Abstract

Background: Mother-to-child transmission (MTCT) of HIV remains a significant public health issue, especially in regions with high prevalence rates. Understanding the knowledge and practices surrounding the prevention of MTCT among pregnant women is crucial for effective intervention.

Objective: This study aimed to assess the knowledge and practices of mother-to-child transmission of HIV/AIDS among pregnant women in the Mile 16 Bolifamba community, as well as to identify factors associated with MTCT and the challenges faced in prevention efforts.

Method: A cross-sectional study design was employed, targeting pregnant women in the Mile 16 Bolifamba community. A convenient non-probability sampling technique was used to collect data through structured questionnaires. Data were analysed using Microsoft Excel 2016, presenting results in frequency tables, bar charts, and pie charts.

Results: The study found that 85% of participants had heard of HIV/AIDS; however, only 60% were aware of the potential for mother-to-child transmission. While 63.83% recognized that effective treatment could reduce transmission risk, 36.17% remained uninformed. Additionally, 31% of respondents identified inadequate healthcare facilities as a major barrier to accessing PMTCT services.

Conclusion: Despite a general awareness of HIV/AIDS, significant gaps in knowledge regarding MTCT and prevention practices were evident among pregnant women in the Mile 16 Bolifamba community. This underscores the need for targeted educational initiatives and improved access to healthcare services.

Recommendation: Community outreach programs should be implemented to enhance awareness and understanding of PMTCT, aiming to empower pregnant women to engage in preventive practices and reduce the incidence of HIV transmission.

CHAPTER ONE

GENERAL INTRODUCTION

Background

The prevention of mother-to-child transmission (PMTCT) of HIV is a critical public health issue that significantly impacts the health and well-being of both mothers and their children. Globally, HIV/AIDS continues to pose serious challenges, particularly in regions with high prevalence rates. Pregnant women living with HIV face unique challenges, as the potential for transmission of the virus to their infants during pregnancy, childbirth, or breastfeeding necessitates comprehensive healthcare strategies.

In recent years, advancements in medical treatment and public health initiatives have made it possible to significantly reduce the risk of HIV transmission from mothers to their children. Antiretroviral therapy (ART) has been proven to be effective in lowering viral loads, thereby minimizing the likelihood of transmission. However, despite these advancements, gaps in knowledge and access to care persist among pregnant women, particularly in underserved communities.

Understanding the knowledge and practices surrounding PMTCT among pregnant women is essential for implementing effective interventions. Education plays a pivotal role in empowering women to make informed decisions about their health and the health of their unborn children. Moreover, cultural beliefs, stigma, and socio-economic factors can influence both the understanding and the uptake of PMTCT services.

This assessment aims to explore the current levels of awareness, attitudes, and practices related to PMTCT of HIV among pregnant women. By identifying barriers and facilitators to effective PMTCT, we can enhance healthcare strategies and ultimately contribute to the global goal of eliminating new HIV infections among children. Through targeted education and support, we can pave the way for healthier generations and a brighter future for families affected by HIV. The Human Immunodeficiency Virus (HIV) can be transmitted from HIV positive Mothers to their child during pregnancy, at time of giving birth and breastfeeding (WHO; 2027).

Majority of children infection with HIV is due to Mother to Child Transmission (MTCT) (Latham et al; 2021). The prevalence of Mother to Child Transmission (MTCT) of HIV in pregnant HIV women with no intervention ranges from 15%-45%. Intervention such as Antiretroviral Therapy (ART), post exposure prophylaxes and Prevention of Mother to Child Transmission (PTMTCT) service can reduce the proportion of MTCT to less than 5% (Leleago and Unicef 2020).

Worldwide, 1.3 million pregnant women and 2.8 million children and adolescents are living with HIV (CDC and WHO, 2019). Despite significant efforts and achievements in PMTCT over the past decade, app5roximately 1.7 million children were newly infected with HIV in 2019, mainly through the transmission of the virus from their mother during pregnancy, delivery, or breastfeeding (UNICEF Data).

Globally, 38 million ±4.5 million people were living with HIV at the end of 2021. An estimated 0.7% ± 0.1% of adults aged 15 years – 49 years worldwide are living with HIV, even though the encumbrance of the epidemic continues to vary considerably between countries and regions (WHO, 2018).

Among the WHO regions, the African region is the most severely affected, with nearly 1 in every 25-adult living with HIV and accounting for more than two-thirds of the people living with HIV worldwide (Peter et al 2015). The global HIV epidemic has been transformed with the large-scale expansion of antiretroviral therapy, reducing global HIV-related deaths to their lowest since 1994. Nevertheless with 680,000 people dying from HIV-related causes in 2020, mortality continues to be unacceptably high and progress in reducing mortality is stalling. Further, more than 1.5 million people acquire new HIV infections each year and the global targets for reducing this number are off-track. Access to services for children and adolescents’ lags behind the progress achieved for adults.

Key populations, in the context of HIV, include men who have sex with men, people who inject drugs, sex workers, transgender people and people in prisons9. Key populations and their partners account for 65% of the people acquiring HIV worldwide, yet these populations face many barriers to accessing services, including legal and policy barriers and structural and social health determinants within and beyond the health sector ( global health strategy 2022-2030).

About 1.3 million pregnant women and 2.8 million children and adolescents are living with HIV. Despite significant efforts and achievements in PMTCT over the past decade, approximately 1.7 million children were living with HIV and 150,000 children were newly infected with HIV in 2019, mainly through the transmission of the virus from their mothers during pregnancy, delivery, or breastfeeding (UNICEF, 2020). During this year, an estimated 95,000 children under the age of 15 died of AIDS-related causes globally and mainly in sub-Saharan countries (WHO and UNICEF, 2018).In Ethiopia, the precise prevalence of HIV infection in children is unknown. However, 19,000 children ages 0–14 years are supposed to live with HIV/AIDS in urban areas (EPHI P, 2021)

Since 2011, the global community has committed itself to accelerating progress for the PMTCT initiative to eliminate new pediatric HIV infections and improve maternal, newborn, and child survival within the context of HIV (WHO and UNICEF, 2021) Adherence to these practices is variable with better results obtained in developed countries than in developing countries (Stover j et , 2021). Not surprisingly, the continuum of care, the magnitude of PMTCT, and associated services including HIV testing and counseling and ARV prophylaxis are still very low in developing countries (UNAIDS W and WHO ,2019) In 2020, globally approximately 37.6 million people living with HIV and 700,000 children are born infected from their parents.

Every day there are nearly 1800 new Human Immune Virus (HIV) infections in children, more than 90% occurring in the developing world. Approximately 90% of these infections are associated with mother-to-child transmission (MTCT). In 2019, Ethiopia had over 100,000 pregnancies in HIV-positive women and over 12,000 HIV-positive (Tigabu W et al, 2018). Therefore, this study aimed to assess the knowledge, attitude, and practice of pregnant mothers toward the prevention of mother-to-child transmission of HIV(WHO,2015). Throughout history, mankind has observed and fought an invisible enemy of several pandemics; where a number of which were more disastrous to humans (Nadeem S et al, 2019).

Acquired immunodeficiency syndrome (AIDS) is a chronic disease caused by the Human Immunodeficiency Virus (HIV) and continues as an epidemic (Walker N et al, 2021). The most common routes of HIV transmission include sexual contact, blood contact, and mother-to-child transmission (MTCT). MTCT is vertical transmission from HIV-positive pregnant women to their neonate during pregnancy, labor, delivery, or breastfeeding and is the most common mode of transmission in children (Rogers A et al, 2020). It’s succumbed to many people throughout the planet since it was first recognized in the early 1980s and no continent is spared of the pandemic (Mc Farland W.et al, 2018).

In African countries showed that there was a low level of knowledge (Haghdoost, Samira Navazandeh). The various economic crises that have hit African countries as well as the following structural adjustment policies from mid-80s had a serious impact on the creation of jobs and services (Lachaud J-P. L.; 1989. Etude sur le secteur informel en Afrique.; 2008). Consequently, an exponential increase of population impoverishment and informal activities were observed (Union Africaine.; 2008).

The latter will develop and spread in all sectors of activity, including health sector. Following the impoverishment of populations in low-income countries, they mainly resort to the informal health system for their health cases management. This massive recourse was explained by its geographical proximity, its financial accessibility and the flexibility of the mode of payment which is practiced there, as well as the reduced waiting times [Journal de gestion et d’économie médicales 2015].

In Cameroon, coverage rate of antiretroviral prophylaxis is low despite the involvement of the state and other developing partners. The prophylaxis has progressed slowly from 2005 (4.2%) to 2007(10%). Meanwhile. The national Demographic and health Survey in 2004 revealed that 98% of women in the general population had heard about HIV national institute of statistics (INS) and ORC Macro.

Some authors have argued that most of the knowledge on specific aspects of PMTCT is spare among women of reproductive age (Neves LAS, Gir E). The economic crisis of the 1980s led to the reduction of public health expenditure. These decrease from about 5% of the national budget in 1994 to less than 3% in the following years (National Institute of Statistics). Third Cameroon Household Survey 2007. The immediate consequence was the deterioration of the health system and the quality of care and the parallel exponential rise of a vast network of informal health providers (Wogaing J.; 2010).

This huge informal health network includes several actors: street medicine vendors, traditional healers and Informal Health Centers (IHCs). In 2017, the Ministry of Public Health made a census of 3,058 informal health facilities operating on the national territory (Ministry of Public Health. Assainissement de la carte sanitaire 2017). They operate without an official act of creation or operation issued by the government. However, they are subject to taxation which seems paradoxical. These IHCs, despite their limited technical facilities, generally provide a wide range of services, integrating antenatal consultations and childbirths services (Ekane G, et al. IJTDH 2015).

Antenatal 68 consultations (ANC) are an essential aspect for the prevention of HIV transmission from mother to child (PMTCT), since it represents a critical entry point into the PMTCT cascade (Turan JM,  et al. 2015). Especially in our context, client demand-based HIV (Psaros C, Remmert JE, et all, 2015). Moreover, ANC is all the more important since the majority of pediatric HIV cases result from mother-to-child transmission (Embree J.; S2005).

Currently, nothing is known about PMTCT activities concerning the ICHs in Cameroon.  As part of the ECIP PMTCT study, carried out in the cities of Douala and Ebolowa, we evaluated PMTCT in informal health centers. This paper aims to present the current state of PMTCT in IHCs in these two cities. Specifically, this work involved analyzing the PMTCT offer and assessing knowledge and practices of PMTCT. We also determined factors associated with the “insufficient” knowledge and practices among Healthcare Providers (HP) in the IHCs.

Statement of the problem

HIV continues to be a major global public health issue. After five decades of its emergence, in the year 2021 children of fewer than 15 years of age of living with HIV, acquiring HIV and dying from HIV related causes were 1.7 million, 160,000 and 98,000 respectively. In the same year women who live with HIV, acquiring (newly infected) HIV and dying from HIV related causes were 19.7 million, 64,000 and 240,000 respectively.

Mother To Child Transmission (MTCT) of the virus can occur in the uterus during pregnancy, in the birth canal during delivery (intrapatum), and after birth through breastfeeding. In low-income society prevention of mother to child transmission is complicated since breastfeeding is the only available means of feeding the new born.

The enormous benefits of breastfeeding such as preventing malnutrition, saving money, energy, cost and decreasing the infection will be missed. In the absence of any intervention, the risk of Mother To Child Transmission (MTCT) of HIV among non-breastfeeding populations is 15%-30%; breastfeeding by an infected mother increases the risk by 5%-20% to a total of 20%-45%. Some studies showed that breastfeeding during also increases the risk of transmission by 30%- 45% if there is breastfeeding through 18 months-24 months.

In some studies, the researcher argued that the knowledge of HIV transmission confined to sexual transmission of HIV, while knowledge on the prevention of vertical transmission is inadequate among women of the reproductive sage. Therefore, the purpose of this study is to assess the knowledge and practice of mother to child – transmission of HIV/AID amongst pregnant women in the mile 16 Bolifamba community.

Objectives

General objectives:

To assess the knowledge and practice of mother to child transmission of HIV/AIDs amongst pregnant women in the mile 16 Bolifamba community.

Specific objectives

• To assess the knowledge of mother to child transmission of HIV/AIDS among pregnant women at the mile 16 Bolifamba community.
• Identify factors associated with mother to child transmission of HIV/AID among pregnant women at the mile 16 Bolifamba community.
• To identify the challenges face by pregnant women in the prevention of HIV/AID from mother to child at the mile 16 Bolifamba community.

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