KNOWLEDGE ON THE PREVENTION OF MOTHER TO CHILD TRANSMISSION OF HIV/AIDS AMONG PREGNANT WOMEN IN EKIADOLOR COMMUNITY OF OVIA NORTH EAST

ABSTRACT 
Background: The goal of the knowledge of mothers on prevention of mother to child transmission (PMTCT) is to minimize new HIV infection with PMTCT interventions the chance of infection has been reduce to as low as 2%. Ovia north east is number five among counties that contribute 65% of new HIV infections in Nigeria. 

Cross sectional study was conducted in Ovia North East L.G.A. among HIV positive mothers with infants on PMTCT follow up and health care workers over a period of 1 month. Mixed method design was used to collect data from both mothers with infants below 18 months and HIV tested on PMTCT follow up and health care workers at the MCH clinic. A structured questionnaire was used for HIV mothers with infants and in depth interview guide for health care workers to collect information on perception of PMTCT uptake. A sample size of 96 out of 128 mothers with infants were conveniently selected and sampling frame was used to select 10 health 

A total of 96 mothers with infants and 10 health care workers were included in the analysis. A total of 13(13.5%) infants were infected with HIV. Hospital delivery, infant prophylaxis at birth, follows up medication of the infant and infant feeding methods 

(p-value=0.001) were significantly and independently associated. Level of knowledge on PMTCT was adequate and the health care workers were source of information. Lack of resources, staffing, counseling, low education, poverty, stigma and discrimination were constraint by health workers. 

The study findings were that; new HIV infection was associated with mixed feeding. Use of anti-retroviral therapy was found to eliminate HIV infections. 

CHAPTER ONE 
BACKGROUND 
Background Information 
It is estimated that 35.3 million people worldwide live with HIV and AIDS with more than two- thirds living in Sub Saharan Africa (NASCOP, 2013). Three quarters of 2.3 million new infections in 2012 occurred in Sub Saharan Africa countries. Despite the scale up on the Prevention of mother to child transmission (PMTCT) programs, in 2012, over 210,000 new HIV infections still occurred among infants in Sub Saharan Africa (CDC, 2014). Globally, Acquired Immunodeficiency Syndrome (AIDS) accounts for three percent of deaths in children below five years of age and six percent in Sub Saharan Africa, where it is the major killer of young children (Ngwede et al., 2013). 

Nigeria has adopted the WHO on the four pronged approach for the prevention of mother to child transmission of HIV. This approach includes: primary prevention of women of childbearing age, preventing unintended pregnancies among women living with HIV, preventing HIV transmission from women living with HIV to their infants and providing appropriate treatment, care and support to mothers living with HIV and their children and families ( Mahy, et al. 2013; NASCOP, 2013; UNAIDS, 2013; UNICEF, 2013 ).Thus, to eliminate the new HIV infections to infants, the four components or pillars will be employed and the third component strengthen on use of antiretroviral prophylaxis to reduce the transmission rate from mother to child. 

According to the global report on HIV and AIDS epidemic, 2013 indicates that most of the new HIV infections among infants were reported mostly from Sub Saharan region and the countries in the region were categorized as priority countries in the virtual elimination of new HIV infections by 2015. The global report on HIV epidemic (2013) indicates that 210,000 newly infected children were reported in 2012 which showed 37% drop from 2009 indicates that with effective intervention the rate can still be reduced, though there are still infections which are reported through breast feeding period. In Nigeria, the prevalence rate was 13,000 which also signified a reduction of 44% from the year 2009. Among women living with HIV only 58% were receiving anti-retroviral prophylaxis and the mother to child transmission (MTCT) rate was at 15% (UNAIDS, 2013). 

Adoption of PMTCT program in Nigeria started in the year 2000 which worked well through piloting in several clinics and since its inception there has been a substantial scale up with more health facilities providing the services with the government implementing the WHO 2006 PMTCT guidelines ( Dutta et al., 2013; Mbori-Ngacha and Shaffer, 2010). According to a recent report Nigeria Aids Indicator Survey (KAIS) in Nigeria, the HIV prevalence is at 5.6 % among adults aged 15- 64 years, in terms of gender, women were at 6.9 % and men at 4.4 % infected with HIV. This states that the HIV infection is mostly in women of reproductive age and therefore, the likelihood of passing the infection to the child is high. In terms of residence, HIV prevalence was high at 6.5% in urban and rural was at 5.1%, and geographically, it was highest in Nyanza region and Edo state county being part of it at 15.1% ( NASCOP, 2013 ). 

The risk of transmission of mother to child transmission rate ranges between 15-45 % and with effective intervention, the rate can be reduced to as low as 5 % (Kinuthia et al., 2011; UNAIDS, 2013). Trials have demonstrated that provision of ARV to breastfeeding mothers or their infants can reduce total mother to child transmission to 1% -5% at six months (Ciaranello et al. 2012). Arising from this background, there is need to eliminate new HIV infections among infants. 

This study established the status of new HIV infections among infants born of HIV positive mothers on PMTCT program in Ovia North East L.G.A., a referral government hospital covering South Nyanza, South rift and entire Ovia north east. 

Problem Statement 
Infants born of HIV positive mothers can turn HIV negative if prevention of mother to child transmission (PMTCT) is followed effectively. The transmission rate with absence of intervention is 15% - 45 % whereas with intervention this has reduced to as low as 2% (UNAIDS, 2013). Based on statistics, PMTCT has been implemented through the four pillars (Cherutich et al., 2008; NASCOP, 2013; Tindyebwa et al., 2011; UNAIDS, 2013; WHO, 2014). 

The Nigerian PMTCT guidelines (2012), estimates 37,000 to 42,000 infants are infected with HIV annually due to mother-to-child transmission. This occurs in utero, during labour and delivery and through breastfeeding. During pregnancy, about 5 to 8 percent of HIV exposed babies become infected through transmission across the placenta. Labour and delivery poses the greatest risk for transmission with 10 to 20 percent of exposed infants becoming infected at this time (NASCOP, 2012). According to Nigeria AIDS Indicator Survey, 2012, despite 90 % of HIV positive pregnant women receiving PMTCT interventions only 83 % of infants came for the interventions and 16 % were reported by their mothers to be HIV positive (NASCOP,2013). 

Despite all the interventions in place for PMTCT, there are still a significant number of infants who turn out HIV-infected. This is attributed to the findings that, quality of PMTCT programs are sub-optimal with significant drop offs between first contacts and completion of service package (Tindyebwa et al., 2011). This has also been evidenced by low maternal educational level and poor knowledge on transmission of HIV and issues on stigma and discrimination (Audureau et al., 2013). 

Research Objectives 
Broad Objective 
To determine the knowledge of new HIV infections among infants born of HIV positive mothers on PMTCT follow up in Ovia North East L.G.A. 

Specific Objectives 
The objectives of the study will be to; 

• Determine the prevalence of new HIV infections among infants whose mothers are on PMTCT follow up in Ovia North East L.G.A. 

• Establish factors contributing to new HIV infections among infants whose mothers are on PMTCT follow up in Ovia North East L.G.A. 

• Establish the level of knowledge of the mothers on PMTCT in Ovia North East L.G.A. 

• Establish the perception of health care workers on PMTCT in Ovia North East L.G.A. 

Research Questions 
• What is the status of new HIV infections on infants whose mothers are on PMTCT follow up in Ovia North East L.G.A.? 

• What are the factors contributing to new HIV infections among infants whose mothers are on PMTCT follow up in Ovia North East L.G.A.? 

• What is the level of knowledge of the mothers on PMTCT? 

v) What is the perception of health care providers on PMTCT in Ovia North East L.G.A.? 

Hypothesis 
Null Hypothesis 
There is a knowledge of new HIV infections among infants born of HIV positive mothers on PMTCT follow up in Ovia North East L.G.A. 

Alternative Hypothesis 
There is a knowledge of new HIV infections among infants born of HIV positive mothers on PMTCT follow up in Ovia North East L.G.A. 

Significance of the Study 
The study was a basis for scaling up PMTCT program to eliminate new HIV infections among infants on the policy makers and add knowledge to existing findings on transmission of new HIV infections towards universal millennium development goals on goal 4, 5, and 6. It was hoped that the study findings will be utilized by Edo state Teaching and Referral Hospital in tackling the gap that has been identified in the study. This will promote evidence based practice in helping mothers on PMTCT program to eliminate new infections in infants and guide in planning health program to mothers on PMTCT program.

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Item Type: Project Material  |  Attribute: 42 pages  |  Chapters: 1-5
Format: MS Word  |  Price: N3,000  |  Delivery: Within 30Mins.
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