Nigerian Journal of Paediatrics

9Socio demographic characteristics of HIV patients diagnosed at immunization centres in Calabar South south Calabar Nigeria

Niger J Paediatr 2016; 43 (4): 281 – 285

ORIGINAL

Venn I

Socio - demographic

Ochigbo S

Anah M

characteristics of HIV patients

Asindi A

diagnosed at immunization

centres in Calabar, South –

south, Calabar, Nigeria

DOI:http://dx.doi.org/10.4314/njp.v43i4.9

Accepted: 12th September 2016

Abstract :

Introduction:

The

Results: Of the 330 subjects re-

World

Health

Organization

cruited, 173 (52.4%) were males

Venn I (

)

(WHO) estimated that 3.2 million

while 157(47.6%) were females.

Ochigbo S, Anah M, Asindi A

children were living with Human

Mean age of the infants was 9.20 ±

Department of Paediatrics,

University of Calabar Teaching

Immunodeficiency Virus (HIV) at

3.1 weeks. Twenty four mothers

Hospital Calabar

the end of 2013, mostly in sub-

and infants tested positive for HIV

Email: odyvenn@yahoo.com

Saharan Africa. Socio- economic

antibodies. After confirmatory

and demographic factors do not

tests using HIV Deoxyribosenu-

only affect viral transmission but

cleic acid (DNA PCR), 14(58.3%)

also the success of preventive

out of 24 antibody seropositive

strategies and treatment.

infants were infected. The trans-

Objective: To determine the socio

mission rate after confirmation

-demographic characteristics of

was 58.3%.

mothers, and the relationship be-

Conclusion: Parental education,

tween maternal and HIV status of

social class and low maternal Anti-

their infants attending immuniza-

retroviral drug (ARV) use were

tion clinics in Calabar.

responsible for transmission. It is

Methods: Using multistage sam-

therefore recommended that health

pling method, 330 subjects were

education on ARV use during an-

enrolled and screened from 63

tenatal period and HIV status of

immunization centres. The socio-

mother baby pair be done at immu-

demographic

characteristic

nization centres. HIV positive

each infant’s mother was docu-

mothers and babies should be

mented. The results of Rapid test

promptly referred for therapy.

for mothers and Dried Blood

Spots (DBS) results for infants

Key words: Immunization, HIV,

were compared.

Infants, DNA PCR, PMTCT, ARV

Introduction

in low early infant diagnosis.

Socio-economic factors do not only affect viral trans-

The World Health Organization (WHO) estimated that

mission but also the success of preventive strategies and

3.2 million children were living with HIV at the end of

treatment. The most important demographic and socio-

2013, mostly in sub-Saharan Africa. Majority of them

economic features that influence HIV infection and

acquire HIV from their HIV-infected mothers during

eventual transmission to children include age, sex, resi-

pregnancy, birth or breastfeeding. Prevention of Mother-

dence, education, marital status, religion, family/social

to-child transmission of HIV (PMTCT) is the key to

units and ethnic identity. Low socioeconomic status and

reducing paediatric HIV/AIDS. With efficacious inter-

lack of formal or primary education were outlined as the

ventions the risk of mother-to-child HIV transmission

major risk factors for HIV infection of infants of HIV

positive mothers.

can be reduced to 2%. Nigeria contributes 32% to the

world gap in achieving the global target of eradicating

MTCT of HIV, the highest in the world.

This study was therefore conducted to determine the

Implementation of PMTCT remains low at 30% as only

effect of socio-demographic characteristics and concor-

about 4% of HIV exposed infants are tested for HIV in

dance between maternal HIV status and HIV status of

the first two months of life. Several challenges hinder

the infants attending immunization clinics in Calabar.

the PMTCT delivery in Nigeria. These arise from poor

This will serve as a portal for early identification of pre-

uptake of antenatal care services and very low utilization

disposing factors and determinants of paediatric HIV

of orthodox health care facilities for delivery

2,4

resulting

infections. The results obtained should help stake hold-

282

ers; governmental and non-governmental agencies to

Results

formulate policies aimed at addressing the socio-

demographic challenges promoting HIV infection.

Of the 330 subjects recruited, 173 (52.4%) were males

while 157(47.6%) were females with M: F ratio 1.1 : 1.

Mean age of the infants was 9.20 ± 3.1 weeks. Twenty

four mothers and infants tested positive for HIV anti-

Methods

bodies. Those that tested negative were taken as con-

trols. After confirmatory tests using HIV DNA PCR, 14

This cohort descriptive study was conducted among

(58.3%) out of 24 antibody sero-positive infants were

infants aged six to 14weeks attending immunization

infected while 10 were HIV exposed. Hence, the preva-

clinics in Calabar, Nigeria. The study was carried out

lence of HIV infection after confirmation was 58.3%.

from 1 August 2014 to 30 September 2014 to deter-

Of the 14 infected infants9(64.3%) were males and 5

mine role of socio-demographic characteristics of par-

(35.7%) females. They were mostly aged 12-14weeks

ents as a risk factor for the transmission of HIV infec-

(42.9%). (Table 1.)

tion to their infants.

Table 1: Age Sex and HIV Status of infants

Calabar as earlier described by Udo et al is made up of

Infected Uninfected

Total

two Local Government Areas (LGAs) namely Calabar

p-value

Municipality and Calabar South. Immunization centres

Variable

n=14(%) n=10(%)

N=24(%)

were used for the study. The study was approved by the

Age group (weeks)

University of Calabar Teaching Hospital, Calabar and

6-8

5(35.7)

2(20

7(29.2)

FET

0.759

the Cross Rivers state Ministry of Health ethical com-

9-11

3(21.4)

3(30)

6(25)

12-14

6(42.9)

5(50)

11(45.8)

mittees. Informed consent was obtained from the moth-

Total

14(100.0) 10(100.0) 24(100.0)

ers. Children aged six to 14 weeks that met the inclusion

Sex

criteria were recruited. Multistage sampling method was

Male

9(64.3)

6(60)

15(62.5)

FET

0. 582

used to select 330 subjects from the 22 immunization

Female

5(35.7)

4(40)

9 (37.5)

centres using table of random numbers. Those excluded

Total

14(100.0) 10(100.0) 24(100.0)

were ill infants and those already on antiretroviral drugs.

Pretest counseling was done. A detailed history was

obtained which included maternal and child’s biodata,

Mothers aged 25-34yrs had the highest HIV infected

maternal and infant HIV status as well as the socio-

infants’. Parents of the HIV infected infants mostly had

demographic characteristics of the parents (Age, Sex,

secondary levels of education (father 85.8%; mother

levels of education and occupation etc). General exami-

78.6%) compared with the uninfected infants whose

nation was conducted and anthropometry measured in-

mothers (70%) and fathers (60%) had tertiary education

cluded weight, Occipito Frontal Circumference (OFC)

respectively.

(Father

FET

0.019;

Mother

FET

and length.

0.004).Parents of the infected infants were mostly from

the middle social class family (71.4%),while parents of

HIV testing was done on all infants-mother pair using

the uninfected infants were of the higher social class

Determine

HIV 1/2 from ABBOT Medical Japan and

(50%). The family sizes 1-3 were similar for both in-

HIV 1/2 STAT PAK

from CHEMBIO Diagnostic

fected (85.7%) and uninfected (90%) infants. Both the

systems, Inc. USA. Post test counseling was done, and

infected and uninfected infants were product of married

infants who were reactive had specimen collected for

couples. Majority (92.9%) of the mothers whose infants

Dried Blood Spot (DBS) using DNA PCR according to

were HIV infected did not receive ARV drugs while

the National guidelines for the diagnosis of Paediatric

50% of the uninfected received ARV drugs. (p value=

HIV. Those who had positive DBS were enrolled into

0.048)Table 2

the treatment programme. All HIV positive mothers

The relationship between maternal antenatal HIV status

were referred for treatment. Refusal to participate in the

and eventual outcome of the Infant HIV status was

study carried no penalty.

highly statistically significant (FET 0.00). (Table 3)

Data were recorded and standard statistical analysis was

performed using SPSS statistical package version 20.

Continuous variables were summarized using means,

median and ranges as appropriate. Proportions were

compared using Chi-square test of significance. A prob-

ability (P-value) less than 0.05 was considered statisti-

cally significant.

283

Table 2: Parents’ related socio -demographic characteristics

reported female preponderance. Alvarez-Uria etal

and HIV infection in infants

contrast reported equal proportion of both males and

HIV Status of infant

females from their study in India. This sex difference is

Confirmation by DNA PCR

probably because neonatal infections are commoner in

Infected Uninfected

Total

test

p-value

males as a result of gene constitution.

Variable

n=14(%)

n=10(%)

N=24(%)

statistic

The sixth week of life is a landmark time in the lives of

Mother’s age

the HIV exposed or non exposed children because this

15-24

4(28.6)

1(10.0)

5(20.8)

FET

0.180

25-34

7(50.0)

8(80.0)

15(62.5)

is the period for immunization, postnatal check up, and

35-44

3(21.4)

0(0.0)

3(12.5)

the diagnosis for HIV infection (DNA PCR) using the

≥45

0(0.0)

1(10.0)

1(4.2)

DBS. In addition, it’s an opportunity to seek for circum-

Total

14(100.0)

10(100.0)

24(100.0)

cisions for their male infants hence responsible for the

Fathers Education

increased number. Though the infants in our study were

Primary

1(7.1)

0(0)

1(4.1)

older this may be due to delay in accessing immuniza-

Secondary 12(85.8)

4 (40)

16(66.7)

FET

0.019 *

tion centres in our communities.

Tertiary

1(7.1)

6 (60)

7(29.2)

Total

14(100.0)

10(100.0)

24(100.0)

The mothers peak age observed in our study corre-

Mothers Education

Primary

2(14.3)

0(0)

2(8.3)

sponded to the peak of age of procreation (21-40

years), therefore it is not surprising that most mothers

Secondary 11(78.6)

3(30)

14(58.3)

FET

0.004*

Tertiary

1(7.1)

7(70)

8(33.4)

in this study were within this age group. This finding is

corroborated by Berhan et al

Total

14(100.0)

10(100.0)

24(100.0)

in Ethiopia and Orenuga

et al

in Nigeria. In contrast, Bucagu et a

Social class

in Rwanda

Higher

1(7.1)

5(50)

6(25 )

FET

0.180

documented a lower maternal age of 18- 20 years. The

Middle

10(71.4)

4(40)

14(58.3)

differences observed in peak age of parents’ are not un-

Lower

3(21.5)

1(10)

4(16.7)

related to cultural and religious differences regarding

Total

14(100.0)

10(100.0)

24(100.0)

timing of marriages of mothers.

Parent’s marital status

Married

9(64.3)

6(60)

15(81.8)

FET

1.000

Cohabiting 2(14.3)

1(10)

3(12.1)

The middle class and secondary level of education was

Single

3(21.4)

3(30)

6(6.1)

responsible for the highest prevalence. This is statisti-

Total

14(100.0)

10(100.0)

24(100.0)

cally significant; it also buttresses the fact that parental

Family size

education had influence on transmission in this study.

1-3

12(85.7)

9(90)

21 (87.5) FET

1.0

However, this is contrary to previous study by Rabasa et

4-6

2(14.3)

1(10)

3(12. 5)

which demonstrated a significant association be-

≥ 7

0(0.0)

0(0)

0 (0.0)

tween high HIV positive sero- prevalence and low socio

Total

14(100.0)

10(100.0)

24(100.0)

-economic class. Similarly, Fetuga et al

in Sagamu,

Maternal ARV Use

Yes

1(7.1)

5(60)

6(25)

FET

0.048*

western Nigeria showed that more than half of the par-

13(92.9)

5(40)

18(75)

ents of infected children were within the low socio-

Total

14(100.0)

10(100.0)

24(100.0)

economic class.

Religion

Christianity 14(100.0) 9(99.4)

23(99.4)

FET

1.00

Different methods of establishing socioeconomic status

Muslim

0(0.0)

1(0.6)

in Nigeria may contribute to these apparent differences.

Total

14(100.0)

10(100.0)

24(100.0)

We therefore recommend that appropriate tool for meas-

* FET = Fisher’s Exact Test

urement of socioeconomic status in the country and

subregion is used across board.

Table 3: Relationship between infant and maternal HIV status

Most of the infected infants were of higher birth orders

HIV Status of infant

(>1) probably because majority of the subjects belonged

(DNA PCR)

to similar families and large family is the norm rather

Infected

Uninfected

Total

p-value

than exception. Family of 1-3 is a risk factor for HIV

Variable

n=14(%)

n= 316 (%)

N=24(%)

infection in children because multiparous women may

Maternal HIV status

be tempted to deliver at home unaided or assisted by

Positive

14(100.0)

10(3.2)

24(7.3)

FET 0.00*

Negative

0(0.0)

306(96.8)

306(92.8)

TBAs having delivered previously. This increases the

Total

14(100.0) 316(100.0)

330(100.0)

risk of HIV infection in infants as the mothers do not

present in hospitals where access to PMTCT is avail-

able. Similarly, Berhan et al in Ethiopia reported that

*Statistically significant (p<0.05)

infected children were mainly from families with 1-3

children.

Discussion

Surprisingly, we observed that many parents of the HIV

infected children were married. This is a serious concern

The prevalence of 4.2% and male preponderance among

as married couples are said to belong to low risk group

HIV infected infants is similar to report by Udo et al

because they have single or stable sexual partners.

in Calabar and Ibeziako et al in Enugu. Okeudo et al

Nonetheless, the premarital HIV status of these parents

in Orlu, Nigeria and Taha et al in Malawi however

could not be ascertained to verify time and possible

284

source of infection. There will be need to screen hus-

missed during antenatal period at the immunization cen-

bands to enable them benefit from ARVs.

tres in all health facilities. Thus provide opportunity for

Antiretroviral therapy (ART) reduces the maternal HIV

health education, identification of HIV infected mothers

levels, thereby minimizing the risk of infection in the

and their children.

infant via perinatal transmission. In the absence of any

intervention, the combined risk of MTCT of HIV in

utero and intra-partum is 15-30 percent This is also

evident from our study that mothers who did not receive

Conclusion

ARV had higher transmission rate. Studies have impli-

cated lack of intervention as a risk factor for paediatric

There is high Mother-to-child transmission due to low

infections as evidenced by lower rates of infection

parental education, social class and lack of maternal

among infants that received intervention in comparison

antiretroviral drugs use.

to those that did not. Esene et al from Benin,

ob-

served that ARVs use in both mother and infant lowered

Recommendation

risk of infection in children. Another Nigerian study by

Anoje et al reported similar results among babies’ zero

It is therefore recommended that health education, test-

to six weeks old.

ing of mother-baby pair be done at immunization cen-

tres. HIV positive mothers should be advised on ARV

Mother-to-child transmission of HIV(MTCT) accounts

use during antenatal period and Mother - baby should be

for over 90% of paediatric HIV infection . Unfortu-

promptly referred for therapy.

nately, about 30% of pregnant women are not tested for

HIV during pregnancy, and another 15-20% receives no

or minimal ANC, thereby allowing for potential new

born transmission of HIV from infected mothers.

22,

Acknowledgement

Our study revealed 58.3% transmission which was also

high. This was probably due to the low use of ARVs as

The authors would like to acknowledge the contribu-

well as middle to low maternal literacy levels and social

tions of the Doctors, Nurses and other staff of the facili-

class. However, lower sero-prevalence of 0.9% was ob-

ties used for this study. Our gratitude also goes to the

served among infants aged one to 55weeks attending

Ministry of Health Cross Rivers State, Nigeria that per-

immunization clinics in Ibadan . It was assumed to be

mitted us to use their facilities for this study.

due to the effectiveness of PMTCT in reducing HIV

infections in their locality.

Conflict of Interest: None

Based on the aforementioned, it is feasible to signifi-

Funding: None

cantly target mother-baby pairs whose mothers were

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