Mother To Child Transmission Of HIV (MTCT)

Mother-to-child transmission (MTCT) is the largestsection also has some effect .
source of HIV infection in children below 15 years .Several questions and challenges remain. For example,
MTCT also known as perinatal or vertical transmissionchoice, availability, affordability, duration and long term
occurs when HIV is spread from an HIV positivesafety of ARV agents to be used during pregnancy
woman to her baby during pregnancy, labour andand early neonatal life, and the issue of transmission
delivery or breast feeding.in situations where alternatives to breast feeding are
HIV and AIDS is one of the major causes of death innot available .
children throughout the world. According to LabbokThe challenge is to find the most cost effective and
(2003) of 580,000 deaths from HIV and AIDS infeasible intervention to achieve zero percent
children under 15years of age, 500,000 have been intransmission of HIV from an infected mother to her
Africa. 80-90% of such deaths are due to MTCT andchild.
200,000 were secondary to breast feeding.Barriers to the effective prevention of MTCT of HIV
Increasing number of children have HIV infection,Pregnant women face many difficult decisions,
especially in the countries hardest hit by theincluding decisions around HIV testing, treatment
pandemic. In 2002, an estimated 3.2 million childrenoptions and infant feeding. A woman’s male
under 15 years of age were living with HIV andpartner(s), extended family, greater community and
AIDS; a total of 800,000 were newly infected andhealth care setting all influence her decision and ability
610,000 died. HIV and AIDS have been estimated toto take advantage of MTCT prevention.
account for about 8% deaths in children under 5In developing countries, there is lack of access to
years of age in Sub Saharan Africa. In areas wheremedications in general and ARV drugs in particular. In
the prevalence of HIV in pregnant women exceededaddition, there is very little access to good health
35%, the contribution of HIV and AIDS to childhoodcare for women both before and after birth, limited
mortality was as high as 42% .HIV counseling and testing, and high stigma and
World wide in 2001, 1.8 million women becamediscrimination against HIV positive women.
infected with HIV and approximately 800,000 childrenIn the developed world, it is recommended that HIV
also became infected, the majority of them via–positive mothers do not breast feed, as
MTCT. Breast feeding is an important mode offormula feeding is safe, well accept and readily
transmission during the post-partum period,available. Formula feeding requires clean water for
accounting to nearly one third of entire MTCT ofmixing formula or sanitation and cannot afford
HIV. In East Africa, it is estimated that 10-20% offormula, and therefore cannot avoid breast feeding.
women are HIV positive2.With the HIV epidemicWhat still needs to be done?
showing shift towards women and young people, theHIV is a preventable disease. MTCT is best
increasing seroprevalence among women will lead toprevented by effective, accessible and sustainable
an increase in the MTCT .HIV prevention, diagnosis and treatment programs
Of great concern in this HIV era is the issue offor women, men and their children. Structural
breast feeding. Besides being an intense personalinterventions are also needed that increase access to
concern, the issue of HIV transmission through breastHIV treatment treatments, clean water and formula.
feeding is also of public health importance especially inEducation and empowerment for all women in every
countries where both fertility rates and HIV infectioncountry are as essential as access to good medical
rates among pregnant women are high. Now it iscare and nutrition for women and their children,
widely recognized that HIV is transmitted to an infantwhether they are HIV positive or HIV negative .
during breast feeding with an average ofWith the Sub Saharan African socioeconomic setting,
approximately one out seven infants born to anexclusive breast feeding of the baby born to
HIV–infected mother becoming infectedHIV-positive mother is inevitable lest the baby dies
through breast feeding up to 24 months . Efficiencywithin the first days after birth. Replacement feeding
of HIV transmission through breast milk rangesis unacceptable, unaffordable, unsustainable, unsafe
between 16-29%. Of the 30% of babies who getand not feasible in most of these countries. So the
infected vertically, the relative frequency of timing ofbig question remains, “how can nutritionists and
transmission is as follows: 2% early in gestation, 3%other health workers make breast feeding safer for
late in gestation, 15% during labour, 5% early inevery baby born to HIV positive mother and improve
post-partum period, and 5% in late post-partumupon complementary feeding for such children?
period . Although WHO,unicef and other UnitedThus, there is greater need for urgent research on
Nations agencies currently recommend thathow to improve the local foods to make them
HIV-positive mothers avoid breast feeding ifnutritionally balanced and safer for complementary
replacement feeding from birth isfeeding and replacement feeding of such children.
acceptable,feasible,affordable,sustainable and safeConclusion
(AFASS),it is not practically possible to adopt thisReducing vertical HIV transmission is challenging,
policy in resource limited countries like Uganda. Thus,particularly in developing countries where mothers
research is necessary to make this feasible.with HIV-infection do not have access to long-term
This article summarizes research findings regardingARV regimens, formula feeding or other preventing
MTCT of HIV particularly through breast feeding.strategies that mothers in wealthier countries
Knowledge on the role of breast feeding in MTCT ofroutinely follow.
HIVThus, more research is required if reduction of MTCT
In order that interventions on the prevention ofduring breast feeding is to be achieved. There is need
MTCT to become effective ,it is important to knowto explore optimal duration of breast feeding,
the level of knowledge, attitude and practices ofweaning recommendations and prominent ARV drug
women in relation to MTCT of HIV and breastfor mothers and infants based on the local conditions.
feeding. According to community basedReference:
cross-sectional study done among mothers aged1. Food and Nutrition Technical Assistance (2004).HIV
16-40 years in Dar es Salaam, only 25% of theAIDS :A guide for Nutritional Care and Support
population knew that breast feeding could be source2004.Academy for Educational
of HIV transmission. Among women who knewDevelopment,Washington,D.C
about HIV transmission through breast feeding,2. Mbori-Ngacha D, Nduati R, John G, et al. Morbidity
54.1% indicated they will avoid breast feeding whileand mortality in breastfed and formula fed infants of
45.9% indicted they will continue breast feeding . TheHIV-1-infected women: A randomized clinical trial.
main reason given was stigmatization. Generally, theJournal of the American Medical Association, 2001;
knowledge and attitudes regarding MTCT and breast286:2413-2420.
feeding in developing countries are not well known.3. Merchant R.H, Lala and Mamatham, Prevention of
Thus, there is need to educate the masses on thismother to child transmission of HIV. Indian Journal of
issue. Unlike in developed countries where MTCT ofMedical Research, April 2005. ([ visited on August 20,
HIV is known to most mothers, a lot still ahs to be2005
done in developing countries where the vast majority4. Mwandime.R, Bijlsma .M, Castleman.T and Lwanga
of women are completely ignorant about it.D (2003), Handbook Developing and Applying National
Prevention of MTCTGuidelines on Nutrition and HIV/AIDS, Kampala.
Current interventions aimed at reducing MTCT targetUganda.
the peripartum period but their application in5. Mwandime .R, 2003. Nutrition and HIV/AIDS-A
populations where breast feeding is the normtraining Manual, Kampala-Uganda.,
presents considerable problem . Effective6. UNAIDS: HIV and Infant Feeding
interventions used include reduction of maternal viral([ site visited on 20 September 2005
load through ARV therapy, the avoidance of7. UNICEF (2003).Action for children and young
exposure to contaminated maternal secretionspeople: What religious leaders can do about HIV
through delivery by caesarean section, and avoidanceAIDS. New York, USA.
of breast feeding. Washing the birth canal with8.
antiseptic to reduce exposure to contaminated