Project Materials

FACTORS INFLUENCING THE UTILIZATION OF PREVENTION OF MOTHER–TO-CHILD TRANSMISSION (PMCTC) SERVICES AMONG PREGNANT WOMEN ATTENDING CLINIC

Chapter one

INTRODUCTION

1.1 Background of the Study

Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) has terrible effects and is currently a pregnancy issue over the world, infecting over 700,000 children each year.

Mother-To-Child Transmission (MTCT) of the virus accounts for more than 90% of cases in children under the age of 15 (United States AIDS, 2012).

HIV can be transmitted from mother to child (MTCT) during pregnancy, labour and delivery, and breastfeeding. During pregnancy, around 5 – 8% of newborns become infected through placental transmission. Labour and delivery represent the greatest risk of transmission (10-20% of exposed infants).

Breastfeeding risks the infant to HIV transmission, especially if it continues for an extended period of time (18-24 months). The extra risk of HIV infection when a newborn is breastfed is approximately 15-25%, according to the World Health Organisation (WHO, 2013), in partnership with other non-governmental organisations such as the Global Fund, the President’s Emergency Plan for Aids Relief (PEPFAR), and so on.

There are now feasible and economical therapies that can cut MTCT rates by 50% (Population Reports, 2010). The Prevention of Mother-to-Child Transmission (PMTCT) process begins with pre-test counselling and continues through HIV testing, intervention enrolment, and hospital delivery.

Hospital birth ensures that both the mother and the baby receive the intervention (Nevira Pine) on time. Maternal Nevirapine is given at the start of labour, whereas the newborn dose is given within 72 hours following delivery.

In 2012, around 400,000 children under the age of 15 were infected with HIV. Almost bulk of these illnesses occur in low- and middle-income countries, with more than 90% caused by mother-to-child transmission during pregnancy, birth, or breastfeeding.

Without interventions, a baby born to an HIV-positive mother has a 20-45% probability of becoming infected (De Cock et al., 2011).

In 2006, the proportion was 23%, and by 2009, it was anticipated that 53% of HIV-positive pregnant women in low and middle-income countries had received antiretroviral medications to prevent HIV transmission to their newborns (World Health Organization/United Nations International Children Fund, 2011).

Botswana is in the forefront of addressing HIV among pregnant women in Southern Africa. High-quality PMTCT services are available in all public facilities throughout the country through the maternal and child health/family planning system, which serves more than 95% of pregnant women (US Global Aids, 2012).

Sub-Saharan Africans have continued to bear the brunt of the HIV/AIDS epidemic. In 2003, Sub-Saharan Africans accounted for 70% of the estimated 37.8 million people living with HIV, 70% of the 4.8 million new infections, 77% of the 2.9 million HIV fatalities, and 90% of the 2.1 million children infected with the virus. 630,000 children were infected with HIV, with Sub-Saharan Africa accounting for 90 percent of the cases.

The high prevalence of HIV in women of reproductive age, combined with high fertility rates, contributes to the relatively high prevalence of HIV transmission to babies.

The high incidence of MTCT of HIV threatens to undo the benefits of the African continent’s child survival strategy (Federal Ministry of Health, 2010).

In Nigeria, the prevalence of HIV infection among expecting mothers is projected to be 30%, undoing previous advances in child survival programmes and increasing newborn and child mortality rates in Chiroma Ward, Lafia Local Government Area, Nasarawa State (FMOH, 2013).

This has demanded an increase in Mother-To-Child Transmission program sites from 11 in 2002 to 622 in 2013 (Chiroma Ward in Lafia Local Government Area, Nasarawa State, 2009).

In March 2010, the president issued a mandate to boost maternal-to-child HIV prevention coverage to 30% by the end of 2010 and 50% by 2013.

According to 2011 WHO recommendations, Chiroma Ward in Lafia has the highest HIV prevalence (10.6%). It is estimated that 7,620 pregnant women with HIV (Lafia Ministry of Health, 2013). Every year, around 2,000 newborns in the study area become infected with HIV from their mothers.

In 2012, 438 HIV positive moms enrolled in the PMTCT Ante-natal Clinic in Chiroma Ward in Nasarawa State’s Lafia Local Government Area and were beneficiaries of the PMTCT programme; only 337 of the 438 persisted to attend the antenatal clinic till the end.

Studies have found insufficient counselling and dropout at various service delivery sites when following the PMTCT protocol, highlighting the necessity for study to identify the causes of such behaviour (Madaki, 2015).

Combs (2013) discovered that MTCT information was insufficient, since respondents stated that all women transmit HIV to their newborns through breast feeding.

Mothers lack information on how to avoid HIV transmission from an infected mother to her child, as well as available risk-reduction methods.

Combs (2013) stated that health care providers required further MTCT training and support materials to provide counselling, appropriate information, and guidance to clients about HIV and breastfeeding options.