By: Lloyd M’bwana
The current food crisis prevailing in the country has compounded those defaulting in travelling to health centre where they can get their Antiretroviral Therapy (ART) regiments, resulting in deteriorating health conditions.
This comes amid Malawi Vulnerability Assessment Committee (MVAC) reports that the country is reeling on a food deficit by 27.7 % in 2015 affecting about 3 million people who are said to be starving due to short supply of maize which is a staple food for many families.
Despite government explanation that the nation has enough maize to feed people till April this year with an additional 10,000 metric tons of maize stock procured last month from Zambia, random visit to various Agriculture Development and Marketing Cooperation (Admarc) deports in rural districts of central region including Nathenje
(Lilongwe), Mtakataka (Dedza), Malomo (Ntchisi), Chinkhoma (Kasungu) vindicated fears that hunger was biting hard as starved families such as women were seen in long queues and even spending nights at Admarc selling points in search for maize.
ADMARC deports have had no enough maize which in some areas the maize is sold at night particularly to vendors who later resorting to sell the commodity at an average of MK12, 000 per bag of 50kilogram which average of Malawians are unable to buy, according to Center For Social Concern (CFSC)’s monthly Basic Needs Basket (BNB) of January 2016.
With the latest report from Civil Society Agriculture Network (CISANET), Oxfam and Cadecom which was released February 2016 shows that for five districts sampled including Chitipa, Kasungu, Machinga, Balaka and Mulanje only 30% of their markets were found selling maize while the rest were run out of stock.
Consequently, food shortage is contributing to low uptake of ARV for the people living with HIV where cases of ARV defaulters have increases especially in rural areas as women abandon their homes in search for food.
For instance a 10 months year-old boy from Chisamba village in the Traditional Authority (T.A) Mazengera in the rural Lilongwe was diagnosed with HIV and AIDS pandemic following his mother’s failure to bid by medical subscription of taking ART drugs which reduces HIV viral Load. The mother resorted not taking the medication due to her quest to source food in Mozambique which cost the innocent child born with the pandemic.
The incident was discovered and captured at Malapila health centre which is just 15 kilometers from Kamuzu Central Hospital (KCH) where all referral complicated cases are sent for further medical attention.
The health facility has a catchment area of 26, 981 whereby deliverers 10 babies daily with only six staff members and five beds in the labor ward. Every Thursday, weekly is a clinic day whereas about 40 women and five under-five children receive ARVs services including blood testing, counseling and drugs provisions.
The visit at the clinic on this day (early March, 2016) was welcomed with an appealing face for hope but dejected from a 36 year-old mother of four children-Chifundo Lukas who carried her 10 year old child both of them waiting anxiously to receive the life-prolonging drug, ARV.
When introduced to her the subject matter of the visit at the clinic on their day, she felt betrayed by medical personnel as to why they allowed strangers coming to their way since being seen on ART treatment is a taboo in the area.
However, it had to take the calm intervention from Joana Mwale, the health Centre’s In-charge convincing Lukas that the visit was in a good faith aiming at appreciating how ART services were implemented particularly challenges affecting the scaling up of pediatric ART’s effectiveness over the delays in transportation of blood sample and receiving the test results to KCH laboratory.
Lukas then accepted the chat who explained that she was diagnosed with HIV virus when she was five four months pregnant but she absconded the dosage over her quest searching food for her children in the nearby Mozambique as the husband ran away upon told that she was HIV positive.
She disclosed that her late pregnancy test for HIV/AIDS was due to distance and the time taken for patients in getting results test which could take almost a month.
“I was found with HIV/AIDS in 2014 when I was pregnant for this child I am carrying (as he is fourth one) when I came here at the clinic for pregnancy test. After counseling, the nurse advised me to carry along my husband for the same test. But just immediately he was informed about my status he changed a face as my husband don’t accept result. Consequently, he ran away from us such that it’s almost two years without him.
“I came back to the clinic on the following week then I was introduced to ART treatment. The medication started well but the challenge lied on food availability. Our nearby Admarc deport did not have maize as private vendors maize price was so exorbitant. Consequently, I left for a nearby village in Mozambique which is about 30 kilometers from my village in order to find peace works in maize garden estate owners pay well us well”, narrates Lukas.
Lukas confessed that for four months she was in Mozambique working (in order to have enough money to buy food) she stopped taking ART which in the course of her work the health condition deteriorated which forced her to come back home for medical attention as access to health services in that country are paid for unlike here in Malawi.
“I had three children plus the pregnancy which compelled me to leave them (children) with my mother. I stopped taking ARVs while I was in Mozambique. When my health condition worsened I came back and I resumed the medication.
“After giving birth to this child, six weeks later the boy was tested HIV positive which shocked me but I was counseled as to why the situation was like that. If we had maize in our country definitely this innocent child couldn’t contracted the HIV”, confesses Lukas who just rely on farming as source of income.
The case of an innocent infant living with HIV virus due to his mother’s ART default is one typical tale on how food situation has worsening efforts to scale up ART’s effectiveness in a bid to reduce further spread of HIV and AIDS pandemic.
No wonder, Joana Mwale, Malapira health center’s In charge expressed sadness over recent increase of numbers of children born with HIV despite efforts under way reduce further spread through provision of free ART.
“It’s always advisable to have food after taking any medication especially on these ARVs. But the case is different here even other health centres. As of later, cases of defaulters (mothers) have risen which has cost innocent souls contracting HIV. Currently, we have three cases of this nature despite all efforts through counseling and free provision of ARV.
“Hunger situation has compelled many mothers leaving their homes in search for food while in the course of stopping taking the life prolonging drugs which reduces HIV viral load. Proper intake of the drug the lesser chances of unborn child of contracting the virus. Unfortunately, our health facility isn’t provided with enough supplements food to support patients”, worried Mwale.
Mwale bemoaned also the time is taken to get results for tested dry blood sample of infants and mothers saying it was contributing to high rate defaulters making the effort to reduce the further spread of the pandemic difficult.
“The current process of testing infants for HIV whose dried blood samples are taken and transported by road to KCH, takes 11 days to reach the referral hospital as its not the only our center using the this process. In fact, it takes four weeks to get the return results.
This contravenes the six weeks period when an infant is supposed start receiving lifesaving medicine. The longer the time is taken between test and result, the higher the default rate of the patients”, worried Mwale.
According to UNICEF, Malawi has a national HIV prevalence rate of 10% which is still the highest in the world as about 1 million of the country’s population are living with HIV and 48,000 died from HIV-related illnesses in 2013.
Records shows that an estimated 10, 000 children died from HIV-related illnesses in 2014 and only 49% were on treatment though vertical transmission of the pandemic has decreased significantly, HIV-infection and HIV-related mortality in children remain unacceptable high and improving pediatric uptake of ARV requires early diagnosis of HIV-exposed infants.
Faced with this situation of food crisis which continues biting the nation hard as also contributing factors to ARV default apart from the longtime of getting blood test results among mothers and infants, UNICEF in conjunction with Ministry of Health is exploring a numbers way of scaling up ARV effectiveness including the use of rapid SMS to transmit results from laboratory to the health centers which has been proved to be on track but transportation of paper results remains a challenge.
This is the reason UNICEF has resorted into another simple and technologically modified of cutting time of transporting blood samples using Unmanned Aerial Vehicles (UAVs or drones) which has been received with hope among medical personnel and patients.
Drones have been used in the past for surveillance and assessments of disaster, but this is the first known use of UAVs on the continent for improvement of HIV services. Thus, Malawi is among the first countries to use drones on health services delivery including Switzerland, Guinea, and Haiti.
“The introduction of using drones is the perfect way of dealing with ARV defaulters as its cost effective ways of reducing waiting times for HIV testing of infants. Definitely, once the system is fully operational cases of default will be minimized.
“HIV is still a barrier to development in Malawi, and every year around 10,000 children die of HIV. This innovation is the breakthrough in overcoming transport challenges and associated delays experienced by health workers in remote areas of Malawi.” delighted Mahimbo Mdoe, UNICEF Representative in Malawi.
No wonder the innovation has come as a relief to the Minister of Health Dr. Peter Kumpalume with an assurance that government is committed to support the technology in a bid to prevent mother to child transmission of HIV.
“Malawi has pioneered a number of innovations in the delivery of HIV services including the Option B+ policy which puts mothers on a simple, lifelong treatment regime. We have also pioneered the delivery of results from the central laboratory to the health facilities through text messages. So, the partnership with UNICEF to test UAVs is another innovation and will help in our drive to achieve the country’s goals in HIV prevention and treatment”, optimistic Kumpalume
