Rising antenatal care at TBAs fuels child HIV cases – Gynaecologists

Lack of antenatal care by many pregnant women has been highlighted by stakeholders in medical sciences as one of the major factors fueling the rising cases of Human Immunodeficiency Virus (HIV) infection among children.

They also noted that the patronage of traditional birth attendants by some pregnant women increases perinatal transmission (Mother-to-Child) transmission of the virus.

They were reacting to the United Nations Children’s Fund report on the 13 per cent rise in the cases of child HIV in Nigeria.

According to them, the major source of HIV infections among children is Mother-to-Child Transmission because some pregnant women, especially those that patronise TBAs, do not know their HIV status and so, cannot protect their babies.

According to HIVinfo.NIH.gov, a site specifically dedicated to HIV reports, Perinatal transmission of HIV is when a woman with the virus passes it on to her child “during pregnancy, childbirth (also called labour and delivery), or breastfeeding (through breast milk). Women were advised to get tested for HIV before they become pregnant or as early as possible during each pregnancy.”

Speaking exclusively with PUNCH Healthwise, a consultant gynaecologist and surgeon at the Epe General Hospital, Epe, Lagos State, Dr. Cynthia Okafor, said one of the major reasons for the rising cases of child HIV is the lack of antennal care among pregnant women.

According to her, many women do not go for antenatal care due to poverty and certain cultural beliefs and patronise TBAs despite the high risk associated with such action.

She said it is unfortunate that TBAs do not prioritize the need to ascertain the HIV status of pregnant women before helping to deliver their babies.

“The need for these women to know their status cannot be overemphasised. When the status of the woman is determined, it helps the attendant to know how the baby would be born,” she added.

Dr. Okafor said when an HIV test is conducted and the pregnant mother tests positive, then, she would be placed on antiretroviral therapy to prevent mother-to-child transmission.

She explained that ATR reduces the viral load of HIV in the mother’s bloodstream and renders the virus inactive so that the mother can no longer transmit the virus to her newborn.

“It takes a second for this lifetime damage to be done to a child. At birth, if the viral load of the HIV is not reduced and rendered inactive, the baby can be infected through contact with the infected mother’s fluid or blood.

“Before a woman gives birth, she loses water. There is a sac inside the uterus that is filled with a water-like fluid known as amniotic fluid. Its work is to protect the fetus.

“Remember that this woman is HIV positive and her fluids and blood are contaminated. So, when the amniotic sac ruptures, amniotic fluid comes out of the vagina, which is the same birth canal the baby will pass through.

“So, once this occurs, the risk of transmission increases. Anything that goes wrong here, the baby will be infected for life. If the water or the mother’s blood comes in contact with the baby’s eyes, it can be infected. You should understand that a baby’s eye contains tender and delicate blood vessels that may allow for a semi-permeable membrane,” she said.

The consultant gynaecologist further explained that the virus in breast milk can also be transmitted as a cell-free virus or cell-associated virus, saying that the quantity of virus and the viral load in the breast milk are the main determinants that affect the rate of transmission.

“Now, coming back to TBAs, when these women visit uninformed birth attendants, they are not tested for this and others. If the mother is positive, the baby will contract it through this process. Ordinarily, an HIV-positive mother goes through caesarean section instead of normal childbirth in order not to transmit the virus to the baby,” she added.

A recent report on women by the National Bureau of Statistics indicates that women in the northern part of the country receive less antenatal care when they are pregnant and that, unlike their counterparts in the south, they patronize TBAs instead of the hospital due to poverty and religious belief.

Meanwhile, a midwife at the Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Mrs. Joy Ibegbuna, highlighted some factors that make pregnant women, especially those residing in rural areas patronize TBAs.

She said, “Despite the TBAs’ limitations in handling some complications in childbirth, TBAs are widely accepted and patronised, especially in rural areas. Low socio-economic status, illiteracy, poor awareness of modern maternal health facilities, strong family influence and easy access to TBA services are some of the factors promoting patronage of traditional midwives, especially in rural areas.”

She noted that on average, only 56.8 per cent of pregnant women in Nigeria visit the hospital for their antenatal care, and they do for at least, four times during pregnancy.

Speaking on how HIV affects children’s well-being, Dr. Ovie Efekodo, said due to the fact that their immune system is not fully developed, they get more severely sick than adults.

According to him, HIV-positive children may experience the same common paediatric infections as HIV-negative children, but their bodies cannot fight the infections effectively.

He noted that common infections in HIV-positive children include ear and sinus infections, sepsis, pneumonia, tuberculosis, urinary tract infections, intestinal illness, skin disease, and meningitis.

“The most effective method for preventing MTCT of HIV is by placing HIV-positive pregnant women on ART as early as possible. There is no cure for HIV yet but early infant diagnosis is critical. Sadly, most children still do not have access to ART.

“Without diagnosis and treatment, one-third of infected infants will die before the age of one, and almost one-half before their second birthday,” Efekodo said.

UNICEF noted that the progress in HIV prevention and treatment for children and pregnant women across the world has reduced over the past few years.

UNICEF’s global snapshot on children with HIV and AIDS indicated that about 110, 000 children and adolescents between the ages of zero and 19 years died from AIDs-related causes in 2021 and another 310, 000 were newly infected, bringing the total number of young people living with HIV to 2.7 million globally.

The Associate Chief of HIV/AIDS, UNICEF, Anurita Bains said, “Children are falling through the cracks because we are collectively failing to find, test and get them on life-saving treatment. Every day that goes by without progress, over 300 children and adolescents lose their fight against AIDS in the world.

“Between 2014 and 2021, the number of new infections among children and adolescents aged 0 to 14 decreased globally by roughly 27 per cent, but rose by 13 per cent in Nigeria.”

Unless the drivers of inequities are addressed, UNICEF warned that ending AIDS in children would continue to be a distant dream in the country.

Similarly, the report said that in the last seven years, the percentage of pregnant women receiving lifetime ART grew slightly from 79 per cent to 81 per cent globally, but declined from 57 per cent to 34 per cent in Nigeria.

“In UNICEF’s HIV-priority countries, including Nigeria, ART coverage for children stood at 56 per cent in 2020 but fell to 54 per cent in 2021. This decline is due to several factors, including the COVID-19 pandemic, which increased marginalisation and poverty,” it stated.

However, the Director-General, World Health Organisation, Dr. Tedros Adhanom Ghebreyesus, said no child should be born with or grow up with HIV, and no child with HIV should go without treatment.

“The fact that only half of children with HIV receive antiretrovirals is a scandal and a stain on our collective conscience. The Global Alliance to End AIDS in Children is an opportunity to renew our commitment to children and their families to unite, to speak and to act with purpose and in solidarity with all mothers, children and adolescents,” he added.

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Author: Maxwell Dudu

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