Uganda: an HIV-clouded pregnancy – and yet, a smile
Margret Achieng is HIV-positive and about to deliver. But, thanks to a new programme put in place with the support of the ICRC, her baby should not be infected. Iolanda Jaquemet reports from Northern Uganda.
On the threshold of a nearby hut, her mother-in-law is cooking cassava, while a couple of ducks waddle along. Margret's daughter, Grace Apio*, who is four, runs happily around the hut.Margret has grown up here, in the sprawling Bibia camp for internally displaced people, just 7 km from the Sudanese border. At the height of the conflict between the Lord's Resistance Army and the Ugandan government, the health centre had even closed its doors. Nonetheless, this is the place where the surviving members of Margret's family took refuge after her father, uncle and aunt had been killed. Margret was so young at the time that, she says, " I have nothing to compare my present life to. I do not remember anything else than the camp. "
A clean razor blade, cotton, disinfectant, a nice cloth to wrap around the mother after delivery, a plastic sheet to protect the bed and, most important, a high quality towel: these are the contents of the "mama kits" the ICRC is distributing to the health centres it supports. "The objective is to ensure a safe and hygienic delivery," explains the ICRC's Florence Aneko Ogwang. The clean razor blade for cutting the umbilical cord is critical in this respect: at home, the cord is often cut with a dirty knife or razor, increasing the risk of post-natal infection.
But what mothers like most are the thick towels and the bars of soap. "A bar like this costs 2,500 Ugandans shillings – 1.60 USD –, an amount most mothers in this region cannot afford. And it allows to wash the baby for two months," says Florence Ogwang. In a country which, with an average of 6.7 children per woman, has one of the highest birth rates worldwide, ensuring safe deliveries is critical.
Even though a majority of women in Northern Uganda still deliver at home, the proportion of births in health centres is slowly increasing. Better facilities, like the maternities the ICRC is building or rehabilitating, are one pull factor. Mama kits are another. At Arum health centre, Samson Ocaya, the clinic officer, remembers that "we started very poorly. Little by little though, the number of deliveries has increased and, last month, we had 67. Our midwives don't sleep at night anymore!"
At Arum maternity, Grace Akot is resting on a bed covered with the bright yellow plastic sheet provided by the ICRC, her three-hour old son in her arms. At 24, this is her third baby, "but it is the first time I give birth in a clinic. I know it is safer. And then, it was really nice to get the mama kit."
Simple treatment keeps baby safe from HIV
Late in her pregnancy, she went to the health centre to be examined, vaccinated, and to receive " the mosquito nets they give to expectant mothers, and also to the husbands who agree to come. " She took the HIV test, too, offered on a voluntary basis under a national policy. Upon learning the result, she asked her husband to get tested. He refused.
Her child, though, need not be infected, thanks to a rela tively simple treatment. " These mothers have to take niverapine a few hours before delivery, to avoid transmitting the virus to their new-born baby, " explains Florence Aneko Ogwang, who is in charge of reproductive health at the ICRC in Gulu. " And the baby must receive niverapine syrup within 72 hours of birth " .
Medical staff are " fighting " , in many midwives'words, to convince as many women as possible, whatever their HIV status, to come and deliver in the health centres. Should that not be possible – because of labour at night when people do not dare travel around, or for any other reason – HIV-positive mothers are given a supply of niverapine to keep at home, and explained why they should absolutely bring the baby to the clinic before the 72 hours have elapsed.
There is an additional hitch. In theory, infected mothers should not breastfeed, because their milk can carry the virus. But, explains Florence Ogwang, " given the level of poverty in this area, there are hardly any other options. " And the risk of deadly diarrhoea, through the use of contaminated water for baby formula, is actually higher than the risk of transmitting the virus through the maternal milk.
Balancing the risks
On balance, " we counsel women to breastfeed for 4 months, then switch completely to solid foods, " adds Florence Ogwang. There should not be mixed feeding: in case of diarrhoea induced by solid foods, the inflammation in the intestines makes transmission of the HIV virus contained in the mother's milk easier.
The test and treatment – called Prevention of mother to child transmission, or PMTCT – has recently been introduced to three of the 14 health centres the ICRC supports in Northern Uganda, and two more should join soon.
Margret Achieng expects to give birth " any time now. I was told I should deliver at the health centre, and I will make sure I do. " How does she feel now? " Not as sad as I was in the beginning, because the nurse explained to me that I will get this medicine before and after the delivery, and my child will be HIV-negative. " Does she hope for a boy, after Grace Apio? A soft smile comes to her pretty face: " I will take what God gives me. "
* Not their real names