Characteristics of HIV positive pregnant women in Ikeja, Lagos state, Nigeria.
Characteristics of HIV positive pregnant women in Ikeja, Lagos state, Nigeria. |
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Key words: HIV 1 and 2, seroprevalence; characteristics; pregnant women; Ikeja, Lagos; Nigeria.
Abstract
An anonymous study was carried out to determine the seroprevalence rate of HIV
infection in pregnant women attending the booking clinic of the Department of
Obstetrics and Gynaecology, (Ayinke House), Lagos State University Teaching
Hospital, Ikeja, Lagos. A total of 300 patients were screened for HIV 1 and
2 using Immunocomb and Immunoconfirm test kits. The design of the study was
anonymous unlinked using the routine antenatal blood test (Haemoglobin, Genotype
and Blood grouping) as the entry point. The result showed a seroprevalence rate
of 6.3%. Majority of those affected were in the age range of 26-30years (57.9%).
While all were married, parity distribution showed a greater preponderance in
the 0 – 1 group (63.2%). Most of them were well educated with 42.1% and
36.8% having gone through secondary and post-secondary education respectively.
Higher prevalence rates were found among the traders (42.1%) and civil servants
(26.3%).
Introduction:
Lagos is a cosmopolitan city characterized by a dense population, a fast tempo
of life and all the attributes of an urban centre. It served as the capital
of the Federal Republic of Nigeria until 1993 when the capital was relocated
to Abuja. It however remains the industrial and commercial nerve centre of the
country with its population increasing on a daily basis. Ayinke House Maternity
Hospital is located in Ikeja, the capital of Lagos State. It is owned by the
Lagos State Government and presently serves as the Obstetrics and Gynaecology
department of the newly established Lagos State University Teaching Hospital
(LASUTH). It is a relatively busy unit with an average delivery rate of 3500
per annum. Since HIV infection was first reported in Nigeria in 1986, there
has been an alarming increase in the reported prevalence of HIV in different
sentinel groups, institutions and health zones. The prevalence rate of HIV infection
among antenatal patients in Nigeria rose from 1.4% in 1992 to 5.4% in 1999.This
has pushed Nigeria into the epidemic zone of HIV infection worldwide. Africa,
south of the Sahara and East Asian countries constitute the largest block of
about 33 million peoples currently living with HIV/AIDS worldwide. HIV infection
is becoming the most common complication of pregnancy in some countries especially
in East and Southern Africa. While HIV transmission can occur in several ways,
about 70% of infections in Africa is as a result of heterosexual transmission,
and over 90% of infections in children result from mother to child transmission
(1,2). Prevalence studies in antenatal patients therefore give an insight into
the relative magnitude of the problem in the community and also serve as an
important template on which to base interventional programmes. In certain parts
of South Africa, the prevalence of HIV/AIDS in pregnant women is over 30% while
in the East African countries of Tanzania, Zambia, Kenya, Malawi, Rwanda and
Zimbabwe, over 10% of women attending antenatal clinics in urban areas were
HIV positive.
The rate of vertical transmission has been variously quoted at 30 to 40% in
areas where antiretroviral drugs are not in use (1,4,5). This can occur in utero,
during labour and delivery or in the post partum period through breastfeeding.
Studies have shown that pregnancy does not have a major adverse effect on the
natural history of HIV infection in women (6,7). Spontaneous abortion (8), low
birth weight, stillbirth, pre-term labour, premature rupture of membranes, bacterial
pneumonia, urinary tract infection have been associated with pregnancies complicated
by HIV infection. The fact that heterosexual and vertical transmissions constitute
the major modes of HIV infection in Nigeria calls for a concerted effort at
establishing the magnitude of the problem in order to plan appropriate intervention.
Patients and methods
Patients attending the booking clinic had blood taken for routine antenatal
blood tests, which were Haemoglobin, Genotype, Blood Group and serological test
for syphilis, VDRL. Part of this blood was put in separate containers for HIV
1 & 2 screening and confirmatory tests. Each of these blood samples was
coded anonymously. Using the codes, relevant demographic information was recorded
for each patient. These included age, parity, marital status, educational level
and occupation. Three hundred patients were screened over a six-week period
between April and May in 2001,by using rapid testing kits (Immunocomb). The
positive samples were confirmed using Immunoconfirm test kits.
A trained laboratory scientist in the HIV screening laboratory of the institution
carried out the laboratory tests. The results were collated and analyzed using
the demographic data obtained during blood collection. The Ethical Committee
of the institution (LASUTH) approved this study.
Results
Of the 300 antenatal patients screened for HIV 1 & 2 antibodies, nineteen
patients were found to be seropositive to HIV 1. No patient was seropositive
to HIV 2. This gives a seroprevalence rate of 6.3%.
Most of the seropositive patients were in the age group 26 – 30 years
(Table 1). All the sero-positive patients were married. Parity distribution
shows that majority of the patients was in the 0 –1 parity group constituting
63.2% (Table 2). All the sero-positive patients were educated to at least the
primary school level. 42.1% had secondary education while 36.8% were educated
beyond secondary school level. Traders and civil servants accounted for the
higher prevalence 42.1% and 26.3% respectively (Table 4).
Table 1 – Age distribution
| Age Group | Number | Percentage |
| <20 | 0 | 0% |
| 20 - 25 | 3 | 15.8% |
| 26 - 30 | 11 | 57.8% |
| 31 - 35 | 2 | 10.5% |
| 36 - 40 | 3 | 15.8% |
| >40 | 0 | 0% |
| Total | 19 | 100% |
Table 2– Parity distribution
| Parity | Number | Percentage |
| 0 - 1 | 12 | 63.2% |
| 2 - 3 | 3 | 15.8% |
| 4 - 5 | 4 | 21.0% |
| Total | 19 | 100% |
Table 3 Level of education
| Education Level | Number | Percentage |
| No Education at all | 0 | 0% |
| Primary | 4 | 21.1% |
| Secondary | 8 | 42.1% |
| Post-Secondary | 7 | 36.8% |
| Total | 19 | 100% |
Table 4. Occupational status
| Occupation | Number | Percentage |
| Housewife/student | 2 | 10.5% |
| Trading | 8 | 42.0% |
| Civil Servant | 5 | 26.3% |
| Artisan | 4 | 21.1% |
| Total | 19 | 100% |
Discussion
The antenatal patients represent the sexually active group of the community.
This sentinel group has been used in various HIV seroprevalence surveillances
in many countries to track the course of the HIV epidemic. In South Africa,
an increase in point prevalence rate of HIV following national anonymous antenatal
surveys, 0.76% in 1990, 1.4% in 1991, 2.69% in 1992, 4.25% in 1993 and 7.5%
in 1994, has been reported (12). In Zimbabwe, sero-prevalence rate of 18% was
reported in 1990 (13) and 29.1% in 1996 (14). The National Sentinel Surveys
in Nigeria also showed a rising trend of HIV sero-positivity among pregnant
women 1.4% in 1992, 3.8% in 1994, 4.5% in 1996 and 5.4% in 1999 (15). The seroprevalence
rate of 6.3% got in this study showed an increasing trend in the overall prevalence
of HIV infection in Lagos. An earlier study in 1991 showed a prevalence of 0.5%
among pregnant women at the Lagos University Teaching Hospital and Lagos Island
Maternity Hospital (16). Various reasons have been given for this increasing
trend. These include high prevalence of sexually transmitted infections, low
level of national and individual awareness, reduced access to quality care and
treatment, health education and primary prevention, low perception to risk,
worsening economic situation, level of education and poverty in the community
(15). If the trend is allowed to continue it would constitute a major national
health disaster in no distant future. Thus there is a need for concerted efforts
at stemming it. The demographic characteristics showed that the majority (57.9%)
is in the age group 26 – 30 years. This, together with the finding of
highest seroprevalence in the 0-1-parity group (63.2%) may be a reflection of
the reported higher incidence of sexual activities among the youths (age <25
years). In this study majority of the sero-positive patients have some level
of education. It can be anticipated therefore that they would benefit from educational
interventions at raising awaraness of`the disease as well as measures to prevent
it. While occupation has been shown in previous studies to have a direct correlation
to the prevalence of HIV infection, for example long distance drivers and commercial
sex workers (15), the finding in this study of a higher incidence among traders
and civil servants calls for closer attention. The rather high seroprevalence
rate recorded in this study raises once again the questions of ethics, rights
and professional duty as they relate to universal antenatal screening for HIV.
We believe that it is desirable to have a universal HIV screening policy for
all antenatal patients. However, adequate pre and post test counselling facilities
should be made available in all centers providing large scale antenatal services.
The reasons of stigmatization, discrimination, abandonment and violence have
been overplayed. The knowledge of the status of the patients would also help
in achieving the main objective of antenatal care. This is to ensure the good
health of the mother and produce a live and healthy baby at the end of pregnancy.
Effective management of sero-positive patients during the antenatal, intrapartum
and post-natal periods will help achieve the desired results.
References:
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