Mother to child Transmission

(Total Health bulletin)

What is mother-to-child transmission?

Mother-to-child transmission (MTCT) is when an HIV positive woman passes the virus to her baby. This can occur during pregnancy, labour and delivery, or breastfeeding. Without treatment, 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.

Is MTCT a serious problem?
In 2005, around 700,000 children under 15 became infected with HIV, mainly through mother-to-child transmission. About 90% of these MTCT infections occurred in Africa as remains the epicentre of the global HIV pandemic.

How can MTCT be prevented?
Effective prevention of mother-to-child transmission (PMTCT) can be prevent with :
Education of Preventing HIV infection among prospective parents
Avoiding unwanted pregnancies among HIV positive women
Preventing the transmission of HIV from HIV positive mothers to their infants during pregnancy, labour, delivery and breastfeeding.
The last of these can be achieved by the use of antiretroviral drugs, safer feeding practices and choose Caesarian section when deliveries a baby.

Preventing mother to child transmision of HIV

1. Antiretroviral drugs

This is the main type of treatment for HIV or AIDS. It is not a cure, but it can stop people from becoming ill for many years. The treatment consists of drugs that have to be taken every day for the rest of someone's life Antiretroviral treatment for HIV infection consists of drugs which work against HIV infection itself by slowing down the replication of HIV in the body.
Women who have reached the advanced stages of HIV disease require a combination of antiretroviral drugs for their own health. This treatment, which must be taken every day for the rest of a woman's life, is also highly effective at reducing the risk of mother-to-child transmission. Women who require treatment will usually be advised to take it, beginning either immediately or after the first trimester. Their newborn babies will usually be given a course of treatment for the first few days or weeks of life, to lower the risk even further.

2. Safer feeding

For most mothers, breastfeeding is without question the best way to feed their babies. Breast milk provides all of the nutrients an infant needs during the first few months of life; it is usually readily available and costs nothing. Breastfeeding strengthens the emotional bond between mother and child and, because of its contraceptive effect, helps to control the spacing of pregnancies.
What is more, breast milk contains agents that help to protect against common childhood illnesses such as diarrhoea and respiratory infections. Even in rich countries, breastfed babies are less likely to become ill than those who are not breastfed. In other parts of the world, where there is little access to clean water, sanitation and health services, not breastfeeding can greatly increase the risks of disease and death.
Unfortunately, breast milk can also transmit HIV.

The risks and benefits of breastfeeding
For HIV-positive mothers, the decision whether or not to breastfeed a child can be a frightening dilemma. The dangers of breastfeeding must be compared with the risk of not breastfeeding. Babies who breastfeed from HIV-positive mothers have a 10 to 20 per cent chance of becoming infected. However, babies who do not breastfeed are six times more likely to die from diarrhoea or respiratory infections than babies who do breastfeed. Moreover, breastfeeding provides complete nutrition and strengthens a baby’s immune system.

So, how should a woman make the choice?
The first step is to get tested. If a woman determines that she is HIV negative, there is no question. She should breastfeed. If she is HIV-positive, she should consider alternatives. Baby formula is an option only if a mother has access to clean drinking water and can afford enough baby formula for at least six months. Other possibilities include home-prepared modified animal milk, milk from breastmilk banks or breastfeeding by an HIV-negative woman
If none of these alternatives are available, safe or sustainable, it is recommended that mothers breastfeed their children for just six months. The longer a child is breastfed by an HIV-infected mother, the higher the child’s risk of contracting the disease.

WHO makes the following recommendations:
When replacement feeding is acceptable, feasible, affordable, sustainable and safe, avoiding breastfeeding by HIV-infected mothers is recommended. Otherwise, exclusive breastfeeding is recommended during the first months of life and should be discontinued as soon as possible.
If a mother has cracked nipples or mastitis (a type of breast inflammation), or if her baby has infections or sores in its mouth, then the risk of HIV transmission is probably increased.It is therefore important that women are taught how to breastfeed correctly, and are able to access health care to clear up any ailments.


3. Caesarean sections

When a mother is HIV positive a caesarean section may be done to protect the baby from direct contact with her blood and other bodily fluids.


Summary
Preventing mother-to-child transmission might seem simple, but there’s much more to it than that. To begin with, the vast majority of women in the developing world have never been tested for HIV and don’t know whether they are infected. Many other women visit clinics only once during pregnancy, and nearly two-thirds give birth unattended by a skilled health worker. The problem is compounded if women have to make follow-up visits to receive counselling, drugs or other services. At each step, some women drop out.
This means that effective PMTCT programmes must provide counselling and testing services to determine which women need assistance.