Prevalence Of Hiv Seropositivity In Neonates Of Non-booked Women Delivering At The Kenyatta National Hospital

Abstract

Background. Non booked women constitute about 67% of women delivering at Kenyatta National Hospital ( KNH). The magnitude of HIV infection in this group of women is unknown hence it is not possible to put in place intervention methods to prevent MTCT of HIV. Objective. To determine the prevalence of HIV seropositivity in neonates of ‘non booked’ women delivering at KNH. Study design. A cross sectional descriptive study was carried out in an attempt to describe the prevalence of HIV antibodies in neonates of women who came to deliver in KNH as ‘non booked’. Setting. Labour ward and newborn unit KNH. Study period. July to September 2001. Study subjects. A total of 253 infants delivered to ‘non booked’ women in KNH labour ward were included in the study. Methods. The non-probability sampling method was used where every consecutive non-booked woman who met the inclusion criteria was recruited . Five milliliters of cord blood was taken from each infant and labeled. Consent was sought from the mother to test the blood for HIV antibodies. Where the consent was denied testing was done anonymously, without identification data, to get the true prevalence. Screening for HIV antibodies was done using Capillus HIVI/HIV2 and confirmed with Immunocomb. Results. A total of 253 babies were recruited of whom 220 (87%) mothers gave consent to testing for HIV and 33 (13%) declined to give consent. The maternal age ranged from 15 to 39 years with a median age of 23 years (24 for HIV seropositive population and 23 for the HIV seronegative population). The median age at first coitus in the study population was 18 years (17.5 for HIV seropositive women and 18 years for HIV seronegative women). There were a median number of two pregnancies among the study population (two for the HIV positive women and one for the HIV negative women). Two hundred and fifty three infants were recruited, of which 134 (53%) were males and 119(47%) were females. Gestational age ranged from 26 to 42 weeks by assessment using Dubowitz criteria (median 38weeks) Birth weight ranged from 650 to 5000 grams (median 2500 grams). Forty infants (15.8%) tested HIV positive by both Capillus and immunocomb rapid methods. Neonatal AZT was provided to 17 (48.6%) of 35 HIV seropositive women who consented to HIV testing while the remaining 18 (51.4 %) declined. Counseling was done to the HIV positive mothers on infant feeding options according to WHO and Ministry of health's recommendations. Twenty-eight (80%) chose to breast feed, 3 (8.6%) chose to formula feed while 4 (11.4%) opted to give their infants cows milk. Mothers whose infants tested HIV positive were requested to come back after two weeks for follow up and further counseling. Only 20 (55.56%) came back and of these only 12 (60%) had informed their partners of their infant's HIV status. Conclusion The prevalence of HIV antibodies in neonates of non-booked women coming to deliver in KNH is 15.8%. The acceptance of HIV rapid testing amongst the study population was 87%. Acceptance rate of neonatal AZT as a post exposure intervention in prevention of mother to child transmission of HIV in the study population who tested HIV positive was 48.6%. Majority (80%) of mothers whose babies tested positive for HIV antibodies opted to breast-feed their babies.