A CRITICAL INVESTIGATION OF THE PREVENTION OF MOTHER TO CHILD TRANSMISSION OF HIV (PMTCT) PROGRAMME AND ITS EFFECTS ON MATERNAL AND CHILD HEALTH AT ALOBA GENERAL HOSPITAL, OYO STATE

CHAPTER ONE

INTRODUCTION

1.1 Background Of Study

The human immunodeficiency virus (HIV) is a virus that weakens an individual's immune system, exposing them to a variety of opportunistic infections. Although unprotected sexual contact is the primary mechanism of HIV transmission, there is also a large amount of vertical transfer from mother to child. When HIV is transmitted from the mother to the child during pregnancy, childbirth, or breastfeeding, it is known as mother-to-child transmission (MTCT) [1–3]. In poor countries, the prevalence of HIV/AIDS has risen dramatically since the 1980s. As a result, it has had a variety of demographic, economic, and social ramifications. More than 2 million children worldwide are infected with HIV/AIDS, with more than 80% of them living in Sub-Saharan African nations. In 2012, for example, 260,000 new pediatric HIV infections were reported, the majority of which occurred in Sub-Saharan Africa. Southern and Eastern African countries are the most severely affected areas in Africa. As a result, the United Nations Programme on HIV/AIDS (UNAIDS) has established a target of 90-90-90 by 2020. By 2030, the goal is to put an end to HIV epidemics. The post-2015 HIV priorities aim to drastically reduce the number of new HIV infections each year, saving the lives of many people in the process.

Approximately forty million people worldwide are infected with HIV. This equates to around 1% of the world's population. In 2006, around 4.3 million new HIV infections were reported worldwide. Women account for 48 percent of all AIDS patients worldwide, with 59 percent in Sub-Saharan Africa. More than 60% of Nigeria's population is thought to live in rural areas, with the majority of them being underserved in terms of social amenities. In addition, service facilities, notably secondary and tertiary health facilities, are concentrated in metropolitan areas. The 38 percent universal coverage of highly active antiretroviral therapy (HAART) for HIV-positive pregnant women in Oyo State falls significantly short of the aim of 80 percent. In most health facilities in Oyo State, postpartum women have access to a restricted comprehensive intervention package. The AIDS Prevention Initiative in Nigeria (APIN) project, which was financed by the President's Emergency Plan for AIDS Relief, provided PMTCT interventions in several facilities in Oyo State (PEPFAR). In Oyo State, child survival is jeopardized due to a lack of access to preventative interventions.

Currently, there are 1,216 PMTCT service locations across Nigeria. In 2009, 18.7% of HIV-positive pregnant women got antiretroviral (ARV) drugs to minimize the risk of MTCT, up from 5.3 percent in 2007, indicating a considerable rise in PMTCT coverage, however ARV prophylaxis coverage during nursing remained low. Since 1995, providing ARV prophylaxis to HIV-positive pregnant women has avoided the infection of almost 350,000 children, resulting in a 24 percent decrease in newly infected infants.

HIV transmission from mother to child can happen during pregnancy (in utero), after delivery (intrapartum), or after birth (postnatally) via nursing. The use of ARVs, caesarean section before commencement of labor or rupture of membranes, and complete avoidance of nursing are all strategies to decrease MTCT during these periods. 7 When properly implemented, these combined therapies can lower the incidence of MTCT to as low as 1-2 percent. Without intervention, 30–45 percent of all infants delivered to HIV-positive mothers would be infected, with 10–20 percent contracting the virus through nursing. 9 Early infant diagnosis (EID) programs can be utilized to assess the impact of PMTCT and enhance survival rates significantly. This study looks into the PMTCT (prevention of mother-to-child HIV transmission) program and its impact on maternal and child health.

1.2 Statement Of Problem

The HIV/AIDS epidemic is one of the world's most severe health problems today. AIDS and AIDS-related illnesses had killed more than 25 million people by the end of 2008 (2 million in 2008 alone, including 280,000 children under the age of 15), and an estimated 35.8 million people were living with HIV, with 15.7 million women and 2.1 million children under the age of 15 living with HIV. In 2008, Sub-Saharan Africa continued to bear the brunt of the HIV and AIDS pandemic, accounting for about 67 percent of overall HIV infections, 68 percent of new infections, and 72 percent of AIDS-related fatalities. Over the years, the pandemic, which was previously dominated by infected men, has become more gendered, with women accounting for about 60% of HIV-positive adults in Sub-Saharan Africa. Mother-to-child transmission (MTCT) accounts for over 90% of infections in children, and as more mothers catch the virus, the number of children infected rises.

1.3 Objective Of Study

The following are objectives of this study:

1. To examine the mode of HIV transmission from mother to child

2. To examine how  HIV transmission affects maternal and child health

3. To investigate the preventive measures for mother to child transmission of HIV.

1.4 Research question

The following research guides this study:

1. What is the mode of HIV transmission from mother to child?

2. How can HIV transmission affects maternal and child’s health?

3. What are the possible preventive strategies for mother to child transmission of HIV?

1.5 Significance of study

The government, particularly the commissioner of health, will benefit from the study. Health-promoting activities and behavioral change should be encouraged through effective communication channels such as refresher courses, training, and workshops. This would go beyond the influence of focused health education messages on knowledge. In order to ensure progress in knowledge and behavior, further detailed studies on this topic should be conducted in various parts of Nigeria. This study will contribute to the current literature in this field and will also serve as a resource for academics, researchers, and students who may want to do future research on this or a comparable topic.

1.6 Scope of study

This study focuses on investigating the prevention of mother to child transmission of HIV (PMTCT) programme and its effect on maternal and child health. The study will further examine the mode of HIV transmission from mother to child; how  HIV transmission affects maternal and child health and also investigate the preventive measures for mother to child transmission of HIV. Hence, the enrolled participants for this study is obtained from Aloba General Hospital, Oyo state.

1.7 Limitation of study

Finance,inadequate materials and time constraint were the challenges the researchers encountered during the course of the study.

1.8 Definition of terms

Transmission: The action or process of transmitting something, or the state of being transmitted.

Hiv: HIV (human immunodeficiency virus) is a virus that attacks cells that help the body fight infection, making a person more vulnerable to other infections and diseases.

Child Health: Child health is a state of physical, mental, intellectual, social and emotional well-being and not merely the absence of disease or infirmity.

Maternal:This refers to a mother, especially during pregnancy or shortly after childbirth.