Acceptability of the Revised Child Health Card by Health Workers and Clients in Mozambique: Continuu

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Acceptability of the Revised Child Health Card by
Health Workers and Clients in Mozambique
Continuum of Care for HIV exposed children B.
da Silva1, E. Karajeanes2, N. Fernandes3, F.
Amod1, E. Mbalane2, D. Trovoada4, F. Mbofana5
Ministry of Health, Mozambique1 Elizabeth
Glaser Pediatric AIDS Foundation, Mozambique2
FORTE Saúde, Mozambique3 World Health
Organization, Mozambique4 National Institute of
Health, Mozambique5
In 2007, the Ministry of Health of Mozambique
reported 151,431 pregnant women with HIV
identified at health facilities 29.7 of them
received antiretroviral (ARV) prophylaxis and
only 14 of HIV-exposed children were tested at
18 months. Follow up of HIV exposed and
identifying HIV-positive children as early as
possible is critical to improve care and access
to ARV treatment. The Ministry of Health, in
collaboration with EGPAF and other partners,
assessed the acceptability of including HIV
specific information on the MOH child health card.
A cross-sectional study was implemented in
December 2008 in six health facilities in three
provinces, using interviews and focus group
discussions. The study surveyed 63 health
workers including 30 MCH nurses and 270 mothers
attending MCH clinic services of which 49 (18)
were HIV-positive. Focus groups discussions were
done with 27 volunteers and 11 community leaders.
Data were entered in EPIdata and analyzed using
SPSS. Qualitative data were reviewed for key
themes manually.
More than 90 of the health workers and 87 of
mothers considered it important to include
information regarding the provision of ARV
prophylaxis, cotrimoxazole prophylaxis, HIV
testing and antiretroviral treatment for
children. Only 27 of health workers and 10 of
mothers responded that they think these additions
to the health card will not be accepted by the
community, mostly because of stigma and
discrimination. No difference in responses was
seen between HIV-positive and negative
mothers All health workers, volunteers and
community leaders thought that the changes would
improve the follow up of HIV-exposed children.

• Changes to the Child Health Card
• Recording of exposure status of child,
  administration of ARV prophylaxis to mother and
  infant, cotrimoxazole administration, HIV testing
  for child, ART regimen for HIV infected children.
  
• Immunization follow-up and inclusion of HiB
  vaccine
• Information on current infant feeding practice
  and promotion of exclusive breastfeeding until 6
  months of age
• Update of Antropometric parameters and
  introduction of 4th growth curve (P97)
• Registration of anti-parasite treatments
• Registration of neonatal follow up
• Registration of milestones up to the age of 5
  years

Including HIV specific information on child
health cards will likely be accepted by health
staff and communities in Mozambique and will
provide a critical tool to improve the follow-up
HIV-exposed children and contribute to a
continuum of care. The revised Child Health Card
was launched nationally and the impact on
improving the identification of children with HIV
will be evaluated.
EGPAF would like to acknowledge the tireless
efforts of the PMTCT partners in Mozambique whose
work made this poster possible. We would like to
thank the thousands of women and their family
members for facing HIV with courage and being the
champions of our mission. We also thank the host
governments for their partnership and for
allowing the continuation of our PMTCT work. We
acknowledge the contributions of Forte Saúde and
World Health Organization. EGPAF's PMTCT
Program appreciates the generous financial
support of USAID, CDC, Bill and Melinda Gates
Foundation, Johnson Johnson, Boehringer
Ingelheim, Jewelers for Children, the Oprah
Winfrey Foundation and Ronald McDonald House
Charities. This poster was made possible through
support provided by the Office of HIV/AIDS,
Global Bureau Center for Population, Health and
Nutrition, of the United States Agency for
International Development (USAID), through the
Presidents Emergency Plan for AIDS Relief
(PEPFAR), as part of the Elizabeth Glaser
Pediatric AIDS Foundation's International Family
AIDS Initiatives (Call To Action Project/
Cooperative Agreement No. GPH-A-00-02-00011-00).
The opinions expressed herein are those of the
authors and do not necessarily reflect the views
of USAID.