The government of Zambia is providing free antiretroviral treatment to patients with HIV, but people living in rural areas still struggle to find care, as the shortfall in skilled health workers hits the countryside hardest.

Preventing mother-to-child transmission of HIV

Services preventing mother-to-child transmission (PMTCT) of HIV are available to just over 60 per cent of women in Zambia, but only 36 per cent of women who start treatment complete it, according to the Ministry of Health. PMTCT demands commitment from a patient: the pregnant woman must first visit a clinic for counselling and testing, and if she is HIV positive she must return for treatment during pregnancy, delivery and afterward. Only when the baby is seven months old will staff be able to tell whether the process has been successful. The long distances that many have to travel to reach clinics offering PMTCT services and the social stigma attached to being HIV positive are significant obstacles to women taking up the service.

At the beginning of 2010, there was little antenatal care available in Luwingu, a rural district of northeastern Zambia. Without antenatal consultations, pregnant women are unlikely to find out whether they have HIV, and those who are HIV positive cannot receive PMTCT services. In June, our mobile teams started working in four rural health centres in Luwingu, providing reproductive health services, antenatal care, emergency obstetric care and PMTCT services. Between June and December, more than 2,650 antenatal consultations were carried out, and 150 women received postnatal care. Staff provided special supplementary food to 52 HIV-positive women, and enrolled 41 women in the PMTCT programme. MSF has been researching two new World Health Organization protocols for PMTCT, testing their feasibility in remote settings and comparing the outcomes. In Luwingu town, we provided training in obstetric surgery to surgeons in the district hospital.

Cholera and measles outbreaks

One of the worst measles outbreaks in the country since 2003 struck the capital Lusaka in April. According to official figures, by the end of December 2010 more than 14,900 measles cases were reported in the city, and there had been 158 deaths. Médecins Sans Frontières staff worked in two hospitals, providing medical care to more than 1,860 patients.

There are often outbreaks of cholera in Lusaka during the rainy season, when houses and latrines flood and water collects in stagnant pools. Cholera is spread through contaminated water or food, and can spread rapidly, particularly if people are living in crowded and unsanitary living conditions. The disease causes watery diarrhoea and vomiting that can lead to severe dehydration and death.

In March, during an outbreak that infected more than 6,000 people, our teams set up three cholera treatment centres with a total capacity of 570 beds, and supported 19 treatment units with staff and materials, caring for around 5,000 patients in total. Water and sanitation specialists worked hard to halt the spread of the outbreak, providing over 500,000 litres of chlorinated water per day in the affected neighbourhoods. More than 100 volunteers conducted outreach activities, teaching people how to prevent cholera from spreading. Médecins Sans Frontières has been responding to cholera outbreaks in Zambia since 2004, and is urging local authorities and international donors to improve the country’s preparedness for cholera outbreaks and prevent the loss of so many lives each year.

Médecins Sans Frontières has worked in Zambia since 1999.