December 2016

Better Care for Tiny Infants

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Elise Ngabouloup, the head nurse of the neonatal unit at the Chantal Biya Foundation Mother and Child Center in Youndé, Cameroon, has a close relationship with her patients. Many of the infants arrive weighing two pounds or less and remain with her for as long as two months as they grow healthy. Mothers stay with their babies for this entire period, sleeping in a dormitory integrated into the unit. This hospital is a godsend for low-income families in this sprawling capital city. From incubators to a fully equipped lab, the hospital provides high-quality care for free. Yet, Elise used to feel frustrated that she could not do more to provide HIV services to her patients.

Two years ago, HIV testing, counseling, and treatment at the Mother and Child Health Center was entirely administered by doctors, who were overwhelmed by the volume of patients. With only two physicians on duty at any time, patients and nurses would often wait hours for a physician. If an expectant mother arrived for an antenatal visit, she might leave without getting tested for HIV rather than wait for a doctor.

Today, mothers at the Mother and Child Center receive prompt and professional HIV counseling, diagnosis, and treatment from nurses who have been trained by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF). Through Project DELTA (Delivering Technical Assistance), EGPAF has greatly improved capacity by establishing pediatric training centers in key locations, including within this hospital. A primary focus of trainings is task shifting—delegating responsibilities to primary care staff, such as nurses.

EGPAF trainers provide mentoring and guidance on a day-to-day basis and lead training workshops here for health workers from around the region.

In addition, EGPAF has outfitted a multimedia center and established Internet access throughout the hospital so that all health workers can independently access and annotate medical records—keeping them up-to-date and decreasing the load on clerical staff.

Elise says that the training has transformed her work, drawing her closer to the families that she cares for. Her ability to provide counseling and treatment improves her interaction with parents, who are already understandably anxious. In a typical month, as many as 50 infants may be placed in the neonatal unit, and nearly half of those mothers had not been tested for HIV prior to giving birth.

In her trainings, Elise learned about the World Health Organization’s recommendation to “test and treat” every pregnant woman or new mother and place her on antiretroviral treatment for life if she tests positive. Elise is empowered to immediately begin antiretroviral treatment for any infant born to a mother who is HIV-positive, adding the proper daily dosage to the feeding tube. The amount of medication is determined by the weight of the child.

I used to wait for the doctor to come and sensitize the parents before the testing is done. Now I can do it. Whenever I come across a positive case, I can immediately put the mother and child on treatment.

Elise always includes mothers in the administration of antiretroviral medicine to their babies to reinforce the pattern of continuing treatment at home once the family has left the unit. She feels great satisfaction when mothers like Annie Djanjoe are able to return home with healthy babies.

“Training has not only increased the knowledge of nurses and doctors,” says Elise, “It has improved the quality of care. I am very grateful for the work that EGPAF has done in this hospital.”


Project DELTA (Delivering Technical Assistance) is funded by the U.S. Centers for Disease Control and Prevention (CDC) through the U.S. President’s Emergency Fund for AIDS Relief (PEPFAR).