ASSESSEMENT OF PREVENTION OF MOTHER TO CHILD TRANSMISSION OF HIV AND EARLY INFANTS DIAGNOSIS IN ASOKORO DISTRICT HOSPITAL, ABUJA 2009-2010


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TABLE OF CONTENTS

Title Page
Summary
Table Contents
Acronyms

Chapter One – Introduction
1.1       Introduction of PMTCT
1.2       Specific Objectives of National PMTCT
1.3       Introduction of Early Infants Diagnosis (EID)
1.4       National Objective of EID
1.5       Specific Objective for IED
1.6       EID in Asokoro Hospital
1.7       Institutional Framework of Asokoro District Hospital
1.8       Challenges of EID Asokoro District Hospital
1.9       Statement of Problem
1.10     Justification for Study
1.11     Objectives

Chapter Two – Literature Review

Chapter Three – Methodology
3.1       Background of Study Area
3.2       Study Design
3.3       Study Population
3.3.1    Eligibility Criteria
3.4       Sample Size Determination
3.4.1    Sample Size ANC Clients
3.4.2    Sample Size for EID
3.5       Sampling Method
3.6       Data Collection
3.6.1    Data Collection Instruments
3.7       Data Analysis
3.8       Ethical Issues
3.9       Limitation

Chapter Four – Result
4.1       ANC Client Assessment
4.2       Distribution of clients Assessing VCT Services
4.3       Early Infants Diagnosis Clients Assessment
4.4       Health Care Providers Assessment


Chapter Five – Discussion
5.1       Socio-demographic variable/characteristics of ANC Clients
5.2       VCT Clients Assessment

Chapter six – Conclusion and Recommendations
6.1       Conclusion
6.2       Recommendation
References
Appendices





SUMMARY

Prevention of mother to child transmission (PMTCT ) of HIV still remains a useful tool of fight against the transmission of HIV virus from mother to child, and early infants diagnosis, confers substantial benefit to HIV infection and HIV infected infants, and also programmes providing prevention of mother to child transmission.

The aim of the study is to find out the rate of perinatal transmission in infants born to HIV positive mother, as well as to study the effect of various predisposing factors of HIV transmission and to evaluate the utility of dried blood spot (DBS) for EID of HIV.

Methodology: This study was designed to assess PMTCT and EID services in Asokoro District Hospital so as to assess the effectiveness and efficiency of this service or programme.

The study design is a quantitative descriptive cross- sectioned study, involving the selection of 98 ANC clients, 185 EID clients and 53 respondents of health care providers. Check list, questionnaire and information from site coordinator were used to obtain information.

Result: The findings were ART, drugs for PEP for EID, VCT, PMTCT and PCR were available and no user fee charged, supplies for test, plumpy Nuts, water guards, long lasting insecticide treated Net (LITN) and IPT for pregnant women at A.N.C were always available.

But obstetric care is not free, infrastructure not adequate most especially for paediatric out patient department

Of the 53 health care providers, 17%were doctors, 58.5 % were registered Nurse/midwives, and 3.8% were counselors while 18.9% were laboratory scientist/technician. The result indicated that 79.2% had knowledge that MTCT of HIV occurred during pregnancy, delivery and breastfeeding.

Of the 53 service provider, those who had no any training in PMTCT were (58)% ,those who had training of about 2-5 were 17(32%) and those with more than 5 training were 5(9%).

The perception of service providers of problems facing PMTCT services were shortage of man power 27( 20%) than followed by lack of training 22(17%). 67.9% believe PMTCT and EID are very important tools/ services for pregnant women and their infants.
Of 98 (100%) of ANC respondents who return their questionnaire, 91(92.9%) were married, 5(5.1%) were single, 2(2%) were divorced.

Based on their education, 53(53.8%) have tertiary education, 35(35.5%) had secondary education, 6(6.5%) had primary education while 4(4.1%) had none. For occupation 43(44.3%) were working class women, 84.7% were aware of HIV counseling and testing before coming to health facility and 81.2% got their information through the media. 93.3% of the ANC clients were willing to continue ANC in Asokoro district hospital, 88.7% were willing to refer their sisters and/ or friends to have ANC care in Asokoro district hospital, while 91.3% believes the health care providers were friendly.

For EID services, out of 185 respondents 1.1% were tested at birth, 94.8% were tested at six weeks, while 4.0% were tested at 18 months.

Infants who were tested and have positive DNA-PCR result were 13.1%, those with negative result were 85.1% while those with in-determed results were1.7%.95.6% of infants who were HIV positive were referred to pediatric HIV clinic for further care, 1.5% absconded and 2. 9 % were referred to another health care facility.

Conclusion: PCR is very valuable in making diagnosis of HIV in exposed babies.

This will help reduce the mortality and morbidity associated with late diagnosis and management, it will also help to study the various predisposing factors of HIV transmission and to evaluate the utility of dried blood spots specimen for EID of HIV. Infants born to HIV positive mothers tested by dried blood spot for PCR at birth to 18 months of age were 185. HIV prevalence of HIV expose infants in the heath facility is 13.1%.

Recommendation: Health care facility needs more improvement in infrastructure and man power. Service providers need more training, motivation and also need feed-back from programme implementers and lastly Sero-discordant couples should have pre exposure prophylaxis.
 



CHAPTER ONE

INTRODUCTION

1.1        Introduction of PMTCT

Prevention of Mother to Child Transmission (PMTCT) of HIV came about because of increasing figure of infants born with HIV through vertical transmission from their mothers.

Acquired Immune Deficiency Syndrome (AIDS) was first reported in 1981 and is one of the most destructive epidemics in the world. An estimation done in 2009 revealed that people living with HIV/AIDS globally was 33.3 million out of which 22.5 million were from Sub-Saharan Africa, where it is hardest hit.

Adults living with HIV/AIDS globally are 30.8 million. Deaths due to HIV/AIDS are 1.8 million out of which 1.3 million occurred in Sub-Saharan Africa. The number of Women living with HIV/AIDS in 2009 is 15.9 million, out of which 1.7 million were in Nigeria. It was also revealed that 360,000 children under the age of 15 years were living with HIV/AIDS in that year. Globally orphans (ages 0-17) due to HIV/AIDS are 16.6 million and almost 90% of them were in Sub-Sahara African. At the end of 2009, women accounted for just half of the adult living with HIV world-wide.1

With this high figure of people living with HIV/AIDS, therefore interventions are needed to reverse it or totally stop it by the year 2015 as recommended by the Millennium Development Goals (MDG).

Among the preventive measures taken is the implementation of PMTCT of HIV and early infant‘s diagnosis.....

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