Submitted by crinadmin on
[BEIRA, 28 July 2008] - In the AIDS unit of the paediatric ward in Beira Central Hospital, Mozambique, four-year-old Jacinto Cruz is glued to the television while he waits his turn to be treated. His mother has brought him to the hospital after a persistent bout of diarrhoea, the most common opportunistic infection among HIV-positive children. The wait to see the doctor stretches to two hours. "It's always like this when we come here; a lot of people need these services, but we value life, so we wait as long as is necessary," said Jacinto's mother, Isa de Abreu. Jacinto belongs to a tiny group of children receiving paediatric antiretroviral (ARV) drugs in Sofala Province, where the HIV prevalence rate is 25 per cent among adults, the highest in the region. The national figure stands at 16 per cent. "The number of children receiving antiretrovirals ... is still almost insignificant in the overall health statistics," acknowledged Juvenaldo Amos, coordinator of the HIV/AIDS section in Sofala province's health department. According to provincial data, more than 15,000 children are living with HIV, but only 2,000 of them – 13 percent - are being treated, an extremely low percentage compared to HIV-positive adults: more than half the women who need treatment, and 42 per cent of the men, are receiving it. Reluctant mothers, children without treatment Approximately half the children on treatment in Sofala live in the provincial capital, Beira, but in some districts there are no children receiving medication. Despite efforts to extend antiretroviral therapy to all districts, most of the children who need it do not show up for treatment. Perhaps even more frustrating to doctors is the number of HIV-positive pregnant mothers seen in antenatal checkups in health facilities who later fail to return with their children for follow-up evaluation and treatment. "Their mothers, fearful of the discrimination associated with HIV, are still reluctant to have their children tested for HIV or treated for AIDS," noted Amos. Few doctors, hard pills to swallow The shortage of medical personnel is another obstacle to treating children: of the province's twelve districts, only seven have doctors; the other five receive fortnightly visits from a doctor in Beira, who attends to everyone, including HIV-positive children. "Paediatric treatment requires regular medical observation of the child, which becomes a challenge," said Amos. Treating children is complicated: fixed-dose combination treatments in dosages appropriate for them are not available, and physicians must often portion out a cocktail of three separate adult-dose medicines as the child grows. To determine correct paediatric doses effectively, doctors should ideally use the three drugs according to the surface area of the child. Health facilities are forced to simplify the process, which means setting dose standards - including combinations of syrups and crushed or broken pills - by the weight of the child, which can change from month to month or even week to week. There is a risk of HIV-positive children sometimes being overdosed, with increased side effects, but overdosing is generally preferred to underdosing, which can lead to resistance to the medication. On top of this, some medicines are unpalatable, require refrigeration and come in large volumes. Existing paediatric formulas, as well as first- and second-line children's ARVs, are between five and eight times more expensive than adult medicines. Consequently, some community associations have got together to help the children. Community-based solutions Rebeca Massada, 29, an activist with the non-governmental organisation, Kubatana ("united" in the Ndau language), a network of HIV-positive individuals that provides care in patients' homes, began her HIV treatment in 2006 at the health centre in Munhava, a poor neighbourhood on the outskirts of Beira. "For us adults it's simple: we know that we have to take one pill in the morning and another at night," she told IRIN/PlusNews. "But how can children follow such a complicated treatment programme? How are their families supposed to administer treatment regularly and always at the right time?" To verify whether the children have taken the correct dose at the right time, activists like Massada visit the families twice a day, and also teach relatives how to control the dosage of syrups by marking a syringe with a pen. When the child's weight increases, the doctor gives the relative a new syringe indicating the revised dosage. The activists also help with the children's nutrition by teaching parents, for example, how to prepare green vegetables and fish for one-year-old babies. Further information