6.7.10 Renovation of Kamuzu Central Hospital in Lilongwe, Malawi is complete. Read more

The Baylor College of Medicine-Abbott Fund Children's Clinical Centre of Excellence (COE) was officially opened on November 2, 2006 within the grounds of Kamuzu Central Hospital (KCH) in Lilongwe. The COE serves as the outpatient pediatric HIV clinic for KCH and a pediatric referral center for the entire country. It is managed by a foundation registered in Malawi, the Baylor College of Medicine Children's Foundation-Malawi. Its mandate in Malawi as per a Memorandum of Understanding with the Ministry of Health signed in 2005 is to assist with scale-up pediatric HIV services nationally.

The Baylor College of Medicine Children's Foundation-Malawi has a clinical staff which supports a number of government health facilities including the large referral hospitals mentioned above. In addition, we program is actively involved in care and mentorship at about twenty other government HIV clinics as part of the Tingathe/PMTCT, and MPHATSO outreach programs. Other special projects include Teen Club, a Grassroots Soccer initiative, and two large projects at KCH - an emergency care and triage project at the Under 5 clinic and a provider initiated testing and counseling program on the pediatric wards. At the beginning of 2010, staff included 46 full-time staff and 56 project staff on closed contracts.

The principal focus of the Baylor College of Medicine Children's Foundation-Malawi is care and treatment. As of January 2010, the COE had 2,326 active patients, 1,589 of whom are on ART, representing approximately 2,500 monthly patient encounters (excluding voluntary counseling and testing clients). The program also supports a very productive outreach program which yields approximately 800-1,200 monthly patient encounters.

Part of the program mission is to assist the government with national scale-up of pediatric HIV services. The Baylor College of Medicine Children's Foundation-Malawi has become the primary consultant to the Ministry of Health for issues related to pediatric HIV care. Baylor pediatricians are actively involved in a number of Technical Working Groups within the Ministry of Health and have been able to help guide and inform national policy. The program has provided in-depth technical consultation on a number of projects including:

• a national pre-antiretroviral therapy program
• an early infant diagnosis program
• expansion of prevention of mother-to-child HIV transmission programs
• pediatric treatment guidelines
• testing and counseling guidelines
• expansion of provider initiated testing and counseling programs
• development of malnutrition and TB/HIV guidelines

The program also is one of three centers recruiting patients for the Trioped clinical trial. This research will provide the Malawi Ministry of Health with important operational data about real-life efficacy of the first-line ART regimen in Malawi. These high-level activities represent a strong ongoing collaboration with our partners in government and other NGOs.

Malawi Epidemiologic Data

Malawi is one of the poorest countries in the world with a GDP per capita of $290 in 2008. The country has made significant strides in child health in recent years with a reduction in its under-5 mortality rate from 225 in 1990, to 100 in 2008. However, it still lags behind in many important health indicators:

Pneumonia

• 52% under-5's taken to appropriate provider
• 30% received antibiotics

Diarrhea

• 27% under-5's receiving ORS and continued feeding

Malnutrition

• 15% under-5's moderate or severe underweight
• 3% under-5's severe underweight
• 4% under-5's moderate or severe wasting
• 53% under-5's moderate or severe stunting

TB

• Good BCG coverage rate at 1 year of 97%, but very limited diagnostic capacity and treatment options in country

Malaria

• 25% under-5's sleeping under ITN
• 25% under-5's with fever receiving anti-malarials

The most recent estimate of national HIV prevalence was 11.9% from a national survey done at ANC clinics, down from an estimate of 14.1% in 2005. This corresponds to an estimated 930,000 Malawians living with HIV in 2007, 93,000 were children 0-14 years. There were an estimated 550,000 orphans aged 0-17 years secondary to HIV in 2007. Maternal to child transmission rates are still high, reflecting operational challenges in prevention of mother-to-child HIV transmission (PMTCT) program uptake and implementation. A PEPFAR report from 2008 estimated 67,500 HIV-infected women received some type of PMTCT intervention, but only 5000 of them actually received ARV prophylaxis. The Malawi Ministry of Health estimated over 12,000 new pediatric HIV infections in 2010. This represents a falling pediatric incidence rate, but adult incidence is projected to increase from 70,000 new infections in 2010, to over 12,000 in 2012.