MALNUTRITION, MALARIA and the MYCOBACTERIUM: HIV(mother to child transmission)

Sunday, 17 July 2011

MALNUTRITION: Zimbabwe: Infant Mortality - the Underlying Causes

Published by the government of Zimbabwe : Johnson Siamachira : 7 July 2011 :
Mary Nerwande, a 25 year old woman who has a five month old baby boy from Unit O in Chitungwiza, is a living example of a mother and child health volunteer.
Her child is healthy and despite her economic limitations, she and her unemployed husband have struggled for their child to have the best.
From the start, Nerwande proved her interest with consistent participation in child care and development.
She has always expressed her opinions, at first only among women.
"I am happy to be a mother and child health volunteer to be able to help my neighbours attain better practices for caring and feeding their children."
The mother and child health volunteers are now regarded as a local authority and enjoy the respect and trust of this Chitungwiza community.
Although living positively with HIV, Nerwande is exclusively breastfeeding her child until he is six months old.
"Thereafter, I will continue to breastfeed and introduce complimentary foods in his diet," she says.
"From the workshops I have attended, I was taught that babies of HIV positive mothers taking anti retroviral drugs, are at less risk of infection if they are breastfed exclusively for up to a year.
"Mixing breast milk and formula has been found to be the leading cause of HIV transmission from a mother to her baby," Nerwande says.
She is a strong advocate of the Prevention of Mother to Child Transmission (PMTCT).
Formula contains a bacteria that can irritate the walls of the gut of the child hence the virus finds it easy to get into the system, according to the United Nations Children's Fund (Unicef).
The UN agency says babies that are given mixed feeding are more likely to acquire HIV.
More infections, says Unicef, occur during and after the weaning process as mothers introduce formula and other complimentary feeding.
62-year-old Gogo Gertrude Matsinha is a volunteer community health care giver, also from Unit O in Chitungwiza.
She works with four others in this sprawling high density suburb.
She says: "Breast milk is the healthiest form of feed for babies. Breastfeeding is culturally acceptable in the community. Also, it is a cost-effective way to feed and nourish the baby."
Gogo Matsinha adds: "We found that mothers could have well nourished children if they initiated breastfeeding soon after birth, exclusively breast-fed until six months old and then introduced to nutrient dense foods."
The strategy to influence behaviour in this community has changed the lives of children who had been destined for chronic malnutrition. In the process, it has empowered their mothers.
Dr Angela Mushavi, the National PMTCT and Paediatric HIV Care and Treatment Coordinator in the Ministry of Health and Child Welfare, says: "We encourage every woman to be tested when pregnant and when found to be HIV positive she would be able to receive treatment so that the child is not infected at birth or during breastfeeding."
Over a third of children under the age of five years in Zimbabwe are chronically malnourished and about 15 000 are at risk of dying from this condition annually.
Sub-optimum feeding practices, especially non-exclusive breastfeeding in the first six months of life, results in 1,4 million deaths and 10 percent of disease burden in children younger than five years
According to results of a 2010 National Nutrition Survey in Zimbabwe, chronic malnutrition is high and increasing at 33, 8 percent.
Exclusive breastfeeding has declined from 26 percent to 5,8 percent, according to Ministry of Health and Child Welfare statistics.
"This is unacceptable for Zimbabwe," says the Secretary for Health, Dr Gerald Gwinji.
"Despite the great strides that have been made in promoting, protecting and supporting breastfeeding, we still have challenges to overcome, one of which is the low rate of exclusive breastfeeding."
According to the World Health Organisation (WHO) underweight for children under the age of five years increased from 13 percent in 1999 to 16, 6 percent in 2006 while stunting - worst form of malnutrition rose from 26,5 percent to 29,4 percent during the same period. Wasting the acute form of undernutrition remained stable at 6 percent over the years.
The latter half of the 20th century saw significant reductions in child mortality in lower income countries worldwide, says the World Health Organisation.
Yet more than 10 million children under the age of five years still die every year.
Over 98 percent of all child deaths occur in developing countries 90 percent in 42 countries, according to World Vision, an international humanitarian organisation.
Underlying these direct causes of death is childhood malnutrition, which is associated with more than half of all child deaths.
"Malnutrition reduces a child's resistance to disease. Even mild nutrition weakens the immune system, rendering a child both more vulnerable to infection and less able to fight it," says Siboniso Chigova, of the Ministry of Health and Child Welfare.
In turn, infections contribute to malnutrition by depressing the appetite just when the baby's effort to combat the illness is depleting stored energy and nutrients. Chigova says: "This vicious cycle of malnutrition and infection leads to ever-increasing weakness, and too often, to premature death."
Malnutrition encompasses a broad range of nutritional deficits, and relates both to quantity and quality of food. Often, it is assumed that insufficient quantity of food, leading to inadequate intake of energy (kilojoules/calories) and protein, is the major nutrient problem in Zimbabwe.
Indeed, protein-energy malnutrition is a serious issue, and research has shown that even mildly underweight children are twice as likely to die from infectious diseases, while moderately or severely underweight children have a five-to-eight fold increase in mortality risk.
Yet in recent years it has become clear that micro-nutrient malnutrition, vitamin and mineral deficiencies, contribute substantially to the global burden of illness and mortality.
For example, vitamin A deficiency responsible for 1,5 million child deaths annually, increase the cause of child blindness, a child's risk of death from diarrhoea,measles and malaria by 20-24 percent, while zinc deficiency raises the risk of death from diarrhoea,pneumonia and malaria by 13-21 percent.
"The 1999 national micro-nutrient survey conducted in Zimbabwe by the Ministry of Health and Child Welfare revealed a high prevalence of vitamin A deficiency amongst women and children," says Tendai Gunda,of Helen Keller International.
The survey also showed that 20 percent of the pregnant women, 59 per cent of lactating women and 35 percent of children of 6-71 months old were vitamin A deficient.
Micro-nutrient deficiencies are also linked with functional problems such as morbidity from infectious diseases, compromised child development, reduced intellectual capacity and decreased work productivity.
"Thus widespread micro-nutrient malnutrition has major implications not only for the survival and health of affected individuals, but also for the development potential and economic situation of their communities," said Professor Rose Kambarami,of the Maternal and Child Health Integrated Programme(MCHIP).
"If Millennium Development Goals (MDGs) 4 (reduce chiAgriculture Reporterld mortality) and 5 (improve maternal health) are to be achieved by 2015, success in improving child health indicators in Zimbabwe will be critical," added Professor Kambarami.
But, the country cannot reach the Millennium Development Goal of reducing child mortality by two-thirds of 1990 levels by 2015 without substantively reducing child malnutrition as it significantly hinders progress towards some other MDGs as well
In fact, providing micro-nutrients to populations with widespread deficiencies has been recognised as one of the best investments in development aid.
Combining nutrition interventions with management of common childhood diseases would reduce child deaths even more dramatically, and is an urgent national health priority for Zimbabwe.
http://allafrica.com/stories/201107070468.html

Friday, 1 July 2011

POVERTY: SOUTH AFRICA: Midwife shortage impacts maternal health

DURBAN, 27 June 2011 (IRIN)

Photo: Anthony Kaminju/IRIN
Midwives can improve outcomes for mothers and babies
At Prince Mshiyeni Memorial Hospital (PMMH) in Umlazi, the largest township outside the South African port city of Durban, using midwives to provide maternity services has positively impacted maternal care in the area, but a national shortage of these specialist health personnel has made it difficult to replicate the model elsewhere.
“Midwives are integral to ensuring that we take quality care of our mothers and babies,” Rachel Gumbi, the hospital’s CEO, told IRIN. “The success story of this hospital is because of the teamwork between doctors and midwives.”
The maternity ward at PMMH is one of the busiest in the country, with more than 1,200 deliveries a month, but the staff of 123 midwives and 15 doctors have managed to reduce both infant and maternal mortality rates.
Although 40 percent of the women visiting the hospital’s antenatal clinic are HIV positive, the midwives play a key role in ensuring that 95 percent of those in need of antiretroviral (ARV) medication receive it, and that the rate of mother-to-child transmission of HIV is below 3 percent.
The midwives are involved in every aspect of a pregnant woman's health, from pregnancy screening to post-delivery care and the provision of family planning and pap-smears to detect cervical cancer.
They receive ongoing training through monthly meetings where they discuss difficult cases, and information-sharing sessions that ensure they are up-to-date on the latest policies and protocols. An outreach mentorship programme is also in place for midwives in outlying clinics who may need to refresh their skills.
Such success stories are relatively rare in South Africa. Rather than making progress towards the Millennium Development Goal of reducing maternal mortality by 75 percent by 2015, the number of deaths resulting from pregnancy or childbirth has doubled in the past 20 years.
For every 100,000 babies born, up to 625 mothers die due to childbirth complications. Mortality in children under five has also risen steadily and remains stubbornly high at 104 deaths per 1,000 live births, according to government figures.
Loveday Penn-Kekana, a maternal health researcher at the Centre for Health Policy, University of the Witwatersrand in Johannesburg, believes South Africa’s poor maternal health outcomes are linked to the lack of midwifery services.
“In order for us to address South Africa's maternal health we need to invest in more and better trained midwives,” she said. “Doctors only come into maternity wards from time to time, but it is the midwives who are running the entire service and they are overworked.”
For us to address South Africa's maternal health we need to invest in more and better trained midwives
Midwives are classified as nurses in South Africa so there are no figures on their numbers, but it is clear that there are too few. Low enrolment at nursing colleges is part of the problem but many midwives have also left the public sector to work for higher salaries overseas or in managerial positions because of the limited opportunities for career development and advancement in the clinical area.

No more home deliveries
Although pregnant women in South Africa are entitled to free healthcare, Penn-Kekana noted that some face difficulties accessing services because they lack money for transport. The Department of Health has initiated the use of maternal ambulances to transport pregnant mothers to health facilities but challenges remain in rural areas where there are no roads.
“I have no job and it is expensive for me to get to the hospital,” said a woman at PMMH who was expecting her seventh child. “I am happy with the service, but it is sometimes very difficult for me to get to my appointments here… because I have no money.”
In the past, midwives helped women give birth at home, but there are no longer enough of them for this to be possible. “It makes more sense for the few trained midwives to be stationed at facilities so that they can see more women than for them to be scattered across areas,” said Meisie Lerutla, National Programme Officer for Sexual and Reproductive Rights at the United Nations Population Fund in South Africa.
Deliwe Nyathikazi, President of the Society of Midwives of South Africa, noted: "The biggest challenges for us as midwives in South Africa is that there are not enough of us to provide the best care possible. Because people are first trained as a nurse and then given midwifery skills, midwifery is not prioritized.”
A plan by South Africa’s Health Minister, Dr Aaron Motsoaledi, to reopen unused nursing colleges across the country and increase the number of nurses should also result in more midwives being trained.
Lerutla pointed out that “Once we have increased the number of midwives in South Africa dramatically, the practice of midwife-assisted births at home for women in remote areas can be revisited.”