In settings where there is a high prevalence of HIV, preventing mother to child transmission (PMTCT) of HIV programs should be linking to existing maternal, newborn and child health programs, assuming the quality of care is adequate. However, in many developing countries such routine care is not adequate, especially related to newborn health and early postpartum/postnatal care of the mother. Though conventional postnatal care starts between 4-6 weeks after delivery, most maternal and newborn deaths occur within the first 72 hours of delivery, and causes other than HIV and AIDS are generally more common though many can be prevented with appropriate care.
This presentation looked at integrating postnatal care and PMTCT within Swaziland where HIV prevalence is very high: 26% in women of reproductive age (DHS 2006) and 39% in antenatal clinics (MoH PMTCT survey 2006). At the time there was poor follow-up for HIV care and treatment after delivery and not enough focus on maternal and newborn care, especially in the early post delivery period. In response to these indicators, the Ministry of Health expressed an interest in changing the postnatal care guidelines to ensure early coverage for a mother and her child.
Previous PMTCT programs have tended to be vertical, and while they have linked with MNCH ones, they have not considered or contributed to their quality. In Swaziland, an emphasis was made so that both mother and child care could be assessed and managed together.
Findings reveal that the first week, especially the first three days, should be covered as a priority in the most feasible and effective manner at both the facility and community levels with proper links between the two. PMTCT programs can safeguard their investment by ensuring that mothers and babies receive quality routine and HIV care, treatment, prevention and counseling AND avoid getting ill and dying of other more common causes of death. This integration of services also increases the platform for PMTCT and prevention of HIV/AIDS.
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By Indira Narayanan, Maternal, Newborn and Child Heal Consultant
Goldy Mazia, Newborn Health Technical Officer