Preventing Mother-to-child Transmission Of HIV In Nigeria

Preventing Mother-to-child Transmission Of HIV In Nigeria
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Chika Mefor-Nwachukwu

Mary Isaac, a 20-year-old pregnant woman walked into the Internally Displaced Persons (IDP) Camp at Durumi 1, in the Area 1 axis of the Federal Capital Territory (FCT) with discomfort written all over her face. She was in labour.

Isaac had come for the delivery without any delivery items except a bag that contained a single wrapper.

A native of Gombe State in North-Eastern Nigeria, Isaac had come to Abuja to seek greener pastures but fell pregnant for a man whom she had met while trying to settle down in the capital city. He had abandoned her for an unknown destination. She had no one but her neighbors to help her through the trying times.

She had decided to come to the camp to deliver her baby because she had no money to go to the hospital, which means that she had not accessed any Antenatal care (ANC).

The traditional birth attendant(TBA) who attends to the pregnant women in the camp tried her best to deliver the baby safely. Few hours later, Isaac and her baby headed home with no record of her delivery.

Now, if Isaac was a Person Living with HIV(PLHIV) without knowing it, she would be living in ignorant because she had not accessed any health care from the hospital during her pregnancy. It endangers her and her baby who possible might have contracted the virus. If Isaac had been able to access the antenatal services, mother-to-child transmission of the virus, would have been avoided. ANC can provide HIV testing and medications to prevent mother-to-child transmission of HIV.

Lack of access to the hospital and inadequate data  have become a hindrance in the Prevention of Mother-to child transmission (PMTCT) of HIV.

Speaking at a UNICEF funded workshop recently, Dr. Gbenga Ijaodola, of the Federal Ministry of Health lamented the fact that Nigeria has not been able to adequately collate data on pregnant women for many reasons.

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There are many pregnant women like Isaac who either deliver their babies at traditional birth places or faith based clinic. Many others deliver their babies at home.

Ijaodola stated that agencies in the country have resorted to working with estimates, because in most cases, pregnant women do not seek ante natal services.

According to the 2018 Nigeria Demographic and Health Survey (2018 NDHS) data, 59 per cent of pregnant women deliver at home and only 39 per cent deliver at health facilities. Two percent of these women deliver in other places like traditonal birth centers and Faith based clinic.

Ijaodola revealed that  3 in 4 pregnant women in Nigeria are not captured at antenatal care  adding that 63 per cent of HIV Positive women do not access PMTCT services.

“So many pregnant women especially those in the rural areas hardly go to the hospital for ante natal care(ANC), they patronize traditional birth attendants, because the health facilities are too far from them or they cannot afford to pay for the services of these facilities so they take themselves to traditional birth attendants(TBAs)”

“Three out of four pregnant women in Nigeria attend ANC, this  means over 40% of pregnant women don’t go for ANC at all. So the question is where do they give birth,  then how can the nation have a proper data of pregnant women, prevent HIV transmission of mother to child, when the pregnant women don’t even go for HIV testing?”, he asked.

He added that the key issue is to ensure that the nation is getting the accurate data to help it plan but added that the data cannot be gotten if the pregnant women do not go to hospitals for ANC.

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The implementation of effective PMTCT programs would require innovative strategies that leverage improvement of ANC uptake as an entry point for PMTCT.

Therefore, Nigeria through the Federal Ministry of Health has introduced the Hub and Spoke approach. According to Ijaodola, the approach helps in decentralization where the main hospital( the hub) is linked to various communities, surrounding  semi-urban and rural areas which are the spokes.

Explaining further, he stated that Community testers, HIV Testing Services Facilities and the TBAs, which represent the “spokes” in the communities provide HIV testing services  to pregnant women and link them to PMTCT facilities where anti-retroviral treatment and anti-retroviral prophylaxis of HIV exposed infants is provided. The facilities also provide early infants diagnosis and linkage to ART services postpartum.

“Thereafter, the pregnant women if they need more services would be linked to Comprehensive Art facility which is the “hub”. At the facility, full comprehensive HIV services, including ART and related services will be provided,” he explained.

He added that the  government to address data lapses in the country, it requires the federal, state and local government  to work together.

Ijaodola who spoke passionately about the importance of data in the PMTCT, also spoke of the need for the establishment and empowerment of local government team to address data, sample logging commodities and other relevant HIV services.

Also speaking during the media dialogue, Dr Atana Ewa, from University of Calabar, Teaching hospital at, lamented that HIV is a major cause of infant and childhood mortality and morbidity in Africa.

She added that according to recent report, over 1.9 million Nigerians is estimated to be living with HIV. In 2018 the incidence of HIV was estimated at 8per 10,000 persons.

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She stressed that, in order to prevent mother to child transmission, a mother cannot breast feed the child more than 12 months,  “A breast feeding mother who is HIV positive must know her viral load and must be taking her anti retroviral drugs.

“And no matter how much she loves breast feeding and the baby, she must stop at 12 months,  exclusive breast feeding for 6months and she continues but not beyond 12 months.

“The longer you breastfeed , the more you are increasing the chance of passing the virus. Even though she is on ART, let not do it too long, nobody knows the level of which infection can or can’t occur,” she said.

While mother-to-child transmission of HIV can be prevented, health experts still maintain that Nigeria has to get its data right. It is said that countries that do not understand the importance of data management are less likely to survive in the modern economy. And it is believed that the data of a country stands as its most valuable asset.

Experts say that Nigeria need to urgently link all its data sources to National Data  Repository (NDR) and incorporate PMTCT data to NDR.

A survey lead by the government indicates that there is a national HIV prevalence in the country of 1.4% among adults aged 15–49 years. Previous estimates had indicated a national HIV prevalence of 2.8%. UNAIDS and the National Agency for the Control of AIDS estimate that there are 1.9 million people living with HIV in Nigeria.


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