“[It is a basic] human right for every woman to survive pregnancy and childbirth and for their child to survive to reach their 5th birthday,” said Dr. Philippa Musoke, a pediatric infectious diseases specialist from Uganda, at the Wednesday plenary session of the 2011 International AIDS Conference in Rome. Her presentation outlined progress and challenges in meeting the Millennium Development Goals (MDG) related to reducing maternal and child mortality.
Most maternal and child deaths are associated with infectious diseases and the majority of them are preventable, she said, and sub-Saharan Africa and Southeast Asia bear the brunt of these deaths. HIV infection is a major cause of child mortality in sub-Saharan Africa, representing 20 percent of all deaths.
Dr. Musoke detailed the critical components of vertical transmission prevention:
- primary prevention of HIV infection in women,
- prevention of unintended pregnancies,
- prevention of mother-to-child transmission (PMTCT) during pregnancy, delivery and breastfeeding,
- and provision of treatment care and support to mothers and children.
Musoke suggested that the elimination of vertical transmission requires that 90 percent of women need to be reached with services. The majority of vertical transmission occurs from women with a CD4 count less than 350. Currently, according to data presented by Musoke, coverage of PMTCT services varies considerably across Africa, ranging from 99 percent coverage in Botswana to 13 percent coverage in Nigeria. Musoke reminded the audience that maternal antiretroviral therapy (ART) improves health and survival for mother and infant, and that a healthy mother improves child survival and health. Scale-up requires the integration of these services into antenatal care and into routine maternal, neonatal and child health services.
She also called for the integration of pediatric HIV care and treatment into maternal and child health service delivery and into existing adult HIV treatment programs. The percentage of HIV-infected children less than 15 years old who have access to ART is only 38 percent worldwide and only 35 percent in sub-Saharan Africa where most infected children live.
Musoke identified the urgent need to address the unmet need for family planning services as a key intervention for the elimination of pediatric HIV and to improve maternal and child health broadly. For example in Uganda, the unmet need for family planning services is 40 percent and in Rwanda it is 38 percent.
In regard to maternal health and the reduction of maternal mortality envisioned in MDG 5, Musoke identified these key ingredients:
- educate girls,
- economic empowerment of women,
- family planning and child spacing,
- access to skilled birth attendant during delivery (less than 50 percent in sub-Saharan Africa currently),
- and ART for women’s health.