ABSTRACT
Background: The proportion of females infected by HIV worldwide increased from time to time. Sub Saharan Africa is the one part of the world where HIV prevalence and AIDS death are higher for women than men death. African women are the group most sever affected by the epidemic accounting 66% of those infected between the ages of 15-24 years. Pregnancy provides a unique opportunity for implementing HIV infection prevention strategies in women. Prevalence of HIV in pregnancy would indicate the HIV prevalence in female population and to some extent in general population mothers to child transmission Objective: The main objective of this study was to determine the HIV sero-prevalence among pregnant women attending JHC ANC clinic.
Methods: A one year record based retrospective analysis was carried out from April 25-30 in Gwagwalada health center. Sample population was selected by systematic random sampling technique from patient record reviews according to serial number every 3 consecutive registration number. Data was collected using structured check lists. The collected data was analyzed manually by scientific calculator and was present by using table and charts.
Result: A total of 137 mothers record reviewed and almost all 134(97.8%) of them were tested. Majority of the mothers 90(65.4%) who accepted HIV testing were aged between 15 to 24 years. One hundred forty one (56.2%) had gestational age between 0-28 week.
Only7(5.1%) of the mothers who were PMTCT counseled got their partner tested. There is no association in overall sero prevalence between gestational age of mothers, which has lacked statistical significance (p<0.005)
Conclusions and Recommendation: The percentage of ANC attendees who have got their partners HIV tested are extremely low. overall HIV prevalence among the mother is 5.97, the prevalence is higher for age group 35-49 (14.2%), and no observed sero prevalence for 40-44 years age group of mothers, the difference in sero reactivity is may due to under report or this age group was may less likely to became pregnant, and there is statistically significant association between HIV sero prevalence and age group 15-44.The poor PMTCT data quality observed at J health center needs to be improved and maintain the current increasing trend in voluntary HIV testing practice among Primigravida and primipara ANC attendees, awareness creation campaigns on PMTCT of HIV and available services have to be further strengthened and expanded
CHAPTER ONE
INTRODUCTION
• Background information
Although HIV/AIDS is Global epidemic, the majority of people living with HIV/AAIDS are Sub Saharan Africa, Thirty eight million people living with HIV worldwide in 2006. Sub Saharan Africa is a home for 25 million people living with HIV/AIDS. In the early days of the epidemic, men vast it out numbers women among people infected with HIV. It looks along time for the world to admit HIV as a threat to women. The proportion of females infected by HIV worldwide increased from time to time. Sub Saharan Africa is the one part of the world where HIV prevalence and AIDS death are higher for women than men death (1, 2).
Nearly, 50% of the 40 million people living with HIV/AIDS are female. In sub Saharan Africa 59% of those infected with virus are females. Studies in sub Saharan Africa have shown that there are 14 infected women for every 10 infected men (1, 3). According to the Nigeria demographic and health serves (EDHS), the estimated adult HIV prevalence in 2005 was 1.4%. The prevalence in women is nearly 2% while the prevalence among male was under 1% (5).
As HIV infection in women occur primary donning their reproductive years. Pregnancy provides a unique opportunity for implementing HIV infection prevention strategies in women. Prevalence of HIV in pregnancy would indicate the HIV prevalence in female population and to some extent in general population mothers to child transmission, by for the most significant route of transmission of HIV in children below the age of 15 years (6).
Women are disproportional at risk because they are biologically more susceptible to HIV infection than men. Data from number of studies revealed that male to female transmission during sex is 2-5 times greater in female, if no sexual transmission infection present (7).
Postpartum period is the time after childbirth, during which the anatomic and physiologic changes brought about by pregnancy resolve enabling a woman adjust to the new and/or expanded responsibilities of motherhood and nonpregnant life. (Mosby's Medical Dictionary 2009, Elsevier.) This period after birth has been seen to be the most neglected aspect of maternal health, though a time of high risk for maternal mortality (WHO et al., 2011). Further to this, it has been found that while many women access antenatal care, much fewer women globally have access to postnatal care. In a particular finding in Africa, almost 75% of women in Uganda, who have had a live birth, did not receive care during the postpartum period and that only one in five mothers received post-delivery care within the critical first two days after delivery, (Rosen et. al, 2010).
While in some countries, especially in Sub-Saharan Africa, infection rates have been seen to be high among pregnant women, majority of pregnant women in the world remain HIV-negative hence a continuing challenge to the world's health care providers, to enable the nearly 99% of women who become pregnant each year and who are not infected with HIV to maintain their HIV-negative status through even after birth. (WHO et. al, 2022).
Kimanga et.al (2012) provides the HIV prevalence in Nigeria among adult aged 15-49 years, to be (6.9%) among women. Drake et al. (2023), recommended that, because many women have an ongoing risk of acquiring HIV during Postpartum period, emphasis should be put on HIV retesting through to this period (PMTCT guidelines, 2022), which recommend that women, despite being tested during pregnancy, should have repeat HIV tests after delivery, this rarely occurs. In addition, their findings revealed that mothers who acquire HIV during postpartum period are more likely to transmit the infection on to their offspring. According to (Kinuthia et. al. 2004), HIV incidence among women who were 6 weeks postpartum was 2.6% and that mothers who were found to be HIV negative were likely to be employed, married and located in a higher HIV prevalence region (western Nigeria).
Canner J.et al. (2006) concluded that the incidence of HIV infection rose in the first 24 months after birth, while the yearly seroconversion rates being 2.84 per 100 person-years in the one year and 6.66 in the second year postpartum. More findings reveled that, only 2.2% of the women recorded to have had sexual contact in the first 6 weeks after birth.
According to KDHS, (2008), Nyanza had a HIV prevalence of 17.1% among women aged 15-49 years while in Homabay county, HIV prevalence, as revealed by (KAIS 2012), was 27.1% among women. Also, according to the figures of a research conducted by (NACC, 2011), women were leading in HIV infection. The high prevalence rate in Homa Bay County was attributed to some social cultural practices like widow inheritance, widow cleansing and postpartum abstinence that, all which promote the spread of HIV infection. (Global AIDS Progress Report, Nigeria, 2012.)
• Statement of the problem
Human immune virus /Acquired immune deficiency syndrome (HIV/AIDS) has spread throughout the world causing on told suffering and death and creating profound development challenge. It has killed more than 25 million people, since it was first recognized in 1981 (8).Since the HIV/AIDS epidemic began, almost 58million people throughout the world have been intended with HIV and almost 22 million people have died due to the disease. (9)
HIV/AIDS has become a serious global health and psychosocial crisis, with at least 40 million infected individuals worldwide: It is not only strikes a adults, but also children and adolescent. In the third world countries, more than 40 % of all live births involve HIV infected children. Epidemiological data from the US center of disease control (CDC) and prevention indicate that approximately 950.000 us citizen are infected with HIV, and 280.000 [30 0/0] don’t know they are infected (CDC,2004] [10] . The HIV AIDS epidemics are not of the largest public health crises of twenty one [21 century). While the epidemic has spread over two decades a core or valline for HIV has remain elusive (11).
HIV/AIDS is more prevalence among female adults under the age of 40 in nearly all age groups in the world. Roughly, 4 is very 5 people HIV/AIDS age 20-24 are women’s only one third of people HIV/AIDS age 25-29 are men (12).Thirty eight million people living with HIV/AIDS worldwide in 2006. Sub Saharan Africa is a home for 25 million people living with HIV/AIDS. HIV/AIDS is a major public health concern and cause of death in Africa.
Although Africa is in habited by just over 14.7% of the world’s population, it is estimated to have more than 88% of people living with HIV and 92% of all AIDS deaths in 2007. (13) Throughout the world, the unequal social status of women places them at higher risk for contracting HIV- women are at disadvantage when it comes to access to information about the ability to negotiate date sexual encounters and access for HIV/AIDS once infected. As a result of these inequalities and epidemic dynamics the proportion of women among people living and HIV/AIDS is rising in many regions (17).
HIV infection was the 5th leading cause of death among all women aged 35-44 years and the 6th leading cause of death among all women ages 25-34 years (15).The HIV/AIDS epidemic interests with the problem of maternal mortality in many circumstances in sub- Saharan Africa. The extent of contribution in HIV/AIDS maternal mortality is difficult to quantity at the HIV states of pregnant women in sub region is not always known (16).
1.3 OBJECTIVES
General Objectives
To assess the prevalence of HIV infection among pregnant mother attending antenatal clinics in Gwagwalada health center, Gwagwalada zone, Abuja SWE June 2023.
• Specific Objectives
• To determine HIV sero-prevalence rate of the year among ANC attendees
• To identify factors associated with sero-positivity, among ANC attendees.
• Research Question
• What is the HIV sero-prevalence rate of the year among ANC attendees
• What are the factors associated with sero-positivity, among ANC attendees.
1.5 Significance of Study
In order to provide the quality health care and Prevention of maternal to child transmission of HIV infection the prevalence of HIV among pregnant women should be continuously assessed among pregnant women’s. In addition to these estimating sero-prevalence in pregnant women is used to initiate the effective and timely prevention that reduce infection to babies and also studying sero-prevalence in this group is used to draw appropriate program and policy used to strengthen efforts towards PMTCT and also indicates sero-prevalence of HIV among females and to some extent general populations more over the finding from the study was used as secondary data or base line data for those who wanted to conduct for the study in the area of the problem.
• Limitation of the study
• Positive client may recorded as negative due to window period.
• Access to general ANC logbooks, PMTCT counseling logbooks and ANC follow up cards was limited since they were misplaced or being used by ANC staff at the time of data collection. Data varied in quality (handwriting was not always clear). The variables recorded in the logbooks of PMTCT were not complete. For example, gravidity, parity, occupation, and marital status data were missing in PMTCT counseling log books. The worst was with individual ANC follow up cards which were the only data sources for such variables as marital status, occupation and other socio economic variables. Large number of those cards was completely lost at all visited health centers.
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