Mother to child HIV transmission is the spread of HIV from a woman with HIV to a child during pregnancy, child birth or breast feeding through breast milk.The health status of mothers and children is an important indicator of the overall health and wellbeing of a country (UNITED NATIONS 2010)Acquired immune deficiency syndrome is caused by the Human immune deficiency virus type 1 (HIV1). There are two types of HIV viruses which are common in sub-Saharan Africa and throughout the world.
HIV 2 is common in west central Africa, parts of India and Europe. AIDS represent one of the most serious health crisis in the world, contributing to more than 35 million deaths so far. In 2017, 940,000 people died from HIV- related causes globally. There are approximately 36.9 million people living with HIV at the end of 2017 with new 1.8 million people becoming newly infected in 2017 globally. 59% of adults and 52% of children living with HIV were receiving lifelong antiretroviral therapy (ART) in 2017 and Global ART coverage for pregnant and breastfeeding women living with HIV is high at 80%.
(WHO 2018)According to the Kenya Demographic Health survey (2014) , 89% of women and 87% of men know that HIV can be transmitted through breastfeeding, 76% of women and 68% of men know that the risk can be reduced by mothers taking special drugs during pregnancy and 72% of women and 62% of men both know that HIV can be transmitted through breastfeeding and the risk can be reduced by taking special drugs during pregnancy.According to WHO 2007, women currently represent the population with the fastest increase in HIV infection rates, 1400 children under the age of 15 are infected with HIV every day.Kenya has the fourth-largest HIV epidemic in the world together with Uganda and Mozambique (Kenya HIV statistics 2018) with 1.6 million people living with HIV in 2016 and 36,000 recorded deaths from AIDS- related illnesses. HIV has continued to be a growing problem in public health since 1984.It has continuously impacted the economy negatively with the government spending heavily on medication.Prevention of mother to child transmission of HIV has become an important intervention in the control of HIV and AIDS in Kenya with initiatives made to improve maternal and child health survival. Currently HIV infection cannot be cured. However, ARV drugs can control the virus and help prevent transmission. It can also be reduced by interventions that include ARV prophylaxis given to women during pregnancy and labour and to the infant in the first 6 weeks of life. Recently developed countries have advised HIV-positive mothers to avoid breastfeeding and to give their children milk formula.Mother to child HIV transmission occurs vertically at 95% in developing world (Mamatha M.Lala, 2010)In the intranatal period, risk factors for increased transmission are mode of delivery, prolonged contact with maternal blood or cervico vaginal secretions, prolonged rapture of membranes, chorioamnionitis invasive procedures like episiotomy, instrumental delivery and low levels of maternal antibodies make prematurity a risk factor for increased transmission.In postnatal period, risk factors are breastfeeding, new seroconversion of mother, high viral load, and low CD4 cell count. In the absence of any interventions, rates of MTCT of HIV 1 can vary from 15 ” 30% in developed countries, the difference mainly attributed to infant feeding practices that comprise almost universally of breastfeeding for prolonged duration (Mamatha M. Lala 2010)Risk factors for mother to child HIV transmission In pregnancyPoor maternal nutritionSexually transmitted infectionsAnaemiaHigh maternal viral loadDuring labour and deliveryPremature rapture of membraneHigh maternal viral loadChorioamnionitisLow birth weightBreak in skin or mucous membraneInvasive procedures such as episiotomyBreastfeeding periodLong breastfeeding periodMixed feeding e.g introduction of food and fluids in addition to breastfeedingCracked nipplesOral thrush and sores in the babyTo reduce the rate of new HIV infections in children, intervention measures such as Family planning to reduce the rate of unwanted pregnancies in HIV positive women, care during labour, pregnancy and delivery, and during breastfeeding.1.2 Problem statement Mother to child transmission of HIV is responsible for about 20% of all HIV transmission and more than 90% of worldwide paediatrics HIV infection (UNAIDS 2010). The burden of HIV in Kenya accounts for an estimated 29% of annual adult deaths, 20% of maternal mortality and 15% of deaths of children under the age of 5 (NACC, 2014). In 2017, 180,000 children became infected with HIV far from the 2018 target of eliminating new HIV infection among children. Without any measures taken to reduce the transmission, the HIV positive mothers will transmit the virus to their children. HIV /AIDS associated illnesses are responsible for up to 10 % of childhood mortalities in Africa (WHO 2006).1.3 Research questionsWhat is the level of knowledge on prevention of mother to child transmission of HIV among mothers attending Makadara maternity?What are the current methods in preventing mother to child HIV transmission in Makadara maternity?What is the information given to pregnant women before they give their consent for HIV testing?1.4 Purpose of the StudyA study to assess the knowledge of mothers on mother to child HIV-transmission in Makadara MCH Nairobi county was to gather comprehensive knowledge and describe current preventive methods.The target population is continuously exposed to comprehensive information, education, programmes and education materials through focused antenatal clinics to increase their level of general knowledge on prevention of mother-to-child HIV transmission.The findings of this study may inform health workers, educators and policy makers in designing appropriate health education and policies for women. This should increase the levels of knowledge and practices regarding PMTCT among women, resulting into better access and utilization of PMTCT in Makadara. This should eventually result into reduced MTCT and improved maternal and child health.1.5 Research objectivesBroad objectiveTo determine the knowledge on prevention of mother to child HIV transmission among mothers attending Makadara MCH clinic in Nairobi. Specific ObjectiveTo know the current methods used to prevent mother-to-child HIV transmission among mothers attending Makadara MCH in Nairobi. To know the level of knowledge mothers attending Makadara MCH in Nairobi have on prevention of mother-to-child HIV transmission.To determine the nature of information given to mothers before HIV test is carried out on them. CHAPTER TWO: LITERATURE REVIEWMother to child HIV transmission is responsible for about 20% of all HIV infections, but is the rout through which almost all paediatric infection occurs. MTCT can occur during pregnancy, labour or breastfeeding. Advanced maternal disease, acute maternal infections during pregnancy and lactation, and co-morbidity with STDs increase the risk of transmission (UNAIDS, 2011)During breastfeeding, a further 5-15% of infants will be infected. This may be through cell-free or HIV-infected cells in milk. The immaturity of the gastrointestinal tract and its damage by introduction of other foods may increase viral permeability (Newell, 1998).Generally women are at a greater risk of heterosexual transmission of HIV. According to UNAIDS 2009 women are twice more likely to become infected with HIV through unprotected heterosexual intercourse than men .In many countries women are less likely to be able to negotiate condom use and are more likely to be subjected to non-consensual sex.During labour and delivery, 10-20% of all children get infected. This is possible through placental tears, chorioamnionites, cigarette smoking, and use of illicit drugs which disrupt the placenta and cause micro-transfusion of maternal blood to the foetus (Newell 1998). The majority of people living with HIV/AIDS are women. Women aged 15 and older make up 58% of the 42 million people who are living with HIV/AIDS (UNAIDS, 2002). Over 90% of these women live in the developing world. Mother-to-child transmission of the virus, also known as vertical transmission is the main route of HIV infection in children under 10 years of age with more than 600,000 infants becoming infected with HIV yearly (UNICEF/UNAIDS 2006).Limiting infant exposure to infected maternal fluids (including blood, cervicovaginal fluid and breast milk has been shown to reduce the risk of MTCT similarly, ECS conducted prior to the onset of labour and membrane rupture, avoid infant exposure in the birth canal and reduce risk of transmission (Milligan, overbaugh 2014). Without treatment, when a mother has an HIV infection, the risk of transmission to her child is reported to be 20-40% (connor et al 2004). This has over the last two decades resulted in reversal of previous gains in child survival. Since the beginning of the epidemic, an estimated 5.1 million children worldwide have been infected (UNICEF/UNAIDS 2006), of those, the overwhelming majority are in Africa. This is due to high fertility rates and high HIV prevalence in pregnant women, reaching the level of 40% in some cases (UNICEF/UNAIDS 2006).Until recently, there was a means of preventing mother-to-child transmission for those HIV positive women who wished to give birth. Two interventions using AVR (Nevirapine and azidothymidine) concurrently with feeding adjustments have proven to be very effective in reducing mother-to-child transmission of HIV ( NASCOP 2001).The successful implementation of these programs is highly dependent on the choice and effective implementation of the appropriate food regimen.For a HIV negative mother, breastfeeding is preferred for child survival and to provide nutrients and avoid infectious diseases during the first two years of life. For a HIV positive mother complete avoidance of breastfeeding is considered the most reliable way to prevent infant transmission.According to Kenya Demographic and health survey 2014, the knowledge of mother-to-child HIV transmission is lowest among women aged 15-19 (59% &50% respectively) and the knowledge of transmission through breastfeeding and MTCT- reducing drugs increases with increasing education and wealth.The national prevention of mother-to-child transmission (PMTCT) of HIV strategy is the current initiative geared towards improving the health of HIV infected mother and reducing the transmission to the foetus during pregnancy, labour and delivery and during breast feeding. Labour and delivery poses the greatest risk of transmission with 10-20% of exposed infants becoming infected at the time (NASCOP 2002). The country has made significant efforts in prevention of mother to child HIV transmission with initiatives such as beyond zero campaign launched by the first lady Margaret Kenyatta, whose aim is to promote access to quality maternal and neonatal healthcare services, championing country validation for the pre-elimination of the mother-to-child transmission of HIV by 2021. Her leadership has been instrumental in raising awareness on the importance of services to promote the health of mothers and children including HIV prevention.Kenya has also made significant progress in preventing new HIV infections among children, which fell from an estimated 13,000 in 2010 to 8,000 in 2017. This has been made possible through other programmes such as the mentor mother initiative, which supports and cares for women living with HIV, the mother-baby pair approach, which synchronizes appointments for the mother and the child at the health facility, and audits every child exposed to HIV in order to identify barriers in accessing health facility. Effective prevention of mother to child HIV transmission needs three strategies which include:Prevention of HIV transmission from a positive mother to their unborn child during pregnancy, labour and delivery (children , HIV and AIDS 2008).Avoiding unwanted pregnancies in HIV positive women.Providing treatment, support and care to HIV positive women and their infants.ANTIRETROVIRAL DRUGS AND TREATMENT FOR THE MOTHERLifelong ART is recommended for all HIV infected pregnant women and those who are breastfeeding despite of gestational stage and WHO clinical staging.The drugs are(1) EFAVIRENZ(EFZ) + TENOFOVIR (TDF) + LAMIVUDINE (3TC) as the 1st line regimen.PROPHYLAXIS FOR HIV EXPOSED INFANTSAll HIV exposed infants should receive for a minimum of 12 weeks from the time of diagnosis. They should be initiated on NEVIRAPINE (NVP) syrup+AZT (ZIDOVUDINE).The infants should be initiated on the drugs at birth or as soon as they are confirmed to be positive.AZT +NVP should be given for the 1st 6weeks ,then NEVIRAPINE continued for an additional 6weeks.Infant cotrimoxazole should be started from 6 weeks of age.IMPACT OF HIV/AIDSHIV has an effect on food security, health and education sectors in the society and mortality trends.On health sectorThe amount of money spent on buying the drugs strains the health budgets and systems. If the health workers are the ones affected, they miss work leading to shortage of staff and overburdening other workers.Impact on food securityHIV/AIDS is a threat to food security since the affected people are no longer productive . farmers affected will stop attending to their farms leading to food shortages.On educationThere will be a decline in the number of children attending school, since some of them will be orphaned with nobody to pay their fees and others forced to drop out in order to take care of their sick