At Bishoftu Hospital in Ethiopia, a distressed mother arrived with a crying newborn tied to her back. She had traveled many kilometers to seek care at the pediatric clinic for her baby, who was in severe respiratory distress. Before the establishment of the Neonatal Intensive Care Unit (NICU) at Bishoftu Hospital, newborns with emergency conditions like sepsis, respiratory distress, and prematurity would have had to be referred to a hospital in Addis Ababa, 48 kilometers away. Like many in the region, this mother could not afford transportation to the capital. She would be left with little option but to return home with no hope for her baby’s survival.

In July 2012, the first of nine neonatal intensive care units supported by ICAP opened its doors at Bishoftu Hospital. Over the last year, 144 of the 152 newborns admitted to the NICU were successfully treated and discharged home. The new facilities were made possible with support from the President’s Emergency Plan for AIDS Relief (PEPFAR) and are part of ICAP’s work in Ethiopia that is focused on improving pediatric HIV care and treatment programs through expanded basic emergency obstetric and neonatal care programs. Ethiopia struggles with a high child mortality rate—the under-five mortality rate is 77 per 1,000 live births. Outside of urban areas, that number increases. Bishoftu Hospital is serving a catchment population of 1.2 million, including many HIV-positive mothers who travel from remote areas to seek care and treatment for themselves and their children. There is limited local infrastructure for emergency newborn care and when mothers are referred to regional hospitals, continuity of care and communication is easily broken and financial barriers reflect less optimal care. This happens too often and highlights why pediatric strengthening in the ICAP-supported hospital network is vital. The urgent need for expanded service also reflects increasing demand from the community, which has a rapidly growing number of mothers seeking care who may otherwise have had unattended births.

!{filedir_2}ethiopia_neonatal_1.jpg(An ICAP senior PMTCT/MNCH advisor mentors health staff at Bishoftu Hospital’s new neonatal intensive care unit.)!

p=. _An ICAP senior PMTCT/MNCH advisor mentors health staff at Bishoftu Hospital’s new neonatal intensive care unit._

ICAP’s approach to improving pediatric services in Ethiopia is part of an effort to strengthen individual facilities and the health system as a whole. At Bishoftu Hospital, this has included the establishment of the NICU, renovation of the labor ward, state-of-the-art neonatal emergency equipment, and specialized training for healthcare providers in the managing neonatal emergencies. The NICU is staffed by two ICAP-trained nurses, who receive ongoing support from the staff pediatrician. ICAP-supported senior pediatricians also provide on-call support and conduct ward rounds during supervisory visits. This support and enhancement of basic emergency services for mothers and babies is an extension of ICAP’s commitment to strengthening prevention of mother-to-child transmission (PMTCT) services and pediatric HIV care and treatment. In Ethiopia, a leading cause of HIV is mother-to-child transmission, with children accounting for 22 percent of all infections. Currently, only 20 percent of all HIV-positive children in need of antiretroviral treatment (ART) are receiving it. The lack of ART has devastating consequences for children with HIV—approximately 50 percent of these children die before the age of two.

The primary challenges to improving PMTCT include low uptake of antenatal care services and low institutional delivery, with over 90 percent of mothers in Ethiopia delivering at home. That has inevitably translated into compromised infant care. In-part due to low-uptake of care and delayed treatment of the infant, the problems associated with the care of HIV-exposed and HIV-infected infants include advanced disease, infectious comorbidities, malnutrition and fragility, and suboptimal retention in care. Because the care of the mother and infant is intimately intertwined, ICAP has supported PEPFAR’s PMTCT and pediatrics goals by improving uptake and linkage of antenatal care and PMTCT to pediatric care and treatment in Ethiopia.

!{filedir_2}ethiopia_neonatal_2.jpg(With ICAP support, new equipment like phototherapy is changing emergency care available to infants.)!

p=. _With ICAP support, new equipment like phototherapy is changing emergency care available to infants._

ICAP’s work at Bishoftu Hospital is essential for meeting PMTCT and pediatrics goals because it reflects support of both the foundation and overall infrastructure of mother and infant care, from pregnancy and delivery to neonate and infant care. ICAP’s “one-stop shop” service, where care and treatment of mother and infant is comprehensive, well-coordinated, convenient, and high quality, is an essential model that encourages more mothers to deliver in hospitals and receive live-saving care for themselves and their infants, including PMTCT. Importantly, the basic emergency maternal and child health initiative is serving to save the lives of infants at hospitals like Bishoftu and strengthening Ethiopia’s maternal and pediatric care system.

_Contributed by Shanna Kofman, an ICAP Next Generation intern and student at the College of Surgeons and Physicians at Columbia University._

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