The effectiveness of prevention of mother-to-child transmission (PMTCT) of Human Immunodeficiency Virus (HIV) at St.Martin De Porres Hospital, Agomanya

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Women of child bearing age constitute nearly half of the over 40 million adults currently living with HIV/AIDS world-wide. The increasing number of HIV infected women and children has implications for a sustainable health care and society. Integrating a comprehensive prevention of mother- to- child transmission (PMTCT) services (including prevention and treatment interventions) may significantly reduce the number of infants who are HIV infected. The aim of the study was to establish the effectiveness of PMTCT programme (Antiretroviral treatment and prophylaxis, safer delivery practices and safer infant-feeding practices) started at the St. Martin De Porres hospital in 2002. This was a retrospective study. The study aimed at all pregnant women who agreed to Voluntary Counseling and Testing (VCT) whilst attending antenatal care (ANC), tested positive for HIV, attended ante-natal, delivered at the hospital and attended post natal care till the status of the infants were determined from 2002-2007. Folders of all the women who exhibited all of the above characteristics were retrieved from the records section and the following data; demographic characteristics, antiretroviral (ART) treatment prescribed during ANC and delivery, type of delivery, ART prophylaxis for infant, feeding practices and status of the child after 18months collected. From 2002-2007, a total of six thousand, three hundred and fifty-five (6355) patients’ agreed to VCT whilst attending ANC. Eight hundred and forty nine (849) tested positive for HIV and two hundred and five (205) delivered at the facility. However only forty (40) women exhibited all the characteristics for inclusion into the study. Twenty-seven, (67.5%) of the pregnant women were administered with a single dose of Nevirapine and 5 (12.%) took a combination of Zidovudine (AZT) and Lamivudine (3TC) combination. Thirty-seven, (92.5%) of the pregnant mothers had spontaneous vaginal delivery and three (7.5%) had caesarean section. All the 40 HIV exposed babies received antiretroviral prophylaxis. Twenty-seven (67.5%) of the mothers exclusively breastfed their infants for six months, five (12.5%) practiced replacement feeding whilst, eight (20%) practiced mixed feeding. Eighteen months after delivery, thirty (76%) of the children tested negative, and ten (25%) tested positive. All these ten (100%) HIV positive children were born through spontaneous vaginal delivery. Also eight (80%) of the HIV positive children were mixed fed. The prevention of Mother-to- Child Transmission (PMTCT) of HIV programme at St. Martin De Porres hospital is effective, about three quarters of the children born to 40 HIV positive women tested negative to HIV. However a high proportion of children who were mixed fed were HIV Positive. Mixed feeding should be avoided completely in the first six months because the immune system of the child is not well developed and may result in recruitment of white blood cells into the gastrointestinal tract, providing additional target for HIV infection. However a limitation of the research was the lack of follow-up of the HIV positive children after the eighteen months test.
A thesis submitted to the Department of Clinical and Social Pharmacy, Kwame Nkrumah University of Science and Technology in partial fulfillment of the requirements for the degree of Master of Science