GULU UNIVERSITY MEDICAL JOURNAL

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Gulu University Medical Journal (GUMJ) 2009/2010 Vol 5. Bibliography AVERT (2008), http://www.avert.org/aidsuganda.htm accessed on 26 November 2008 Bannister, B., Gillespie, S. et al (2006) Infection: Microbiology and Management 4th ed Blackwell Publishing Ltd, Massachusetts, USA. Carter M. in ‘Good anti-HIV treatment outcomes for children in conflict zones.’ http://www.aidsmap.com/en/ news/2DEEAE41-2058-4806-BDE6-EAE75FF8FB73.asp accessed on 26.11.2008 Gerald Stine G, (2007) AIDS UPDATE Gerald Tenywa And Agencies in ‘Uganda: Stick to Condom Use – WHO’ on http://allafrica.com/ stories/200802111263.html accessed on 26.11. 2008 Kampala Government of Uganda (2007) UNGASS country progress report Uganda, January 2006 to December 2007’ (assessable through UNAIDS Uganda country report, as accessed 06/06/08) Government of Uganda, Ministry of Health (2005), Health Sector Strategic Plan II 2005/06 – 2009/2010 International Organization for Migration et al, December 2006, HIV and AIDS Mapping Northern Uganda HIV and AIDS Service Provision to IDP Communities in Districts of Gulu, Amuru, Kitgum, Pader, Liram Oyam, and Apach AIDS Mapping, 07/03/09 Kalichman, S C ‘Co-occurrence of Treatment Non-adherence and Continued HIV Transmission Risk Behaviors: Implications for Positive Prevention Interventions’ http://www.psychosomaticmedicine.org/ cgi/content/full/70/5/593 accessed on 26.11.2008 Kiboneka, A et al. Pediatric HIV therapy in armed conflict. AIDS 22: 1097 – 98, 2006. Ministry of Health (2005), Health Sector Strategic Plan II 2005/06 – 2009/2010, pg 2 Rang, H.P Dale M.M. et al (1999), Pharmacology 4th Ed. Harcourt Bruce and Company Limited, Edinburgh, UK. Uganda Bureau of Statistics and Macro International Inc. (2007), Uganda Demographic and Health Survey 2006, Calverton, Maryland, USA. Uganda Communication Commission (2003), http://www.gulu.go.ug, accessed on 07 03 09 UNAIDS The Impact of HIV/AIDS (2009) from http://www.globalhealth.org/hiv_aids/?gclid=CIzXms- UkZkCFRFatAod1yyWaw accessed on 07 03 09 UNAIDS (2009) Report on the global AIDS epidemic 2008, August 2008 http://data.unaids.org/pub/Report/2008/ jc1526_epibriefs_ssafrica_en.pdf , 07/03/09 UNICEF (2006) Humanitarian Action Uganda Donor Update, May 2006, http://www.avert.org/aidsuganda.htm 26/11/ 2008 Gulu University Medical Students’ Association (GUMSA) Passion for life 34
Gulu University Medical Journal (GUMJ) 2009/2010 Vol 5. Prevention of Mother To Child Transmission (PMTCT) of HIV: A Review of Service Delivery and challenges in Uganda 1Alobo Jackie, 2Mshilla Maghanga 1Gulu University Third Year Medical Student, 2Lecturer, Gulu University Background HIV/AIDS is a key threat to global health. It has been estimated that over 20 million people have died of AIDS since it was first diagnosed in 1981 and that there was an increase in the number of people living with disease from 35 million in 2001 to 38 million in 2003 (UNAIDS, 2004). According to UNAIDS (2006), at least 63% of the adults and children with HIV globally live in sub-Saharan Africa and that 72% of AIDS related deaths by 2006 had occurred in this region. To curb this trend, a comprehensive HIV/ AIDS strategy linking prevention, treatment, care and support for people living with the virus has been setup by the World Health Organisation (WHO) and adopted by individual countries worldwide. Mother-to-child transmission (MTCT) is when an HIV-infected woman passes the virus to her baby. This can occur during pregnancy, labour and delivery, or breastfeeding. Without intervention, HIV infected mothers have a 35% overall risk of transmitting HIV to their children PEPFAR (2009). Indeed, around 15-30% of babies born to HIV positive women will become infected with HIV during pregnancy and delivery. A further 5-20% will become infected through breastfeeding (AVERT, 2010). In Africa, especially in the countries of eastern and southern Africa most severely affected by the HIV/AIDS epidemic, the transmission of HIV from mother to child during pregnancy, birth, and during the breastfeeding period is by far the most common way of HIV infection in children. It is believed that in sub-Saharan Africa each year more than 500,000 women who live with HIV/ AIDS become pregnant and give birth (Gundel et al 2003) hence a high percentage of babies are expected to be infected. MTCT of HIV accounts for the vast majority of the more than 700,000 new HIV infections in children worldwide annually. In December 2002 around, 3.2 million children were infected with the virus around the world, 90% of them in Africa. Since the prognosis is poor in children than in adults, 20% to 25% of them will die within the first two years of life, and 60% to 70% before reaching their fifth birthday (Gundel et al 2003). In 2001, the number of infants who became HIV positive through MTCT of HIV virus during pregnancy, birth and during breastfeeding was estimated at 800,000. Almost 90% of them lived in Sub Saharan Africa. At the country level, according to a study by Gundel et al (2003), this translated to an estimated 40,000 AIDSrelated infant deaths in Uganda and 56,000. It was recognized that the most effective way of protecting children is by preventing infection in parents UN IRIN (2008) According to the Ministry of Health of Uganda (MoH, 2006), HIV prevalence was as high as 40% among antenatal care attendees in some parts of Africa and AIDS related maternal deaths had increased dramatically and had begun to out space those due to obstetric causes. MoH (2006) reported that MTCT of HIV is virtually the only way those children under five years of age acquire the virus in Uganda, and the burden among children is of great concern to the health sector. For example, the Financial Year (FY) 2004/05 sero behavior survey reported a national HIV prevalence among women of reproductive age of 6.5%. This would translate to almost 25,000 HIV infections among children each year unless effective interventions of preventing vertical transmission are implemented. The most important approach for avoiding mother to child transmission (MTCT) of HIV is still the primary prevention of HIV infection in young women through education, counseling, sexually transmitted disease (STD) treatment, condom use and so on, Gulu University Medical Students’ Association (GUMSA) Passion for life 35
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