CHAPTER ONE
INTRODUCTION
1.1     Background to the Study
Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) has a devastating effects and is currently a complication of pregnancy worldwide with more than 700,000 children infected annually. Mother–To–Child Transmission (MTCT) of the virus is responsible for more than 90% of these cases in children under 15 years (United States AIDS, 2012).
Mother–To–Child Transmission (MTCT) of HIV can occur during pregnancy, labour and delivery, or breastfeeding. During pregnancy, about 5 – 8% of babies become infected through transmission across the placenta. Labour and delivery pose the greatest risk for transmission (10 – 20% of exposed infant). Breastfeeding also exposes the infant to HIV transmission particularly if prolonged (18-24 months). The additional risk of HIV infection when and infant is breast fed is around 15-25% World Health Organization (WHO, 2013) in collaboration with other non-governmental organization like global fund, president’s emergency plan for Aids relief (PEPFAR) etc.
Feasible and affordable interventions now exist to reduce the rate of MTCT by 50% (Population Reports, 2010). The Prevention of Mother–To–Child Transmission (PMTCT) protocol begins at pre-test counseling continues through the HIV test, result and enrolment for the intervention and at hospital delivery.
Hospital delivery ensures that both mother and baby receive the intervention (Nevira Pine) at the time. Maternal Nevirapine is administered at the beginning of labour, while the baby dose is given within 72 hours after delivery.
In 2012, around 400,000 children aged under 15 became infected with HIV (UNAIDS, 2013). Almost all of these infections occur in low and middle-countries, and more than 90% are the result of Mother-To-Child-Transmission during pregnancy and delivery or breastfeeding. Without interventions, there is a 20-45% chance that a baby born to a HIV- infected mother will become infected (De Cock et al; 2011).
In 2006, the proportion was 23% and by 2009 an estimated of 53% of pregnant women living with HIV in low and middle income countries received antiretroviral drugs to prevent HIV transmission to their infants World Health Organization/United Nations International Children Fund (WHO/UNICEF, 2011).
In Southern African where HIV is very widespread among pregnant women, Botswana leads the way. High quality PMTCT services are provided in all of the country’s public facilities through the maternal and child health/family planning system which serves over 95% of the pregnant women (US Global Aids, 2012).
Sub-Sahara African has continued to bear the greatest burden of the HIV/AIDS epidemic. Seventy percent of the estimated 37.8 million people living with HIV, 70 percent of the 4.8 million are new infections, 77 percent of the 2.9 million are HIV deaths and 90 percent of the 2.1 million children infected with HIV in 2003 were from sub-Saharan African. 630,000 children were infected with HIV, and out of these, 90 percent occurred is Sub-Saharan African.
The high prevalence of HIV in women of reproductive age group and the high fertility rates contribute to the comparatively high prevalence of transmission of HIV to infants. The high prevalence of MTCT of HIV is threatening to reverse the gains of the child survival strategy in the African continent (Federal Ministry of Health, (FMOH, 2010).
In Nigeria, the prevalence of HIV infection among pregnant mothers is estimated at 30% and is reversing the recent gains of child survival programmes, thereby increasing infant and child mortality rates at Chiroma Ward in Lafia Local Government Area of Nasarawa State (FMOH, 2013). This has necessitated the increment of prevention of Mother – To – Child – Transmission program sites from 11 in 2002 to 622 in 2013 (Chiroma Ward in Lafia Local Government Area of Nasarawa State, 2009). In March 2010 there was presidential directive to increase coverage of prevention of mother – to child – to 30% by the end of 2010 and 50% by 2013, based on 2011 WHO recommendations, Chiroma Ward in Lafia sentinel report have indicated highest HIV prevalence (10.6%). It is estimated that 7,620 pregnant women are infected with HIV Lafia Ministry of Health, 2013). About 2,000 babies are infected with HIV from their mothers annually in the study area.
A total of 438 HIV positive mothers enrolled for the PMTCT Ante-natal Clinic in 2012 at Chiroma Ward in Lafia Local Government Area of Nasarawa State and are beneficiaries of the PMTCT programme, out of the 438, only 337 continued attending the antenatal clinic to the end. Studies have indicated inadequate counseling and dropout at different service delivery points in implementing PMTCT protocol, posing the need for research to find reasons for such action (Madaki, 2015).