Assessment Of The Effects Of Prevention Of Mother To Child Transmission Of HIV (PMTCT) Programme On Maternal And Child Health At XXXX University Teaching Hospital

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Assessment Of The Effects Of Prevention Of Mother To Child Transmission Of HIV (PMTCT) Programme On Maternal And Child Health At XXXX University Teaching Hospital

Abstract

The goal of the 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% and increase health among both mother and child. Ovia north east is number five among local governments that contribute 65% of new HIV infections. 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; there is correlation between PMTCT and health or mother and child new HIV infection was associated with mixed feeding. Use of anti-retroviral therapy was found to eliminate HIV infections.

Chapter One

Introduction

1.1. 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.

1.2. 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).

1.3. Purpose of the Study

The purpose of the study is assessment of the effects of prevention of mother to child transmission of HIV (PMTCT) program on maternal and child health

1.4. 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;

  1. Determine the prevalence of new HIV infections among infants whose mothers are on PMTCT follow up in Ovia North East L.G.A.
  2. Establish factors contributing to new HIV infections among infants whose mothers are on PMTCT follow up in Ovia North East L.G.A.
  3. Establish the level of knowledge of the mothers on PMTCT in Ovia North East L.G.A.
  4. Establish the perception of health care workers on PMTCT in Ovia North East L.G.A.

1.5 Research Questions

  1. What is the status of new HIV infections on infants whose mothers are on PMTCT follow up in Ovia North East L.G.A.?
  2. 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.?
  3. What is the level of knowledge of the mothers on PMTCT?
  4. Is the relationship PMTCT and mother and child health.?

1.6 Hypothesis

There is a relationship PMTCT and mother and child health

1.7 Significance of the Study

Studies have showed that with effective intervention with PMTCT interventions in treatment and provision of antenatal prophylaxis is able to reduce the transmission rate during pregnancy and delivery, in addition to giving birth with a skilled attendant and stop breast feeding can reduce the risk of transmission to 1% -2%. This is a good basis for scaling up the PMTCT services for prevention of new HIV infections among infants and sealing the gaps at Edo state County. Standard Newspaper, 10th December, 2013 reported that Edo state county is among the six local government in Nigeria that contribute to more than half of new HIV infections with an HIV prevalence rate of 8.9 % against a nationwide prevalence rate of 5.6 % (Miruka, 2013 ). The challenge was to scale up the PMTCT program. In Edo state county PMTCT statistics showed that 1,180 women were diagnosed to be HIV positive with a positivity rate of 4%, of those who were HIV positive only 943 were on ARV prophylaxis and during maternity a HIV positivity rate of 3% with 183 mothers were positive in the year 2013. This study was done in Ovia North East L.G.A. located at Kitutu Chache constituency. The hospital is a referral government district hospital in the region and serves a population of 3 million people. The hospital provides both inpatient and outpatient services and HIV comprehensive services which include HIV testing and counseling services, family planning, anti-retroviral prophylaxis, life-long anti-retroviral treatment and support care and follow up seropositive patients.

1.8 Organization of the Study

This study contains five chapters.

  • Chapter one contains the background information to the problem, statement of the problem, research objectives, and the research questions. Also, chapter one provides the significance and scope of the study.
  • Chapter two is about review of literatures, both theoretical and empirical. It begins with definition of key terms used in the study, the theoretical basis of the study as well as review of empirical literatures on HSB. Chapter two ends up with analysis of the research gap and the conceptual framework.
  • Chapter three provides a discussion on how the research was accomplished. The chapter shows the research design used, the methods of data collection, presentation and analysis as well as techniques to ensure data credibility.
  • Chapter four is all about presentation and discussion of findings; while
  • Chapter five provides summary, conclusion, recommendations and areas for further study.

Chapter Five

Conclusion and Recommendation

5.1 Conclusion

This study shows that there are factors which are significantly associated with new HIV infections among infant born of mothers on PMTCT program in Ovia North East L.G.A.. Mixed feeding was found to be the risk factor in the transmission of HIV infections.

On the other hand, factors that were significantly associated with reduction of HIV infections from mother to child transmission were use of antiretroviral treatment in children and this included use of Nevirapine at birth, anti-retroviral treatment of the infant and hospital delivery. Support from donors was found to be beneficial on the PMTCT program in training staff and availability of resources.

An observation made in the study there was virtual elimination of HIV infections on all the respondents who used exclusive formula feeding and use of highly anti-retroviral therapy though this being a low resource setting.

Additionally, there were gaps in our knowledge concerning preventive measures of MTCT of HIV especially in during pregnancy and delivery.

The findings of this study provide valuable information for improving the quality of programs to prevent mother to child transmission of HIV in the study setting and other areas.

5.2 Recommendation

Based on the findings, following recommendations were made

  1. Health care workers as the main source of information should be exposed for regular training programme by the hospital to update their skills and knowledge on PMTCT update provide quality care to their clients/ patients.
  2. Being a low resource setting, health care workers must encourage exclusive breast feeding period for 6 months and stop breast feeding if acceptable, feasible, affordable, sustainable and safe since early cessation of breastfeeding leads to transmission of new HIV infection in infants
  3. HIV exposed mothers should be invited during peer support group to encourage mothers fellow mothers to embrace exclusive breast milk for 6 months since is found to be protective
  4. Self –stigmatization and discrimination is a challenge on disclosure issues, choice of infant feeding methods and adherence to treatment therefore health care workers should sensitize couple counseling the HIV positive mothers, on infant feeding methods and treatment adherence.
  5. Health care workers at the maternal and child health to empower mothers on use of exclusive formula feeding and provide anti-retroviral therapy to all infants in the virtual elimination of the new HIV infections.

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