Maternal and Child Health
Elimination of mother to child transmission

A WHO programme aimed at eliminating all HIV transmissions from mother to child. In January 2008 the South African government announced a new national protocol for the EMTCT programme to replace the 2003 programme.

The new protocol contains the following guidelines:

  1. To ensure that EMTCT programmes successfully prevent HIV transmission from mother-to-child, EMTCT and antenatal services must be available, efficient and accessible; mothers must be able to access antenatal services early and be retained on EMTCT programmes from beginning to end.
  2. HIV treatment and testing:
  • As part of early antenatal service, mothers can receive a routine offering of an HIV test. All pregnant woman attending antenatal care clinics will be given an HIV test on their first visit unless they specifically decline to be tested. Women who test HIV-negative will be offered a follow-up test at 34 weeks of pregnancy. Those who test HIV-positive will be offered a CD4 count and viral load test at the time of their diagnosis and will be invited to join the government’s free EMTCT programme
  • If the mother is positive she will receive dual antiretroviral prophylaxis. All pregnant women enrolled in the EMTCT programme who do not yet qualify for ART will receive a current course of antiretroviral medicine from 14 weeks (amended in 2010 guidelines from 28 weeks) of pregnancy until labour in addition to a single dose of Tenofavir (a different type of antiretroviral medication) during labour. Infants will be given a single dose of Nevirapine after birth and thereafter daily for 6 week. This intervention treatment will only help to further reduce the risk of transmission during pregnancy and delivery; it will not benefit the mother.
  • The provision of routine testing of infants for HIV. This is essential in order to establish the effectiveness of the new EMTCT interventions. Babies will be tested for HIV at six weeks using PCR testing and will also receive an antibody test at 18 months. According to the new Department of Health guidelines (February 2010) all HIV-positive babies under a year will now receive ART.

Infant and young child nutrition

Undernutrition is associated with 35% of the disease burden for children under 5. Infant and young child nutrition is a strategy aimed to address this issue by improving child survival and promoting healthy growth and development through adequate nutrition.

The first two years of a child’s life are particularly important, as optimal nutrition during this period will lead to reduced morbidity and mortality, a reduction in the risk of chronic diseases and overall better development. Optimal breast feeding and complimentary feeding practices are critical and research has showed that as many as 1.5 million lives in children under 5 could be saved a year, just through these practices.

IYCN supports:

  • early initiation of breastfeeding within one hour of birth;
  • exclusive breastfeeding for the first six months of life; and
  • the introduction of nutritionally adequate and safe complementary foods at six months together with continued breastfeeding up to two years and beyond.

Recommendations have been refined to address the needs for infants born to HIV-infected mothers. Antiretroviral drug interventions now allow these children to exclusively breastfeed until six months old and continue breastfeeding until at least 12 months of age with a significantly reduced risk of HIV transmission.

In 2010 Zoë-Life was contracted by UNICEF and the KwaZulu-Natal Provincial Department of health to roll-out the National IYCN guidelines throughout the Province. Zoë-Life developed the training material, M&E systems and tools with graphics to train and mentor 3800 health care practitioners from DoH to implement the guidelines at facility level.

We do this through:

  1. Training and support of pregnant women before their babies are born
  2. Ante natal and post natal classes in Breastfeeding support
  3. Training and support of feeding buddies
  4. Training in WHO guidelines and South African guidelines around Infant and Young child feeding in the context of HIV
  5. Development and provision of resources for women and families around nutrition