Abstract

In Nigeria, it is estimated that 240,000 children are living with HIV; most of them became
infected through their mothers.5 Prevention of mother to child transmission (PMTCT) is an
important intervention in reducing the magnitude of Paediatric HIV.
The study was a cross sectional prospective study that evaluated the prevention of mother to
child transmission of HIV/AIDS outcomes in the Federal Medical Centre Owerri in Imo
State, South Eastern Nigeria. The study was conducted between July 2010 and April 2011
and a total of 157 mother-infant pairs were studied. The mothers attended antenatal clinic and
delivered their babies in the Federal Medical Centre, Owerri. The mothers were adequately
educated on the study and a written consent was signed by those who consented to be part of
the study. A questionnaire covering the PMTCT services was used to collect information on
the various strategies used by each individually recruited mother and child pair. Some of the
information obtained from the questionnaire was crosschecked with the mother’s hospital
records.
The mother- child pairs were seen in the paediatric infectious disease clinic during their
scheduled clinic visit days according to the national guideline. The child’s health status was
assessed at each visit and common infections, if present, were treated. Early infant diagnosis
was made using the DNA polymerase chain reaction test at six weeks of age for all the
exposed babies and repeated eight weeks after all exposure to breast milk has stopped for the
HIV PCR negative infants who were exclusively breastfed and for the infants who did mixed
feeding at a time. A dried blood sample for the test was done by collecting five drops of
capillary blood on a whatman 903 filter paper for each baby. The samples were dried and sent
for analysis at the virological centre of Nnamdi Azikiwe University Teaching Hospital at
Nnewi in Anambra State of South Eastern Nigeria.
The sex distribution of the study infants was males 72 and females 85 giving a male to female
ratio of 1:1.8. The mean maternal age was 29.01± 4.917 years. The PCR result showed that
5(3.2%) of the infants were HIV positive and 152(96.8%) negative. This gave a mother to child
transmission rate of 3.2% in the Federal Medical Centre Owerri during the study period.
Among the study infants, 2(1.3%) were post term, 8(5.1%) preterm and 147(93.6%) full term
deliveries. All the HIV positive infants were full term deliveries. No statistical significance
exists between gestational age and HIV status. (x2=0.351, p=0.839).
Most of the mothers, 143(91.1%), in our study gave exclusive replacement feeding to their
infants while 6(3.8%) did exclusive breastfeeding and 8(5.1%) practiced mixed feeding at
some time. There was an increased rate (25%) of HIV transmission documented among the
infants who did mixed feeding as compared to 2.1% found in those that did exclusive
replacement feeding(x2=13.093, p=0.001). The babies documented to have been exclusively
breastfed had HIV DNA negative results.
Highly active antiretroviral treatment with a three drug regimen was used by a majority of the
mothers in our study. The mothers on HAART were 117(74.5%) while 9(5.7%) were on
Zidovudine/Lamivudine and 14(8.9%) used single dose nevirapine while in labour. HAART
was commenced before the current pregnancy by 59(50.4%) of the mothers while 58(49.6%)
of the mothers commenced HAART in the current pregnancy. Our study documented that
17(10.8%) of the mothers did not use any antiretroviral drug. 2(1.7%) of the babies born to
mothers on HAART were HIV positive while 3(21.4%) of the babies born to mothers who
used single dose nevirapine were HIV positive.
All the babies in the study received post exposure prophylaxis. Nevirapine was given once
within 72hours of delivery while zidovudine was started at birth and continued for six weeks.

At the sixth week of life, the infants were commenced on Co-trimoxazole as prophylaxis
against pneumocystis pneumonia. The Co-trimoxazole prophylaxis was continued for the
babies who were HIV positive and stopped in the babies who were HIV negative.
The findings in this study indicate that mother to child transmission of HIV can be effectively
reduced even in resource poor countries like Nigeria. Integrating PMTCT services into existing
maternal and child care services will increase accessibility and further improve outcome.