothers who become infected is 20,8%. In other parts of South Africa it is 7%. It stands at 2% in other parts of the world, said Rollins.

He added that while there might be some centres of relative excellence within the country, the overall picture is 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 antenatal 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 pretty dismal. Between 40% and 80% of women at antenatal clinics accept voluntary counselling and testing, while only between 10% and 60% of HIV-infected women get nevirapine and fewer than half of their babies get tested after birth,” he said, adding that the quality of counselling offered to women is often poor.

Dr Harry Moultrie of the Harriet Shezi Children’s Clinic at Chris Hani-Baragwanath hospital said it is critical for the PMTCT programme to function optimally because the health system will not cope with the rising number of HIV-positive children.

He said one-third of children is dying before they were 12 months old. “We are facing an unstoppable wave of child mortality,” he said.

Given the high mortality rate, Moultrie said it is critical to introduce mandatory HIV testing of all children at their six-week immunisation visit to the clinics.

Dr Tanya Doherty, senior scientist at the Medical Research Council and Health Systems Trust, said there is room for improvement of the PMTCT programme. She said results from the District Health Barometer suggest that the quality of the services currently being provided needs greater attention.

The overall rate of HIV-testing uptake among antenatal clients for the country in 2005/06 was 45,2%, and there had been virtually no improvement since 2004/05. “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, most notably in Botswana, to increase uptake of ante-natal HIV testing dramatically.

The barometer also found that only half of the women who tested HIV-positive were recorded as having received nevirapine. — Health-e News