CHAPTER ONE

                                         INTRODUCTION

1.1 BACKGROUND OF THE STUDY 

Mother-To-Child Transmission (MTCT) is responsible for more than 700,000 estimated new HIV infections in children worldwide yearly. In a single day, more than 1800 babies contract HIV from their mothers worldwide; and many of these cases occur in Africa. The probability of infection from mothers who do not receive treatment is higher in Africa (25% - 52%) than the United States (US) or Europe (12%-30%).

Human Immunodeficiency Virus (HIV) is easily transmitted through unprotected (i.e. without condom use) anal intercourse (penis in anus) than other sexual activities. It is also more likely to be transmitted to the receptive partner than the insertive partner in both vaginal (8/10,000 exposures) and anal (138/10,000 exposures) intercourse. Thus, women are more vulnerable to HIV infection because they are more often the receptive partners, especially in sub-Saharan Africa. In the world today, Nigeria accounts for about 10% of all HIV/AIDS cases. Women constitute 57% of adults infected with HIV in Nigeria, a prevalence which is higher than that of the global figure of 48%. Sixty percent of new infections occur in the 15 - 25-year-old age group but the prevalence is highest among productive young people between the ages of 20 - 29 years. Heterosexual transmission accounts for 80% of all infections. The pandemic is having a ruinous effect on the reproductive health of women in Nigeria. The number of HIV-positive women has increased, with an attendant alarming increase in the number of HIV-positive children in recent years. In 2007, around 370,000 children under 15 became infected with HIV, mainly through mother-to-child transmission. About 90% of these MTCT infections occurred in Africa where AIDS is beginning to reverse decades of steady progress in child survival. In high income countries of the world, MTCT has been virtually eliminated thanks to effective voluntary testing and counseling, access to antiretroviral therapy, safe delivery practices, and the widespread availability and safe use of breast-milk substitutes. If these interventions were used worldwide, they could save lives of thousands of children each year. Hence, there is an urgent need to combat this menace. The “Prevention of Mother-to-Child Transmission of HIV” service was started in October 2003 at Aminu Kano Teaching Hospital, Kano. Following the designation of this center as a service center for the program of prevention of mother-to-child transmission, a committee was formed, which involved pediatricians, obstetricians, nurses, pharmacists, public health physicians and counselors to run the program. It is therefore pertinent to determine the knowledge and awareness about HIV/ AIDS and mother-to-child transmission among mothers attending the pediatric HIV clinic. The information obtained will influence the counseling and education of patients and the community about HIV/AIDS. This will further decrease mother- to- child transmission of HIV/AIDS.

Results of the Nigeria Demographic Health Survey of 2003 showed that among pregnant women attending antenatal care clinics only 24.3% (44.4% urban and 16.2% rural) had been counselled about HIV; 79.2% of women and 82.5% of men had never been tested for HIV; and, 46% of women as compared to 56.4% of men knew that mother-to- child transmission is possible. In addition, 60% of pregnant women (83% of urban and 51% of rural women surveyed) made use of antenatal care services, while 2.5% had visited traditional birth attendants (TBAs). But only 32.6% (54.2% urban and 23.8% rural) had their babies delivered in a health facility, while 66.4% had delivered at home (National Population Commission & ORC Marco, 2004).

Antenatal VCT is one of several interventions used to reduce MTCT. In a survey of health and laboratory facilities in all six zones of Nigeria, the data that were collated and analysed concerning an individual’s reason for HIV testing at the surveyed laboratory facilities showed that only 16.3% of those surveyed had used voluntary testing services (Idigbe, Ibrahim, Ubane, Onwujekwe, Esan, Otoh & Ade-doyin, 2000). However, accurate data on the acceptability of HIV testing among pregnant women in Nigeria are scarce, but given the trend of rising HIV infection among pregnant women (National AIDS/STDs Control Programme, 1999) and the promotion of exclusive breastfeeding in the country (Esan, 1997), one would expect a high incidence of mother-to-child HIV transmission. Even so, the success of antenatal VCT is dependent upon women’s and communities’ knowledge and perceptions of HIV. Despite increasing HIV prevalence among women using antenatal clinics in Nigeria (National AIDS/STDs Control Programme, 2002), very little is known about their know-ledge and perceptions of HIV. Such information is important for understanding and determining the likelihood that pregnant women will accept and seek VCT-which would contribute to preventing MTCT, through increased acceptability and demand for confidential antenatal HIV testing, and so prepare for the scaling-up of Nevirapine therapy in the country. Knowledge of this is important if any serious impact is to be made by 2010 to meet the internationally agreed global goal (declared by governments during the United Nations General Assembly Special Session [UNGASS] on HIV/AIDS in June 2001) to reduce by at least one-third the mortality of infants and children under age five during the decade 2001–2010, and by two-thirds by 2015. These goals are to be achieved by reducing the proportion of the infant population infected with HIV by 2% by 2005, and by 50% by 2010, by ensuring that 80% of pregnant women accessing antenatal care have information, counselling and other HIV-prevention services available to them; increasing the availability and access to treatment to reduce MTCT; effective interventions for HIV-positive women including VCT; access to treatment using antiretroviral therapy and, where appropriate, breastmilk substitutes; and the provision of a continuum of care (WHO, 2003a and 2003b). This is vital in view of the over-riding goal of Nigeria’s national policy on HIV/AIDS and sexually transmitted infections (STIs), which is to reduce HIV prevalence to less than 1% of the country’s population by 2010 (National AIDS/STDs Control Programme, 2002). Realizing this, it becomes imperative to investigate pregnant women’s knowledge and perceptions about HIV, particularly as it concerns transmission to infants during birth or breastfeeding (Berer, 1999). Because the prevention of mother-to-child transmission of HIV (MTCT) programme with Nevirapine therapy for HIV-positive pregnant women has commenced in selected health institutions across the country (National AIDS/STDs Control Program, 2002), data on the grassroots knowledge of pregnant women can inform planning, policy development, advocacy and counseling plans.

1.2 STATEMENT OF THE PROBLEM

Despite improvements in PMTCT services over the years, MTCT of HIV infections is high especially in Nigeria. Despite increasing HIV prevalence among women using antenatal clinics in Nigeria (National AIDS/STDs Control Programme, 2002), very little is known about their know-ledge and perceptions of HIV. Such information is important for understanding and determining the likelihood that pregnant women will accept and seek VCT-which would contribute to preventing MTCT, through increased acceptability and demand for confidential antenatal HIV testing, and so prepare for the scaling-up of Nevirapine therapy in the country. Knowledge of this is important if any serious impact is to be made by 2010 to meet the internationally agreed global goal (declared by governments during the United Nations General Assembly Special Session [UNGASS] on HIV/AIDS in June 2001) to reduce by at least one-third the mortality of infants and children under age five during the decade 2001–2010, and by two-thirds by 2015. The researcher intend to assess the knowledge of HIV among pregnant women in Borno State. Knowledge of the interventions of PMTCT is important, so that pregnant women can be aware and through motivation they can have a positive attitude towards PMTCT.

1.3 OBJECTIVES OF THE STUDY

The general objective of this research is to examine the knowledge of hiv among pregnant women in Borno State. However, the specific objectives of this research are:

i)             To examine pregnant women’s attitude towards antiretroviral drugs in prevention of Mother-to-Child Transmission of HIV

ii)           To examine the role of the hospitals in the utilization of PMTCT services

iii)          To investigate the pregnant women’s knowledge of Prevention of Mother- to-Child Transmission of HIV (PMTCT) services

iv)         To understand the perceptions of pregnant women towards prevention method as a factor in preventing the spread of sexually transmitted diseases (HIV/ AIDS) to their unborn child.

1.4 RESEARCH QUESTIONS

1. To what extent has the society try to educate its pregnant women about HIV/AIDS?

2. Does economic status and educational background among women determine pregnant women’s knowledge of HV/AIDS?

3. Are the married men responsible for HIV/AIDS among pregnant women?

1.4 RESEARCH HYPOTHESES

H0: There is no relationship in the knowledge of HIV/ AIDS and the prevention of the disease among pregnant women in Borno state.

H1: There is a relationship in the knowledge of HIV/ AIDS and the prevention of the disease among pregnant women in Borno state.

H0: Economic status and educational background among women does not determine pregnant women’s knowledge of HV/AIDS.

H2: Economic status and educational background among women determine pregnant women’s knowledge of HV/AIDS.

1.5 SIGNIFICANCE OF THE STUDY

Human Immune deficiency Virus (HIV) and acquire immune deficiency syndrome (AIDS) has continue to be the major concern not only to Borno State Government but the Federal Government and the entire world. Specifically, the study will be beneficial to pregnant women, to follow recommended steps and advices that will help fight against mother to child transmission of HIV. To doctors and mid-wives on administering necessary care, counselling, to pregnant women during antenatal and prenatal check-ups. To the women generally in the area of public-enlightenment, on the need to follow doctor’s directives on adequate medication during pregnancy. This study will also serve as a pioneer effort towards the understanding of HIV/ AIDS among antenatal attendees in Maiduguri Teaching Hospital, Borno State. The result of this study may help policy maker’s particularly educational planners in Borno State to design more appropriate instructional programme on HIV/ AIDS. Finally, the findings of this study will serve as a reference point to scholars that chose to embark on a project of this nature.

1.6 SCOPE AND LIMITATION OF THE STUDY

This study centers on examining the knowledge of HIV among pregnant women in Borno State, specifically antenatal attendees in Maiduguri Teaching Hospital. In the course of the study, the researcher encounters some constraints which limited the scope of the study;

Time: the time at the disposal of the researcher which was allocated for the study was a major limitation as the researcher had to combine other academic activities with the study.

Finance: The finance at the disposal of the researcher in the course of the study could not permit wider coverage as resources are very limited as the researcher has other academic bills to cover.

Availability of research material: The research materials available to the researcher at the time of this study were insufficient, thereby limiting the study.

1.7 DEFINITIONS OF TERMS

Pregnancy: Pregnancy, also known as gestation, is the time during which one or more offspring develops inside a woman. A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy can occur through sexual intercourse or assisted reproductive technology.  Childbirth typically occurs around 40 weeks from the last menstrual period (LMP).

HIV: HIV is a member of the genus Lentivirus, part of the family Retroviridae. Lentiviruses have many morphologies and biological properties in common. Many species are infected by lentiviruses, which are characteristically responsible for long-duration illnesses with a long incubation period. Lentiviruses are transmitted as single-stranded, positive-sense, enveloped RNA viruses.

Knowledge: Knowledge is a familiarity, awareness, or understanding of someone or something, such as facts, information, descriptions, or skills, which is acquired through experience or education by perceiving, discovering, or learning.

PMTCT: Prevention of mother-to-child transmission (PMTCT) programmes provide antiretroviral treatment (ART) to HIV-positive pregnant women to stop their infants from acquiring the virus.

MTCT: this is an acronym for Mother-to-child transmission.

1.8 ORGANIZATION OF THE STUDY

This research work is organized in five chapters, for easy understanding, as follows. Chapter one is concern with the introduction, which consist of the (background of the study), statement of the problem, objectives of the study, research questions, research hypotheses, significance of the study, scope of the study etc. Chapter two being the review of the related literature presents the theoretical framework, conceptual framework and other areas concerning the subject matter.     Chapter three is a research methodology covers deals on the research design and methods adopted in the study. Chapter four concentrate on the data collection and analysis and presentation of finding.  Chapter five gives summary, conclusion, and recommendations made of the study.

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