Prognostic of the New Nests of Seropositive Mothers Beneficiaries of the Prevention of Mother-Child Transmission in the City of Mbuji-Mayi/Drc ()
1. Introduction
While encouraging progress has been observed in countries where the disease burden is high and in low- and middle-income, efforts are deployed in the mother-child transmission of HIV worldwide, [1] .
The mother-child transmission in the absence of prevention is estimated at 40% of children born to HIV-infected mothers who are infected. Among them, an estimated two-thirds are infected during pregnancy and childbirth, a third during breastfeeding [2] .
In the world, 17.5 million women are infected with HIV/AIDS and every year, about 1.4 million women living with HIV in low- and middle-income countries become pregnant (8.0%), and about 2.3 million children under 15 are infected [3] . The same source indicates that more than 90% of infections in infants and young children are due to mother to child transmission, either during pregnancy, labor and delivery, or during breastfeeding. If nothing is done, almost one in three children born to mothers with HIV will be infected himself (in Europe for example, new HIV infections in children are estimated at 190,000 of which 15,000 are from Ukraine, the countries occupying the first place in the European continent).
In Africa, the situation analysis and response to the AIDS epidemic in 2006 reveals that 30% of children born to HIV-positive mothers are infected (the distribution of the frequency of pregnancies and children infected is different from one country to another), and countries pay heavily are: South Africa, Zimbabwe 45% 41% [4] .
In the Democratic Republic of Congo, DRC, the joint report of the national program against STI/AIDS and WHO reported 20.5% seroconversion in children born of HIV positive mothers HIV [5] . This area is less exploited by researchers in the DRC.
Also in Kasai Oriental, particularly in the city of Mbuji-Mayi, the results presented by the provincial coordinating fight against STI/AIDS reveal that in 2014, among children followed, 15 samples were taken of which 4 children were HIV + 26.6%, while in 2015, 10 of 115 children positive sample is 8.7% while in 2016, 92 samples taken among which 7 are positive 7.6% [6] .
So to prevent mother to child transmission of HIV, the PMTCT program was considered an access response to antiretroviral (ARV) having the best cost/efficiency and one of the most relevant approaches to preventing HIV infection in children [7] .
Our objective is to evaluate the impact of PMTCT into health zones having in their interventions; the prevention of HIV transmission from mother to child finally helps the program to adjust prevention and achieve the goal 4 and 5 of the millennium “reduce maternal and child mortality related to HIV/AIDS 90%”.
2. Material and Method
This is a descriptive correlational study in which data collection is done in a transversal way of 1 to 30 June 2017 among screened women with HIV and on antiretroviral treatment in the targeted area health study. To get to collect these data, we used the technique of semi interview―structured face to face with a questionnaire.
3. Results
3.1. Presentation of the Results
It appears from this Table 1 that 52.0% of respondents had positive women age over 30 years, 73.1% were married which 55.7% was polygamous, 36.0% had a secondary level of study, 92 1% were Christian, 55.4% had less than 5 children.
After analysis of these results (Table 2), we find that 94.2% of respondents knew about the modes of transmission of HIV/AIDS, compared to the knowledge of practices favoring transmission from mother to child, 21.5% had mentioned multiple maternal infections, 18.6% spoke of mixed feeding; 77.8 M evoked the absence of maternal treatment, 80.8% spoke of multiple pregnancies and 82.3% spoke of sexual multistakeholder. In connection with the knowledge of practices to prevent transmission from mother to child 97.2% evoked voluntary testing for HIV, 94.2% evoked monitoring PMTCT program, 88.5% had also spoken to the non-delivery home, 79.3% spoke of avoidance of mixed feeding, 83.6% of them were applicable all three proposals given above. 95
Regarding the results of this Table 3 and Table 4, 94.2% of respondents knew the center offering PMTCT services within its range, 43.3% was embarrassed to go to the NPC, 93.2% felt that there were privacy in service, 95.7% received regular ARVs, 87.6% was regularly the contrimozasole and 90.4% had received a proposal for contraception.
Compared to this Table 5, 69.3% of respondents were engaged in a professional activity. Regarding the knowledge of sexual practices at risk of contamination, 97.4% spoke of unprotected sexual practice, 21.6% also spoke of homosexuality and 94.9% spoke of early sexual intercourse. In connection with the practical knowledge to avoid contamination of the child, 77.4% had spoken mother of voluntary testing and 67.2% evoked mixed feeding; 87.0% were prepared to implement a family planning method and 64.0% had no income generating activity.
3.2. Results of Bivariate Analyzes
It appears from this Table 6 that the parity of more than 5 children (X2 = 10.05; p = 0.001) was the only factor that was the basis of HIV status of children born to HIV positive mothers.
After analysis of these results (Table 7) should be said that ignorance of certain HIV modes of transmission (X2 = 70.06; p = 0.000), lack of knowledge: several maternal infections (X2 = 91.16, p = 0.000), mixed feed (X2 = 76.5; p = 0.000), the absence of treatment of the mother (X2 = 74.17; p = 0.000), multiple pregnancies (X2 = 85.98; p = 0.000 ) and multiple sex partners as factors promoting HIV transmission from mother to child. What are factors that are associated with the child’s infection from HIV-positive mothers.
These results also show that the lack of knowledge of PMTCT (X2 = 7.00, p = 0.008), home delivery (X2 = 44.57, p = 0.000), avoid mixed feeding (X2 = 70.06, p = 0.000) as a practice to prevent mother-to-child HIV transmission and non-follow-up of PMTCT service with all pregnancies after positive HIV diagnosis (X2 = 68.01, p = 0.000). What are some of the factors that are associated with the contamination of the child from HIV-positive mothers?
Given these results (Table 8), the conclusion is that it is links of association between HIV seropositivity among children born to HIV positive mothers and the center of ignorance offering PMTCT services in its radius (X2 = 10.82; p = 0.001), poor monitoring of antiretroviral treatment (X2 = 18.88; p = 0.000), the absence of contrimoxazole by time (X2 = 12.62; p = 0.000) and the effect of not implementing a FP method (X2 = 17.36; p = 0.000).
After analysis of these results (Table 9) consistent that certain characteristics influence the HIV status of HIV children born to HIV positive mothers, they are: ignorance of sexual violence (X2 = 16.11; p = 0.000), ignorance of the early sex before the age of majority (X2 = 5.46; p = 0.019) as sexual risk of HIV infection/AIDS from mother to child and ignorance of mixed feeding as a way to avoid contamination from mother to child.
4. Discussion
The risk of transmission from mother-to-child is a permanent concern faced by health professionals and all partners involved in the fight against HIV/AIDS. Due to the possibility of vertical contamination and therefore void the dream of an HIV/AIDS. The contamination of the transmission of mother-to-child has been documented in several countries.
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Table 1. Distribution of subjects by socio-demographic categories.
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Table 2. Distribution of subjects according to their knowledge about the mode of transmission of HIV and practices favoring contamination HIV.
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Table 3. HIV prevalence among children of HIV positive mothers.
The prevalence was 10.7%.
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Table 4. Distribution of subjects by organizational factors.
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Table 5. Distribution of cases socio-professional characteristics.
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Table 6. Association between socio-demographic categories of HIV-positive mothers and become the child of these mothers.
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Table 7. Association between knowledge of HIV transmission mode, practice promoting HIV contamination and become the child of these mothers.
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Table 8. Association between certain organizational characteristics and become the child of these mothers.
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Table 9. Association between certain socio-professional characteristics and become the child of these mothers.
It appears from this study that 10.7% of children born to HIV positive mothers were also infected. With the success of multiple therapies, in industrialized countries, a growing number of women start PMTCT pregnancy while they are receiving highly active antiretroviral therapy. Transmission rates observed with these treatments are extremely low, in the order of 1% to 3% [8] . Our results are far superior to those of a French study ANRS 075, with AZT treatment as soon as possible after starting 14 weeks of pregnancy associated with lamivudine (3TC) from 32 weeks, the transmission rate was 1.6% [9] [10] . Finally, a multicenter study conducted in the United States, France, Brazil and the Bahamas, PACTG 316, confirmed in more than 2000 pregnant women, when they receive optimal antiretroviral therapy for their own health (HAART if necessary) the transmission rate is extremely low, in the order of 1.5% [1] . For their hand UNICEF et al., the estimated growth rate in the number of cases of HIV-AIDS among under 15 between 4% and 5% and more than half of these infected children die before their first birthday and most before the age of five [11] .
The mother-child transmission of HIV can be done either during pregnancy or during labor and delivery, or during breastfeeding. Schematically, in the absence of preventive treatment, approximately 25% - 40% of children are infected with 5% - 10% during pregnancy, 15% during labor and about 5% - 15% through breastfeeding. By 1994, the PACTG 076-ANRS 024 study demonstrated the remarkable efficacy of AZT to reduce mother to child transmission of HIV by 26% to 8% in women not breastfeeding their children. To test the effectiveness of anti-retroviral drugs in the mother and/or child to reduce transmission during breastfeeding [12] [13] .
Many factors have been studied in the hope of preventing mother-child transmission of HIV/AIDS. The correction of these factors is unfortunately not always associated with a reduction in transmission. The risk of transmission during pregnancy and childbirth is higher when the mother is at an advanced stage of the disease, their immune system is already impaired or it has a micronutrient deficiency such as vitamin A [13] .
However it is the association between viral load and transmission, which is the most significant: the higher the viral load, the higher the risk of transmission is high. Some evidence suggests that transmission is more common with certain subtypes of HIV-1 as subtype C, particularly widespread in East Africa, but these results were not confirmed (16). Due to its rapid mutational capabilities, HIV gradually adapts better to escape the natural or artificial defenses (ART) host: thus, the absence of agreement between the mother and child for certain characteristics HLA would be protective for children [14] .
The results of this study show that the HIV status of children born to HIV positive mothers is influenced by the following factors: parity of more than 5 children (X2 = 10.05; p = 0.001), the ignorance of certain HIV modes of transmission (X2 = 70.06; p = 0.000), the ignorance of certain factors favoring transmission of HIV from mother to child as: several maternal infections (X2 = 91.16; p = 0.000), mixed feed (X2 = 76.5; p = 0.000), the absence of treatment of the mother (X2 = 74.17; p = 0.000), multiple pregnancies (X2 = 85.98; p = 0.000); Besides these factors, the results also show that ignorance of certain practices to prevent transmission of HIV from mother to child as: failure monitoring PMTCT (X2 = 7.00; p = 0.008), home delivery (X2 = 44.57; p = 0.000), mixed feeding (X2 = 70.06; p = 0.000) and not follow the PMTCT service with all the pregnancy after a positive HIV diagnosis (X2 = 68.01; p = 0.000);
The same study also revealed that the center of ignorance offering PMTCT services in its radius (X2 = 10.82; p = 0.001), poor monitoring of antiretroviral treatment (X2 = 18.88; p = 0.000), the absence of contrimoxazol by time (X2 = 12.62; p = 0.000) and the effect of not implementing a method of family planning (X2 = 17.36; p = 0.000);
The other factors identified in this study are: ignorance of sexual violence (X2 = 16.11; p = 0.000), ignorance of early sex before the age of majority (X2 = 5.46; p = 0.019) as sexual risk of HIV infection/AIDS from mother to child and ignorance of mixed feeding as a way to prevent contamination of the mother to her child.
5. Conclusion
The mother-child transmission in the absence of prevention is estimated at 40% of children born to HIV-positive mothers who are infected. Among them, an estimated two-thirds are infected during pregnancy and childbirth, a third during breastfeeding. Thus the WHO advises in this case to promote education, information and communication to health services that are ignored by the people using the communication channels available in the respective areas; apply the mass communication to inform pregnant women of the existence of PMTCT services at health centers or hospitals.