Abstract

Mother-Child Transmission of HIV (MTCTH) is a major public health challenge in Cameroon. Monitoring and evaluating of the rate of HIV transmission among infants born to HIV-positive mothers are the major indicators to understand the performance of a national HIV control program. However, this is not well documented in Bonassama health district.

The main objective of this study was to investigate the prevalence and risk factors of HIV transmission from Mother-to-child. In order to achieve the study objective, simple and convenient random sampling techniques were used to sampled nursing mothers and their infants using a structured questionnaire at the Bonassama health district. Collected data were analysed using SPSS (24.0) where descriptive statistics of variables were calculated.

Findings revealed the mean age of the respondents was 25±1.2 years. (38.33%) of the mothers were between the age group 21-30yers. (46.67%) of the mothers had achieved a secondary level of education, with (53.33%) married with (48.3%) having 3-4 kids.

Infant seroprevalence of HIV infection to be (16.67%). Clinical factors such as Mother’s ANC visits, HIV status of the mother, presence of an STD, and administration of ARV prophylaxis had a statistically significant relationship with the seroprevalence of HIV transmission of MTCT.

Demographic characteristics such as place of birth, mode of delivery, and age of the mothers had an influence on the rate of transmission of HIV infection from mother to child. It was concluded the risk of HIV infection among infants born to HIV infected mothers was high in the study area. Hence, early screening, mothers counselling and early introduction of ARV prophylaxis were recommended to reduce the risk of HIV infection among infants born to HIV infected mothers.

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

By the end of 2007, an estimated 2.1 million children younger than 15 years of age were living with HIV and 90% of these children were infected through mother-to-child transmission of HIV.

In the same year, 290 000 children younger than 15 years of age died of HIV-related causes (WHO, UNICEF & UNAIDS, 2008). Sub-Saharan Africa, of which Cameroon is part, accounts for about 76% of all children living with HIV globally (WHO et al, 2008). In East and Southern Africa, HIV is the leading cause of death among children aged five and below.

It is affecting the general health of children, especially in countries with high burdens of HIV (Stringer et al, 2009).  The WHO, UNICEF and UNAIDS (2009) assert that, beyond the goal of ensuring an HIV and AIDS-free generation, global action to prevent the mother-to-child transmission of HIV directly supports achieving the Millennium Development Goals (MDG) 4, 5 and 6.

The MDG 4 target is to reduce by two thirds the mortality rate of children younger than five years. The WHO, UNICEF and UNAIDS further state the need to reduce by three quarters the maternal mortality ratio (MDG 5) and halting and beginning to reverse the spread of HIV/AIDS (MDG 6) by 2015.

According to African Network for the Care of Children by AIDS (ANECCA, 2004), HIV/AIDS accounts for 7.7% of mortality worldwide in children under five years of age, while AIDS already accounts for a rise of more than 19% in infant mortality and a 36% rise in under-five mortality.

The WHO, UNICEF and UNAIDS (2009) state that the use of antiretroviral drugs to prevent HIV transmission is emerging as a potential set of interventions for prevention.  Antiretroviral drugs, combined with HIV testing of pregnant women and appropriate infant feeding practices, are already being used to prevent HIV transmission from pregnant women to their children.

The guidance also exists on the use of antiretroviral drugs for post-exposure prophylaxis, and research is ongoing on their use for pre-exposure prophylaxis. The same report continues to provide observational evidence that antiretroviral therapy may reduce the sexual transmission of HIV in generalized epidemics, especially among discordant couples (WHO., 2009).

The Global HIV Prevention Working Group (2006) asserts that HIV rates continue to be disturbingly elevated with more than four million people infected annually. The authors state that for women, despite the availability of effective existing interventions, only “one in five people” in the high-risk groups have access to effective interventions. As a result, many existing approaches continue to be difficult to access for women (Global HIV Prevention Working Group, 2006).

The progress report, towards universal access: scaling up priority HIV/AIDS interventions in the health sector (WHO et al, 2009) reports a continuously increasing number of women, infants and children living with HIV every year, and that the HIV epidemic continues to radically affect their health, livelihood and survival across regions.

The report further estimated the number of women living with HIV to have increased from 14.1 million in 2001 to 15.5 million by 2007. The authors state that in sub-Saharan Africa, women now account for almost 60% of the adults living with HIV, although in other regions women continue to represent less than half of all people living with HIV. While globally the percentage of adult women aged 15 years and older among people living with HIV has stayed steady at 50% for the past 10 years (WHO et al, 2009); they further describe HIV as the primary cause of mortality among women of reproductive age worldwide.

HIV can affect mortality both directly and indirectly; and contributes to deteriorating pregnancy outcomes as an underlying cause of maternal death. A study from Zimbabwe found that HIV accounted for 27% of reported maternal deaths in 2006 (WHO et al, 2009).

1.2 Statement of the problem

HIV transmission from mother to child has been a serious public health problem and over 70% of children are suffering from mother to child transmission of HIV according to the UNISAID/WHO AIDS epidemic update 2009, an estimate of 430000 children were newly infected with the HIV virus in 2008 in the world more than 90% of them through vertical transmission from their mothers (without treatment more than 50% of these children will die before their second birthday.

Protection of mother to child transmission (PMTCT) of HIV is a key to the reduction of mortality and morbidity due to HIV infection in children .91.1% transmission rate from mother to their infants has been archived true early access to HIV treatment by pregnant women, elective caesarian and infant formula feeding.

According to WHO with specific interventions in the non-breast feeding population, the risk of MTCT can be reduced less than 2% and to 5% or less in breastfeeding and infants population in the society. One of the major impediments to the implementation of PMTCT in our setting is the fact that a great number of pregnant women in this area do not attend an antenatal clinic, turn to deliver their babies out of health facilities and thus have no or poor compliance to PMTCT program. it is, therefore, crucial to improving public awareness on the importance of antenatal consultation and PMTCT interventions for pregnant women.

There is also a need for more effective counselling of the mothers already enrolled in the PMTCT program in other to improve the precocity of HIV PCR testing and the completeness of the Early Infant Diagnosis process.

However, this study which is one of the rare ones on PMTCT all over the country provides some relevant new insights on MTCT in Cameroon. Further studies are needed to evaluate all the key steps in the cascade Early Infant Diagnosis and care process in Bonassama health district and in other sites in Cameroon, in other to identify the local obstacles that have to be overcome to achieve effective PMTCT and HIV care programs.

1.3 Research questions

1. What is the prevalence of HIV among known PMTCT-exposed infants in Bonassama health district?
2. What specific mother clinical indications play a role in the PMTCT program outcome?
3. What are the major Socio-demographic indicators contributing to the low coverage of PMTCT services in Bonassama district hospital?

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