Swaziland: A nation cares for its women and children (February 2006)

The Emergency Plan provides technical and financial assistance to the Swazi Ministry of Health and Social Welfare to scale up prevention of mother-to-child transmission (PMTCT) services countrywide.

The King Sobhuza (KSII) Public Health Unit, the busiest maternal and child health primary health facility in Swaziland, has scaled up PMTCT services in order to accord HIV-exposed infants the opportunity to receive antiretroviral (ARV) prophylaxis within 72 hours after birth. Between November 2004 and September 2005, KSII registered 3,269 antenatal clinic first-visit women, counseled 3,606 (including referrals and revisits) for HIV, and tested and gave results to 3,570 clients. Of the 3,570 women who were tested for HIV, 1,602 tested HIV positive and 12% of these women were given packed nevirapine suspension for use to prevent mother-to-child transmission of HIV in the event of an unavoidable home delivery. The provision of nevirapine suspension for home use is essential to PMTCT efforts because approximately 26 percent of women in Swaziland deliver their babies at home.

KSII staff used triple layers of aluminum foil paper to protect the potency of the nevirapine suspension, allowing pregnant women at 36 weeks of gestation to take the medication home and keep it until delivery. To support the provision of take-home nevirapine suspension, counselors gave information about the drug to pregnant women during pre- and post-test counseling sessions, encouraged women to deliver in health facilities, demonstrated administration of nevirapine in case of unavoidable home delivery, and advised clients on appropriate storage of the medication.

A number of mothers who received the take-home doses expressed their appreciation for the program. Additionally, the nevirapine suspension program at KSII, implemented through PEPFAR partner the Elizabeth Glaser Pediatric AIDS Foundation, contributed to increasing the number of HIV-exposed infants receiving ARV prophylaxis at a neighboring maternity unit by over 40 percent and influenced the ongoing review of the Swaziland national PMTCT Guidelines.

The success of counseling and testing for women at KSII is owed to dedicated nurse counselors, trained with support from PEPFAR, who provide PMTCT services in labor wards and in antenatal clinics. Lushaba Mathanda and Sibongile Malaza, two nurses providing PMTCT services at the Mankayane Hospital, felt strongly that the PMTCT training changed their attitudes towards their work. They agreed that mothers developed trust in them because of the one-on-one counseling and the friendliness they extend to the women. Lushaba and Sibongile said that some mothers go back to them after discharge from the hospital to ask them questions about subjects that worry the mothers. With support from PEPFAR, nurses like Lushaba and Sibongile are helping to ensure that children born to HIV-positive mothers remain HIV-free.

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