KNOWLEDGE & PRACTICE OF CONTRACEPTIVES AMONG FEMALE STUDENTS.

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KNOWLEDGE AND PRACTICE OF CONTRACEPTIVES AMONG FEMALE STUDENTS

CHAPTER ONE

INTRODUCTION

BACKGROUND OF THE STUDY

UNAIDS (2007) estimated that 33.2 million women had HIV infection worldwide. In many regions of the world more women than men are at risk of HIV infection with not less 50% of all new daily infections in sub-Saharan Africa being in women. Children account for 12% of all new infections and globally 2.5 million children less than 15years of age were living with HIV in 2007, about 1,200 children under the age of 15years became infected with HIV daily (UNAID/WHO, 2007), without appropriate care and treatment, more than 50% of newly infected children will die before the second birthday. In 2008, around 430,000 children under 15years become infected with HIV, mainly through mothers –to child transmission (MTCT), infection occurred in Africa where AIDS is beginning to reverse decades of steady progress in child survival. In high income countries MTCT has been virtually eliminated thanks to effective HIV counseling and testing, access to antiretroviral therapy ART, Safe delivery practices, and the widespread availability and safe use of breast-milk substitutes. If these interventions were used worldwide, they could save the lives of thousands of children each year. Owing to the transmissibility of HIV from mother to child, the feeding of HIV-exposed infants remains a significant challenge in controlling the spread of HIV/AIDS. The dilemma concerning feeding infants of HIV-positive mothers is how to balance the risk of HIV transmission through breastfeeding with the risk of death from causes other than HIV such as pneumonia, diarrhoeal diseases and malnutrition among formula-fed infants (WHO, 2010). Exclusive breastfeeding (EBF) plays a critical role in the overall health of infants. It is estimated that 3% of all under-5 mortalities in low-income countries could be prevented through optimal breastfeeding during the crucial first year of life (WHO, 2013).

Optimal breastfeeding is considered to be EBF for the first 6 months of life, followed by continued breastfeeding combined with safe and nutritionally adequate complementary feeding up to 24 months of age (WHO, 2009).EBF is regarded as a global health goal given its strong association with reduced morbidity and mortality, particularly in low-income countries where safe water and sanitation are often lacking. The HIV/AIDS epidemic is one of the major factors challenging women’s health with 20 million women living with the virus and more than 2 million pregnancies occurring in HIV sero-positive women annually. Thus, HIV infection has become a major problem complicating the management of pregnancy. In Africa, HIV prevalence varies considerably, with most countries in Southern Africa having more than one in five pregnant women infected, and in a few sub-Saharan countries, median HIV prevalence in antenatal clinics in 2003 exceeded 10% (McIntyre,2005). As at 2005 the prevalence in Nigeria was 4. 4%, and by the end of 2006, it was estimated that there are 2. 99 million Nigerians living with HIV, with 305, 080 adult new infections and 74, 520 in children, largely (up to 90%) acquired through mother-to-child transmission (MTCT). Between 25 and 44% of mother-to-child transmission (MTCT) of HIV occurs through breastfeeding (FMOH, 2007) The promotion of breastfeeding is a key component of infant health polices globally because of its obvious health benefits. It is widely practiced not only in Nigeria, but most of Africa, as it is socially and culturally acceptable and natural. However, in the present context of HIV epidemic, this has become a public health dilemma as the overwhelming source of HIV infection in young children is through MTCT (FMOH, 2007). There is also the dilemma of infant feeding decisions by HIV sero-positive mothers, because most breast milk transmission of HIV- 1 occurs in the first four months of life, a time when replacement feeding carries the greatest risk of increasing infectious disease morbidity and the benefits of the breastfeeding are highest. In developing countries, decisions regarding the best mode of infant feeding can be difficult due to social, economic and practical constraints. The relative risks of morbidity and mortality associated with replacement feeding vary according to many factors: the environment, individual circumstances of the mother and her family including her education and economic status (WHO, 2004).

The WHO/UNAIDS strategic response to prevention of HIV infection in infants centered on four ‘pillars’: primary prevention of infection generally in women, prevention of transmission from HIV infected women to their infants and provision of treatment, care and support to HIV infected women and their families (WHO, 2004) . Thus, the option most likely to be chosen by HIV infected women who do not wish to risk breastfeeding their infants is replacement feeding with formula or other foods. However, WHO recommended that HIV infected women avoid breastfeeding when replacement feeding is acceptable, feasible, affordable, sustainable and safe (AFASS) (Throne C., Semenenko I., Pilipenko T., Malyuta, 2009). Most women in sub-Saharan Africa have their human immunodeficiency virus (HIV) status diagnosed during pregnancy because of testing available through programmes for the prevention of mother-to-child transmission (PMTCT) of HIV. The programme commenced in Nigeria in 2001, and has since undergone several scale-up of both in scope and coverage mainly in secondary and tertiary health facilities. Despite all these, participation/enrollment has been very low. It is in the light of this, that an assessment of feeding practices and determinants of feeding practices among HIV sero-positive mothers was carried out in one each of secondary and tertiary health facilities in Abuja, the capital of Nigeria, with a view of identifying relevant and appropriate interventions for resolving some of the problems faced by these mothers

PURPOSE /AIM OF STUDY The study is carried out to explore the knowledge and practice of safe infant feeding amongst mothers living with HIV attending postnatal clinic of Central Hospital Sapele, Delta State.

STATEMENT OF PROBLEM

The 2010 HIV Sero-prevalence sentinel survey conducted among women attending antenatal clinics in Nigeria. Shows that HIV/AIDS is still on the increase among pregnant women, HIV/AIDS still remain one of the leading causes of morbidity and mortality in Sub-Saharan Africa. According to the study reports by the former Minister of Health Nigeria Professor Onyebuchi Chukwu, the epidemic has affected all parts of the country with varying degrees of severity. The current national prevalence of 4.1%, the number of people infected is estimated at about 3.1 million. This means that Nigeria still has the second largest number of people living with HIV/AIDS in sub-Saharan Africa and the highest in West African Sub-region. As at 2009, there were 1,074 health facilities where HIV counselling and testing services can be accessed. Presently there are 875 facilities providing services on PMTCT of HIV and 393 health facilities providing Anti-retroviral drugs. The problem is; are they adequately utilised? Very few persons go to such centres. Despite the awareness of HIV/AIDS and the facilities provided by the Government of Nigeria, most HIV positive pregnant women are still reluctant to enroll for the prevention of mother-to-child transmission of HIV programmes. In order to offer better services, the attitude of the women to child feeding would help programme designers to better understand the target services audience for specific intervention (Bulawayo Health Services report, 2006). The problems so identified above are not different from what the researcher observed in Sapele. Hence this study which investigated the knowledge and practice of infant feeding amongst mothers living with HIV attending postnatal clinic.

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