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Open Access Highly Accessed Research article

Uptake and outcomes of a prevention-of mother-to-child transmission (PMTCT) program in Zomba district, Malawi

Monique van Lettow12*, Richard Bedell1, Megan Landes13, Lucy Gawa1, Stephanie Gatto4, Isabell Mayuni1, Adrienne K Chan13, Lyson Tenthani5 and Erik Schouten6

Author Affiliations

1 Dignitas International, Zomba, Malawi

2 Dalla Lana School of Public Health, University of Toronto, Toronto, Canada

3 Department of Medicine at St Michaels Hospital, University of Toronto, Toronto, Canada

4 Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada

5 Department of HIV and AIDS, Ministry of Health, Malawi

6 Management Sciences for Health Lilongwe, Malawi

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BMC Public Health 2011, 11:426  doi:10.1186/1471-2458-11-426

Published: 3 June 2011



HIV prevalence among pregnant women in Malawi is 12.6%, and mother-to-child transmission is a major route of transmission. As PMTCT services have expanded in Malawi in recent years, we sought to determine uptake of services, HIV-relevant infant feeding practices and mother-child health outcomes.


A matched-cohort study of HIV-infected and HIV-uninfected mothers and their infants at 18-20 months post-partum in Zomba District, Malawi. 360 HIV-infected and 360 HIV-uninfected mothers were identified through registers. 387 mother-child pairs were included in the study.


10% of HIV-infected mothers were on HAART before delivery, 27% by 18-20 months post-partum. sd-NVP was taken by 75% of HIV-infected mothers not on HAART, and given to 66% of infants. 18% of HIV-infected mothers followed all current recommended PMTCT options. HIV-infected mothers breastfed fewer months than HIV-uninfected mothers (12 vs.18, respectively; p < 0.01). 19% of exposed versus 5% of unexposed children had died by 18-20 months; p < 0.01. 28% of exposed children had been tested for HIV prior to the study, 76% were tested as part of the study and 11% were found HIV-positive. HIV-free survival by 18-20 months was 66% (95%CI 58-74). There were 11(6%) maternal deaths among HIV-infected mothers only.


This study shows low PMTCT program efficiency and effectiveness under routine program conditions in Malawi. HIV-free infant survival may have been influenced by key factors, including underuse of HAART, underuse of sd-NVP, and suboptimal infant feeding practices. Maternal mortality among HIV-infected women demands attention; improved maternal survival is a means to improve infant survival.