GULU UNIVERSITY MEDICAL JOURNAL

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