KIGALI, 3 November 2008 (PlusNews) - While neighbouring countries struggle to get pregnant women to visit antenatal centres, women in Rwanda seem to be flocking to them.

Rwanda manages to reach 72 percent of pregnant women with HIV testing and counselling and other prevention of mother-to-child services (PMTCT), but fewer than 20 percent of Burundi’s health centres offer PMTCT services, while Kenya is reaching half its pregnant women.

In Uganda, 70 percent of women still give birth in their homes, assisted by non-medically trained traditional birth attendants (TBAs), compared to 40 percent in neighbouring Rwanda.

Between 1999, when the first PMTCT site was opened, and 2001, just over 11,000 Rwandan women were tested for HIV; by 2006 the number had grown to well over 200,000 annually.
Rwanda’s HIV prevalence rate is about three percent, but in urban areas it can be as high as seven percent. Experts have attributed the country’s success in combating HIV/AIDS to an energetic campaign to reduce the number of paediatric infections; the government is hoping to more than halve the number of babies born with HIV by 2012.

"PMTCT services are now based at all three healthcare levels: the national referral hospitals, district hospitals and health centres,” said Dr Martha Mukaminega, associate technical director of the Elizabeth Glaser Paediatric AIDS Foundation (EGPAF), which has supported the government in providing PMTCT services to more than 100,000 women over the past seven years.

"The focus on eradicating paediatric HIV means that we have had to focus on prevention among adults, so that we reduce the probability of infant infection,” she said.

"We have also boosted the number of people on ART [antiretroviral therapy], because if people are on ART they are less likely to transmit the virus to sexual partners, and pregnant women to transmit it their unborn children ... almost all areas of the HIV response affect paediatric HIV.

Health centres are using routine opt-out HIV testing for all pregnant women, which offers the women the choice of being tested or not, and are actively encouraging men to accompany their wives on antenatal visits.

The country has also involved traditional birth attendants in their PMTCT campaign. At Nzige health centre, about 50km outside the Rwandan capital, Kigali, traditional birth attendants are taught to encourage women to visit the centre.
"Each village in our catchment area has two TBAs trained as community health workers; they accompany expectant mothers to the health centre for delivery, rather than helping them to deliver at home,” said Gaspard Maburanturo, who manages the Nzige centre.

EGPAF and the government give the TBAs allowances to facilitate their work and ensure that they do not lose income because more women are giving birth at health centres.

A growing number of men are also being tested along with their partners. Jean-Claude Gasana and Béata Mukankundiye, both 35, are now expecting their fifth child; this is the first time Mukankundiye has visited a health centre for antenatal care.

"My children have all been born at home, but this time we were told by community workers that we had to come for testing and I had to have the baby at the health centre,” she told IRIN/PlusNews.

Need for more thorough education

However, a staff member at the health centre, who preferred anonymity, noted that the PMTCT programme was being made routine to bring up the numbers, but the population was not being adequately informed of the advantages.

"Many people in the villages only come here because they are told to do so - no one takes the time to explain to them the benefits of the test or of giving birth at the health centre.

Unless people understand the benefits, they will only come under pressure, not because they really understand the point,” he said.

"If you are HIV-positive a health centre delivery can protect your baby from infection, but I don’t know why one needs to deliver here if they are HIV-negative,” Mukankundiye said.

Staff at Nzige said post-natal HIV transmission during breastfeeding posed problems, but the biggest problem was widespread poverty among rural people, many of whom could not afford to eat a healthy diet, which often forced them to abandon their ART regimen.

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