Inter Press Service - June 15, 2009
Ruth Ayisi

"They are so weak. They are eight months old, and they cannot even sit up," she told IPS at a rural clinic in Homoine in Mozambique's southern province of Inhambane.

The other twin is being looked after by Christina's five-year-old son, Daniel. He tries to soothe her as he walks around the health care centre, carrying the baby in a cloth wrapped around his shoulder. He watches her spindly body and hollow eyes.

A couple of hours later, the twins are diagnosed with severe malaria. Their treatment will be complicated, the nurse says, because they also suffer from anaemia and, like their mother, the twins have just tested HIV-positive.

Daniel, who looks stunted for his age, probably due to chronic malnutrition, has skipped school for a few days to help care for his sisters.

They have trekked two hours on foot to the health centre, where they will have to spend a few days while the twins receive quinine intravenously to treat the malaria.

Christina does have reason to be scared. Mozambique has one of the world's highest infant mortality rates, with more than ten percent of babies not reaching the age of one, according to the United Nations Children Fund's 2009 State of the World's Children Report.

The main cause of child death in Mozambique is malaria, closely followed by HIV/AIDS, the report states.

Dr Stella Langa, who works at the Homoine health centre, is optimistic about the twin's survival chances, however, because their health has already slightly improved since they arrived at the clinic this morning.

Although Mozambique will be unlikely to meet the Millennium Development Goal (MDG) of reducing child mortality by one third by 2015, the country has made some strides towards advancing child healthcare, believes Dr Roberto De Bernardi, chief of child health and nutrition at UNICEF Mozambique.

Paedeatric ARVs

One major improvement has been the adoption of the Integrated Management of Childhood Illness approach which takes into consideration child health in a holistic manner, not just the illness the child presents, says De Bernadi.

"This has involved upgrading the skills of health workers, strengthening the health system, improving family and community health practices and treating neo-natal illness and HIV/AIDS".

According to De Bernardi, about 10,000 of Mozambique's HIV-positive children, or 15 percent, receive antiretroviral (ARV) treatment, compared to 500 in 2004. Most children who have access to ARVs live in the country's provincial capitals, and about 6,000 of them in Maputo, the country's main city.

Access to public health facilities remains a problem: about 60 percent of the 19 million Mozambicans live more than 30 minutes away from the nearest clinic. In addition, public health facilities outside of urban areas tend to have limited drug supplies and staff who is overburdened and underskilled.

The number of HIV-positive children on ARVs has increased since the dry blood spot test to detect HIV became available a few years ago. This method can be used to test babies soon after birth; before then, a Mozambican mother would have to wait for her baby to be 18 months old to test for HIV antibodies.

AIDS develops quickly in infants and children and, without treatment, a third of HIV-positive children will die of AIDS before they are one year old, according to the World Health Organisation (WHO).

WHO therefore recommends that all HIV-positive children start ARV treatment immediately, regardless of symptoms or CD4 count, but this will be difficult to achieve in a country like Mozambique where health infrastructure is poor.

Poor infrastructure

Treating children presents not only medical but also psychological challenges, says Alima Momad, a nurse working at Maputo's paediatric AIDS clinic: "Some of the mothers are frightened to get their children tested because they fear discrimination from people who may see them enter the clinic."

Christina's twins will be started on ARV treatment soon. Langa explains to her the importance of providing her children with sufficient food and a nutritious diet to support the treatment. She tells Christina to visit the clinic regularly, even though it is a two-hour walk from her home.

This will be difficult for Christina, who is a 35-year-old single parent and hardly has an income. "I went to Maputo to find work as a domestic worker. I didn't succeed, but I met the father of the twins. He abandoned me when I got pregnant," she explains.

She returned to Homoine to live with her parents and her two sisters. The family grows beans and cassava on their plot of land. As there is no surplus to sell, Christina works on other people's plots to earn money. "But the money is not enough to satisfy our hunger," she says.

She is worried about the health of her children and is unsure how to find a way out of poverty and hunger: "I want to do something for them, but I don't know what."

(*Not her real name.)

*****

+ MOZAMBIQUE: Researchers Ponder Value of Cash Transfers (http://ipsnews.net/africa/nota.asp?idnews=46808)

+ LESOTHO: Cultural Beliefs Threaten Prevention of Mother-Child HIV Transmission (http://www.aegis.org/news/ips/2009/ip090511.html)

+ UNICEF: Child survival in Mozambique (http://www.unicef.org/mozambique/child_survival.html)

090615
IP090607

Always watch for outdated information. This article first appeared in 2009. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2009. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .