HOW ACCEPTABLE ARE THE PREVENTION OF MOTHER TO CHILD TRANSMISSION (PMTCT) OF HIV SERVICES AMONG PREGNANT WOMEN IN A SECONDARY HEALTH FACILITY IN IBADAN, NIGERIA?

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F.M. Balogun and E.T. Owoaje

Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria.

Abstract

Background: Prevention of mother to child transmission of HIV (PMTCT)
programme was designed to reduce mother to child transmission (MTCT) of
HIV and it has been shown to be effective. However, the uptake of the services is still very low in Nigeria.

Objective: This study was designed to determine how acceptable the different services of PMTCT are to pregnant women in Ibadan, Nigeria.

Method: Systematic random sampling was used to recruit 500 pregnant women attending antenatal clinic in a secondary health facility. Questionnaires were used to obtain data regarding socio-demographic characteristics, knowledge about MTCT of HIV and prevention, the awareness and attitude towards infant feeding options for HIV positive mothers. Data were analysed using student’s t test and Chi-square test with p set at 0.05.

Results: Mean age of respondents was 27.4±6.1years. Most known routes of MTCT of HIV were during pregnancy (86.0%) and from breastfeeding (86.0%). More than 80% knew that having good antenatal care, appropriate supervised delivery, taking antiretroviral drugs and not breast feeding a baby are ways of PMTCT. About two thirds had a positive attitude towards HIV testing and counselling (HTC). Only 18.4% were aware of the exclusive breast feeding option for feeding infants of HIV positive mothers while 52.2% would not comply if asked not to breast feed. Women aged 35 years and above had better attitude towards non breast feeding.

Conclusion: Intensified health education on the importance of HTC and promotion of exclusive breast feeding for infants of HIV positive mothers is recommended.

Introduction

The Prevention of Mother to Child Transmission of HIV (PMTCT) programme which was started in 2001 by the World Health Organization (WHO) aimed to reduce the spread of HIV from mother to child, as it is known that more than 90% of paediatric HIV infection is from mother to child transmission of the virus.¹ The programme comprises of interventions which include comprehensive antenatal care aid safer delivery practices, HIV testing and counselling (HTC) (which is conducted in antenatal and labour ward settings), use of antiretroviral drugs(ARV) infant feeding, counselling and support.²

More than 60% of the global burden of paediatric HIV is found in sub-Sahara Africa which has just 13% of the world’s population.³ In Africa, some factors which contribute to the high burden of paediatric HIV infection include the high rate of maternal HIV infection, high birth rates, lack of access to currently available and feasible interventions, and the widespread practice of prolonged breastfeeding.¹ The transmission risk for a child born to an HIV infected mother in an African setting without intervention for prevention of mother to child transmission is about 25-45% during pregnancy, delivery and breastfeeding² compared to less than 2% in developed countries where necessary interventions are readily available.¹ In the absence of breastfeeding, transplacental (intrauterine) infection accounts for 25-40% risk and peripartal infection for 60-70% risk of vertical infection of HIV.³ Breastfeeding alone carries 8-25% risk of vertical transmission in developing countries.

Nigeria has the highest paediatric HIV burden worldwide.⁴ There were 56,681 HIV positive births in the country in 2009 contributing 15.3% of the 370,000 global new paediatric HIV infections for that year.⁵ PMTCT started in Nigeria in July 2002 with the goals of providing effective PMTCT services for women of reproductive age in selected health facilities. Efforts have been made to scale up these services over the years but these efforts have to be greatly intensified as indicators from the 2008 National Demographic Health Survey ⁶ still showed poor utilisation of PMTCT services among Nigerian pregnant women even when they were made available.⁶ Most pregnant women still do not have supervised pregnancies and a lot of deliveries take place outside health facilities.⁶ Studies have shown that Nigerian women are willing to undergo HIV Testing and Counselling (HTC) especially if it will help to protect their unborn baby from getting HIV infection.^7,8 HTC is the entry point to the services of PMTCT as the HIV positive mothers are given the appropriate care they required to protect their unborn child and have better quality of life while the HIV negative ones are taught how to stay negative.

The new national guideline on PMTCT now recommends exclusive breastfeeding for six months for infants of HIV positive mothers while the baby or mother continue to use ARV.⁹ The baby’s chance of survival is increased because of good nutrition and other protective factors from the mother who usually is neither able to afford formula nor meet the demands of ensuring its safe preparation. Breastfeeding is a culturally acceptable way of feeding infants in most African countries including Nigeria. The new recommendation which favours breast feeding should remove the burden of fear of stigmatisation from HIV positive mothers as the formula feeding option has raised suspicion of their being HIV positive in the past.¹⁰ In 2011 in Nigeria, it was estimated that only 17.1% of HIV infected pregnant women received ARV.5 Even though this represented a 45% increase from the proportion of pregnant women who received ARV for prophylaxis for mother to child transmission (MTCT) of HIV in 2010, it is still a far cry from the universal access of 80% that is being advocated as a step towards elimination of MTCT of HIV.¹¹

Knowledge and attitude about health services are basic factors which are important determinants of the acceptability of such services.¹² Therefore an insight into these factors will help in assessing acceptability of PMTCT services. There are obviously various factors affecting the uptake of PMTCT services by pregnant women which need to be explored. This study was carried out to determine how acceptable the different services of the PMTCT of HIV programme are to the pregnant women utilising them as this can determine the level of uptake of these services.