ABSTRACT
Introduction
Mother to child transmission (MTCT) of HIV is a preventable route of
HIV transmission in Nigeria. The federal government of Nigeria introduced the
prevention of mother to child transmission (PMTCT) of HIV programme in NAUTH
Nnewi in 2002. This study was carried out to assess the effects of the PMTCT
services on the health of mothers and children who accessed these services in
NAUTH Nnewi, SE Nigeria.
Methods
This is a cross-sectional descriptive study. 288 mother-child pairs who
had accessed the PMTCT services and attending the paediatric follow-up clinic
were recruited into the study by a systematic sampling method using the daily
clinic register of exposed babies. Data was collected using a structured
interviewer-administered questionnaire and analyzed using SPSS version 16. A
p-value <0 .05="" considered="" significant.="" span="" was="">
The mean age of all the respondents was 30+4.86 years. Most
(89.2%) were married, 10.1% had less than secondary education while 4.2% had no
formal education. 55.2% were traders while 18.4% were unemployed. Median parity
was 2. Partner notification was 87.2%. 99% of the pregnancies was carried to
term while mean birth weight was 3.02+0.49kg. Mother to child HIV
transmission rate was 1%. Majority of the mothers had good knowledge of routes
of HIV transmission. 99% of mothers identified MTCT as main mode of
transmission. 93.4% did not perceive risk of transmission in homosexuals and
bisexuals. 75.8% used contraceptive methods. 94.7% did not breastfeed while
breastfeeding was associated
with MTCT of HIV (X2 = 9.16; p < 0.02). Infant formula was
associated with impaired baby’s current health status. Majority of mothers
reported excellent health status.
Conclusion
The PMTCT programme has resulted in good knowledge of routes of HIV
transmission and modes of prevention of MTCT of HIV, low MTCT
rate, high rate of contraceptive use and excellent health status
among participating mothers
and children.
CHAPTER ONE
INTRODUCTION
Acquired immuno-deficiency syndrome (AIDS) is a disease
condition caused by infection of the human body by a retrovirus called the human immunodeficiency virus (HIV) 1.
On entry into the body, the virus invades the Cluster differentiation 4 (CD4)
cells in which it replicates. Its successful multiplication leads to the destruction of the CD4 cells. Thus, the CD4
cells count reduces as the viral load increases.
The CD4 cells are responsible for the protection of the human body against numerous pathogenic organisms with which it
comes into contact in day to day living. Depletion of the CD4 cells leads to immune deficiency state and an increased
likelihood of the body being invaded by opportunistic organisms. These
organisms, which are ordinarily harmless to the human body, then become
pathogenic and cause what is known as opportunistic infections 2. It is the opportunistic
infections that persistently reduce the quality of life of the individual and eventually result in death if treatment is not
promptly and adequately provided. Highly Active Anti-retroviral Therapy
(HAART), when promptly and adequately provided and taken, reduces HIV morbidity and mortality 3, 4.
Magnitude of the Problem of HIV/AIDS
The HIV and AIDS pandemic is one of the most serious health
crises in the world today. By the end of 2008, AIDS and AIDS-related illnesses
had killed more than 25 million people (2 million in 2008 alone including
280,000 children under 15 years) and an estimated 35.8million people were
living with HIV, out of which 15.7 and 2.1million were women and children under 15 years respectively5. Sub-Saharan Africa has
continued to bear the greatest burden of the HIV and AIDS epidemic, with
approximately 67% of the total number of people living with HIV, 68% of the new
infections and 72% of AIDS-related deaths in 2008. Over the decades, the
epidemic, once dominated by infected males has become progressively feminized
and in sub-Saharan Africa approximately 60% of adults living with the HIV are women6,7,8.
Over 90% of infection in children is acquired through
mother-to-child transmission (MTCT) and as more women contract the virus, the number of children infected also increases9.
Estimate of the Global HIV pandemic demonstrated that in sub-Saharan Africa,
more than 1200 children become infected with HIV each day5. In 2008 alone an estimated 2.1 million
children were living with HIV and up to 430,000 were newly infected worldwide,
with sub-Saharan Africa accounting for about 90% of both of these figures5.
Nigeria, with a population of 140 million10, is the most
populous country in Africa and was ranked 2nd worst affected by HIV/AIDS in the world in 2008 after South Africa5. Since
the first case of HIV/AIDS in Nigeria was reported in 1986 involving a 13 year old girl who died of the disease11, there
has been progressive increase in the total number of people living with
HIV/AIDS (PLWHA). The national prevalence rose from 1.8% in 1991 to 5.8% in
2001 but declined to 5% in 2003 and 4.4% in 2005 before rising again to 4.6% in
2008 with prevalence in Anambra State determined to be 5.6%12.
The HIV prevalence rate is higher in the urban (5.4%) than
rural areas (3.4%). Among young persons, the highest
prevalence rate of 5.6% is in the age group 25 to 29 years13.
The average number of adults living with HIV was 3,500,000 in 2005 at a time
when number of women (15-49 years old) living with HIV was 1,900,000, giving a
female: male ratio of 1.2:1. Heterosexual transmission accounts for nearly 80%
to 95% of all infections14. About 10% of HIV infections are
transmitted by MTCT, while another 10% is transmitted by the use of
unsterilized needles and surgical implements, infected blood and blood products15.
Mother-to-Child Transmission of HIV
Over 90% of HIV infections in children less than 15 years are
due to MTCT. In the absence of interventions, between 15% and 45% of infants
born to HIV-infected mothers acquire the infection during pregnancy, delivery
or through breast-feeding16. The burden of MTCT of HIV is higher in sub-Saharan
Africa than the rest of the world, because of higher levels of hetero-sexual transmission, high female to male
ratio, high total fertility rate (TFR) and high rate of breast-feeding17,18. Transmission of HIV in children has become a
critical health problem undermining the positive impact of child survival strategies in the African continent19,20.
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