In Lesotho, color-coded Mother-Baby Packs save lives
Malume Mohale, UNICEF
MASERU, Lesotho (July 23, 2012) — A two-country delegation from Cameroon and Zambia, led by UNICEF Chief of HIV and AIDS Craig McClure, recently visited Lesotho to learn about the country’s experiences with the Mother-Baby Pack (MBP), a color-coded kit that provides essential medicines and supplies to pregnant women.
The MBP makes it easier for pregnant women who cannot return to a clinic to receive the basic services they need to stay healthy, said Dr. Mpolai Moteetee, the Director General of Health Services in Lesotho. In cases where mothers find they are HIV-positive during antenatal testing, the MBP helps them give birth to HIV-negative children.
Both HIV-positive and HIV-negative pregnant women receive the MBP, which includes essential vitamins and minerals for a healthy pregnancy. Only the packs for HIV-positive women include antiretroviral (ARV) prophylaxis for preventing mother-to-child transmission.
Making sure babies are born healthy
Mampaleng Setente, 24, is pregnant with her first baby. She already has a name for her child: Bohlokoa, which means ‘the most important one’. As she waits for the result of her HIV test—a routine part of antenatal care—Setente speaks about her confidence in the program.
“The greatest fear is being afraid of HIV. I am not afraid because I already know what I have to do to prevent my child from contracting HIV,” she said proudly.
She is eager to get her Mother-Baby Pack, or ‘Mofao’, meaning ‘provisions’, which is the name used in Lesotho. “I know that in that package are medicines that will make sure that I have a healthy, HIV-free baby,” she said.
Factors fuelling pediatric HIV in Lesotho
The Lesotho Demographic Health Survey (LHDS) of 2009 cites mother-to-child transmission of HIV as the second most common mode of HIV transmission after heterosexual sex in the country. The Lesotho Sentinel Survey, 2009, also reveals that an estimated 27.7% of pregnant women attending antenatal care clinics are already infected with HIV.
According to the 2011–2016 Strategic Plan for Elimination of Mother to Child Transmission of HIV and For Pediatric HIV Care and Treatment, challenges such as difficult terrain, coupled with poor access to transportation, prevent many pregnant women from fully utilizing services that prevent HIV.
Home deliveries are also a major public health challenge for the country. According to Sister Mampeshe Selebalo, a public health nurse from the Botha-Bothe District, these infants may be exposed to HIV infection and other complications that contribute to higher rates of neo-natal deaths among children born at home compared to those born in clinical settings.
Reaching all pregnant women
LHDS also found that instead of the four recommended visits during pregnancy, a woman’s first antenatal care visit is often her last. To deal with this, take-home antiretroviral prophylaxis for preventing mother-to-child transmission of HIV was introduced by the country in 2007, according to Maneo Mohai, the head of the Family Health Division at the Ministry of Health. She added, “In the beginning, this Minimum PMTCT Package was targeting only HIV-positive women and was implemented through to 2010.”
But in January 2011, with support from UNICEF and the World Health Organization (WHO), the country launched the Mother-Baby Pack for all pregnant women irrespective of HIV status.
There is now a pack for HIV-negative women containing micronutrients for a healthy pregnancy—MBP1. The second category is for HIV-positive women who do not yet need treatment; it contains prophylaxis to stop HIV transmission to the baby–MBP 2. The third, MBP3, is for HIV-positive women who are already receiving treatment.
“We are seeing more women coming for subsequent visits… [and] reductions in stigma as every woman leaves the clinic carrying her own pack,” said Sister Matau, an antenatal care nurse at Mafeteng Hospital.
She also suggested there has been a reduction in workload because, initially, packaging was done at health center level, whereas the new MBP is packaged by the National Drug Service Organization (NDSO).
Commitment to zero HIV infections among infants
When summarizing the mission visit, McClure commended the Government of Lesotho for its commitment to eliminating new HIV infections and keeping mothers living with HIV alive and well. This, he said, was demonstrated by the fact that the government is funding 70% of ARVs directly from its own budget.
Overall, the mission was impressed by improvements in the delivery of PMTCT services as well as Lesotho’s continuing efforts to optimize and simplify treatment using PMTCT as an entry point.