CHAPTER ONE
INTRODUCTION
BACKGROUND OF THE STUDY
Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) has a devastating effects and is currently a complication of pregnancy worldwide with more than 700,000 children infected annually. Mother–To–Child Transmission (MTCT) of the virus is responsible for more than 90 percent of these cases in children under 15 years (United States AIDS, 2012). (United States AIDS, 2012).
HIV transmission from mother to child (MTCT) can happen during pregnancy, labor and delivery, or breastfeeding. Approximately 5–8% of newborns become infected during pregnancy because to transmission via the placenta. Transmission is most likely during labor and delivery (10–20 percent of exposed infants). Breastfeeding risks the infant to HIV infection, especially if it is done for a long time (18-24 months).
The additional risk of HIV infection when and newborn is breast fed is roughly 15-25 percent World Health Organization (WHO, 2013) in partnership with other non-governmental organization like global fund, president’s emergency plan for Aids relief (PEPFAR) etc.
Feasible and inexpensive therapies already available to reduce the risk of MTCT by 50 percent (Population Reports, 2010). (Population Reports, 2010). The PMTCT process begins with pre-test counseling and continues through the HIV test, result, and enrolment in the intervention, as well as during hospital delivery.
The intervention (Nevira Pine) is given to both the mother and the infant at the same time when the baby is born in a hospital. The maternal dose of Nevirapine is given at the start of labor, and the baby dose is given within 72 hours of delivery.
In 2012, 438 HIV positive mothers joined for the PMTCT Ante-natal Clinic in Chiroma Ward, Lafia Local Government Area, Nasarawa State, and became PMTCT program beneficiaries; however, only 337 of the 438 stayed to attend the antenatal clinic to the end. Inadequate counseling and dropout have been reported in studies following the PMTCT protocol at various service delivery points, necessitating more research to determine the reasons for such behavior (Madaki, 2015).
Combs (2013) discovered that MTCT knowledge was lacking, as all moms transmit HIV to their newborns through breast feeding, according to individuals interviewed. Mothers lack knowledge about how to prevent HIV transmission from an infected mother to her kid, as well as available preventative strategies. In Nigeria, the incidence of HIV infection among expecting mothers is projected to be 30%, undoing previous advances in child survival programs and increasing newborn and child mortality rates in Chiroma Ward in Nasarawa State’s Lafia Local Government Area (FMOH, 2013). As a result, the number of Mother-to-Child Transmission Prevention Program locations has increased from 11 in 2002 to 622 in 2013. (Chiroma Ward in Lafia Local Government Area of Nasarawa State, 2009). According to a presidential decree issued in March 2010, coverage of mother-to-child prevention should grow to 30% by the end of 2010 and 50% by 2013, based on 2011 WHO standards. The Chiroma Ward in Lafia sentinel report revealed the highest HIV prevalence (10.6 percent ). According to estimates,
In underdeveloped or resource-poor nations, HIV in children is a big issue. In Nigeria, some 277,000 children live with HIV, accounting for 11% of the global pediatric HIV burden. Every year, between 65,000 and 117,000 HIV-positive infants are born. HIV infection is responsible for about 8% of all child deaths. This is due to the failure of the PMTCT (Prevention of Mother to Child Transmission) program (FMOH, 2013). The incidence of HIV infection in pregnant women in Chiroma Ward, Lafia Local Government Area, Nasarawa State, is estimated to be 24,620, with 1868 (1.04 percent statistically insignificant) receiving antiretroviral prophylaxis.
There were 3,328 HIV-positive pregnant mothers (1.86 percent) who received baby feeding advice and support (Federal Ministry of Health, 2012). This is reversing recent gains in the stock market.
STATEMENT OF PROBLEM
The burden of HIV infection has now become a hot topic around the world. On the planet, an estimated million people are afflicted with the virus, with 2,000 babies infected every day. The majority of new infections in various settings have aided in lowering the HIV infection rate. The nationwide HIV zero prevalence rate has demonstrated that the infection responds to focused and coordinated intervention.
Each year, HIV infects around 2.2 million women and 600,000 newborns around the world (UNAIDS, 2012). The number of infected children has increased dramatically since the first pediatric AIDS case was identified in 1985, and health treatment for these youngsters is becoming an increasing strain on the public health system (Philips, 2013). As a result, the PMTCT program was begun.
Johnson (2014) stated that if the health system has adequate resources and personnel, a successful implementation of the PMTCT program for a higher number of women is possible. This means that having the services available and using them properly will reduce or eliminate the risk of HIV MTCT. Unfortunately, research has revealed that a number of factors obstruct the availability and use of PMTCT. By implication, one could be tempted to dispute the availability and adequacy of PMTCT resources, as well as the extent to which pregnant women use these services. Skinner (2015) discovered that several clinics serving the local community were already understaffed and overburdened. However, it is well acknowledged that the availability and appropriateness of resources are critical in the use of PMTCT.
Despite an improvement over the 2003 rate, Nigeria’s HIV zero-prevalence rate of 4.4 percent in 2005 is still too high and unacceptable. In Nigeria alone, over 100,000 newborns were projected to get HIV from their mothers in 2004. (UNAIDS, 2011).
In the issues of early newborn HIV diagnosis, the PMTCT intervention remains the only sure and viable hope. In order to place a greater emphasis on prevention rather than care and treatment, the greatest unmet need remains the HIV PMTCT (UNAID, 2011).
As a result, it is critical to conduct this research in order to determine the quality of PMTCT clinic services as viewed by customers, which would help to reduce the incidence of HIV/AIDS in Chiroma Ward, Lafia Local Government Area, Nasarawa State.
Understanding the viewpoints of clients can also assist determine whether services are being offered in accordance with their needs, and if not, where improvements are needed.
OBJECTIVES OF THE STUDY
The goal of this study is to determine the factors that influence pregnant women’s use of PMCTC services at a clinic in Chiroma Ward, Lafia Local Government Area, Nasarawa State. It aims to do the following in particular:
(1) Determine the extent to which PMTCT is being implemented in Chiroma Ward, Lafia Local Government Area, Nasarawa State.
(2) Determine the number of skilled workers available for PMTCT implementation.
(3) Determine the number of clients who use the PMTCT services in Chiroma Ward, Nasarawa State’s Lafia Local Government Area.
(4) Determine the factors that influence HIV and AIDS PMTCT services.
SIGNIFICANCE OF THE STUDY
The information on the factors influencing the use of PMTCT services by health workers and parents may be useful in determining whether their local hospitals provide a full PMTCT program and advocating for improvements in accordance with the recommendations made for the benefit of mothers of childbearing age and their infants.
The information may also be useful to hospital administrators in reorganizing and training their staff in order to fully implement the PMTCT program in their hospitals and realize their responsibilities in providing health care to pregnant women, particularly those who are seropositive, and their children who have vertically acquired HIV.
The data gathered will assist service providers in becoming more motivated to raise awareness in rural regions about the need of prenatal care for expecting women. This may also assist hospital administrators in determining the capabilities of their employees, allowing them to support staff training and retraining for that reason.
The statistics gained from the amount of HIV testing service consumption may serve as a wake-up call to service providers, propelling them to strengthen measures to encourage pregnant moms to gladly take HIV testing. This may also serve as a motivator for hospital managers to provide all of the essential equipment and supplies for HIV testing services in their facilities. Their laboratory scientist, in particular, may be retrained in HIV testing.
The information gathered on the availability of PMTCT services could assist pregnant women in locating hospitals that offer the service. This will assist in increasing the target group’s utilization of services, as well as improving their quality of life.
The information will also aid service providers in enhancing public awareness campaigns about the importance of HIV-positive pregnant women using services. The information gathered could aid in determining the need for new PMTCT sites.
The results of the availability of qualified PMTCT service providers will assist hospital administrators in planning and implementing numerous approaches to training and retraining service providers in order to improve their skills. The information could potentially be useful.
The findings will aid hospital administrators in procuring additional PMTCT products. Donor agencies may be enticed to obtain these products for the hospitals as well. The information could also assist hospital administrators in requesting material assistance from the World Health Organization.
The data on the availability of certified PMTCT service providers will aid hospital management in recruiting and training more PMTCT service providers. The information could also aid the government in preventing service providers from seeking work in other nations. This will invariably put a stop to the county’s brain drain.
Service providers will be inspired and encouraged to raise awareness among pregnant women about the adequacy of PMTCT materials by receiving information on their suitability. The government will take action.
The data could also aid health-care practitioners in educating the public about the importance of antenatal care and deliveries aided by MTCT-trained attendants.
The data on the use of safer infant feeding options will assist service providers in advising HIV-positive expectant moms on how to make an informed decision about which safer feeding option is best for their newborns. Infants born to HIV positive mothers may benefit from informed and safer choices, which may improve their quality of life.
The data will aid PMTCT service providers in continuously improving their services and the way they work, as well as improving the coordination of the PMTCT program, resulting in changes in the way preventative treatments are delivered in practice. They will make decisions based on the facts.
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