Maternal and fetal determinants of perinatal transmission of HIV among HIV positive mothers attending ANC at a northern Nigerian tertiary health institution
Objective: To ascertain the major determinants of perinatal transmission of HIV among HIV positive women attending ANC and delivery at the University of Maiduguri Teaching Hospital, Maiduguri.
Patients and methods: A prospective case control study of 52 HIV positive pregnant women who were attending ANC and delivery at university of Maiduguri Teaching Hospital (UMTH) was carried out. Known HIV positive mothers sent from the adult HIV clinic and those found during ANC HIV screening and diagnosis using rapid tests were recruited, while Fetal diagnosis of HIV was done using polymerase chain reaction (PCR) technique at 6 and/or at 12 weeks of birth age. Socio demographic and obstetrics history were obtained and analyzed using SPSS version 11 and test of significance was carried out using chi square tests.
Results: Of the 52 women that were found to be HIV positive, the perinatal transmission rate was 11.5%. Elective caesarean section (ELCS) was offered to 11(21.2%) and all the babies delivered through ELCS were negative for HIV. Advanced maternal age (X2 =33.53 P <0.001), Low CD4 count (X2 =15.58 P =0.016), high maternal viral load (X2 =21.85 P =0.005), prematurity (X2 = 9.872 P= 0.007), low birth weight (X2 = 63.80 P < 0.001) and birth asphyxia(X2 = 24.149 P< 0.001) were the major determinants of perinatal transmission of HIV infection in this study.
Conclusion: The perinatal transmission of HIV is high. Prompt identification of both maternal and fetal risks' factors and Effective interventions aim at minimizing the impact of these factors before or during pregnancy will help to lower some of the preventable determinants of perinatal transmission.
Recommendations: A prenatal and antenatal risks reduction strategy should be advocated. All effort should be geared toward identifying those positive and minimized or modify risks factors through behavior change, prompt initiation of treatment and prophylaxis for those found positive with a view to reduce the incidence of perinatal transmission.
Key Words: perinatal transmission, HIV, maternal, fetal determinants, Maiduguri