Masters Degrees (Nutrition and Dietetics)

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Browsing Masters Degrees (Nutrition and Dietetics) by Subject "Antiretroviral Therapy (ART)"

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    Effectiveness of the prevention of mother-to-child transmission (PMTCT) policy in the Northern Cape, South Africa
    (University of the Free State, 2015-07) Myburgh, Bianca; Lategan, Ronette
    English: Introduction Human Immunodeficiency Virus (HIV) infection in children is mainly caused by Mother-to-Child Transmission (MTCT). The Prevention of Mother-to-Child Transmission (PMTCT) policy has been implemented in South Africa to reduce the rate of MTCT. Even though this policy has been in place for more than ten years and despite the reduction in MTCT, the challenge remains to eliminate MTCT completely. This study investigates the factors that may influence the effectiveness of the PMTCT policy. Methods Four clinics in the Frances Baard District, South Africa, where PMTCT services are rendered were included. A hundred mothers-child-pairs, where the mother is HIV infected and breastfed her child, but has stopped breastfeeding and the six week post cessation of breastfeeding HIV test was done on child, were included in the study. A questionnaire was completed by the researcher during an interview with the mother and anthropometric measurements of both mother and child were taken. The clinic files of mothers were also used to collect data. Ethical approval to conduct this study was obtained from the Ethics Committee, Faculty of Health Sciences, University of the Free State and the Northern Cape Department of Health Research Ethics Committee. Mothers provided informed consent before interviews were conducted. The Department of Biostatistics, University of the Free State performed the statistical analysis of data. Results All mothers included in this study attended antenatal clinics. Mothers who were not known to be HIV infected were tested antenatal and CD4 cell counts and HIV stages were indicated in all files. Twenty two mothers visited the antenatal clinic less than four times as recommended and 23 mothers visited for the first time during their third trimester. Only one mother reported that she received no counselling on feeding practises, and even though mothers were mostly knowledgeable about feeding practices, only 58 mothers introduced solids at the correct age and 31 mothers mixed fed their children.The number of counselling sessions did not affect breastfeeding duration (95% CI: [-2; 3]) or the age of introduction of solids (95% CI:[-2; 1]) Knowledge about MTCT was poor as most mothers (82%) only knew that MTCT could occur during breastfeeding. Younger mothers were more knowledgeable (95% CI: [0.17; 5.56]). The number of counselling sessions did not affect the knowledge of the mother (p=0.12). Five children and eight mothers never started with any antiretroviral therapy (ART). Thirteen children and 27 mothers defaulted their ART treatment. No children tested HIV infected at six weeks but three children tested HIV infected at the 18 month test. Mothers with HIV infected children had a more advanced stage of HIV infection (95% CI: [23.5%; 87.1%]), lower CD4 cell count (p=0.03) and defaulted their ART during breastfeeding (95% CI: [21.5%; 85.4%]) compared to mothers with HIV uninfected children. All three children that tested HIV infected were of mothers with Stage 2 HIV infection, with a CD4 cell count of less than 350 cells/mmᶾ and defaulted their ART during breastfeeding. Conclusions and recommendations Using the 2010 and 2013 PMTCT policies as benchmark, the PMTCT programme is implemented relatively well in this district although improvements still need to be made. The knowledge of the mothers about feeding practices and MTCT should be addressed by means of counselling by properly informed health care professionals. Missed opportunities for training resulted, as mothers did not attend antenatal clinic as soon and as often as recommended. Mothers should be motivated to improve ART adherence as this can affect CD4 cell count and HIV progression, all factors that contributed to MTCT. Counselling should be focussed on ART adherence and MTCT. Shortages of ART at clinics should be addressed to eliminate this reason for ART defaulting. All women of childbearing age should also be made aware of the importance of early antenatal attendance. The rate of HIV transmission in this district is below the national reported rate but it remains a challenge to eliminate MTCT completely.