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How poor clinic attendance fuels HIV infections in children


Poor attendance of antenatal clinics (ANCs) in 25 counties holds back the elimination of mother-to-child HIV infections in Kenya, data shows.

Although campaigns have helped to sharply lower mother-to-child HIV infections in Kenya, thousands of children are still infected each year — turning the spotlight of counties where the attendance of ANCs remains poor leading to dismal prevention of mother-to-child transmission (PMTCT).

In 2016, the number of HIV infections among children in Kenya stood at 6,091 compared to 14,905 in 2010 — representing a 59 per cent drop, new data by the United Nations joint Aids programme (UNAids) shows.

George Githuka, an official of the National Aids STIs Control Programme, says attendance of ANCs is critical because it helps to screen mothers for HIV and prevent the spread of infections to newborns.

Despite this, an estimated 42 per cent of pregnant women do not attend antenatal clinics in Kenya, according to a study published last year in the Global Health Action Journal.

Mother-to-child HIV transmission occurs either during pregnancy, delivery or through breastfeeding. Mothers are required to remain on the prescribed anti-retro therapy (ART) to suppress viral load and minimise the risk of infecting the child.

“The PMTCT coverage is part of a cascade that begins with antenatal clinic attendance. In counties where ANC attendance is low PMTCT coverage as a consequence of this will be low,” Dr Githuka said.

The World Health Organisation recommends two ANC visits in the first two trimesters and two more during the last three months.

A 2016 progress report by the Health ministry indicates that in the 23 counties where the number of new infections increased, PMTCT coverage was also low. In Wajir and Mandera the coverage was found to be below 19 per cent. It is not surprising that the number of child HIV infections in Mandera went up to 48 in 2015 from 17 in 2015 while in Wajir it increased from two to 18 in the same period.

The two worst performing counties had poor antenatal clinic attendance too. The 2014 Kenya Demographic Health Survey indicates that Wajir and Mandera counties had the lowest ANC attendance in the country at 57 and 50 per cent, respectively.

According to the study, northeastern Kenya has the highest illiteracy levels regarding mother-to-child HIV transmission. Women in the two counties scored 30 per cent on the awareness levels about special drugs mothers take to prevent transmission and that HIV virus can be transmitted through breastfeeding.

According to the progress report, new infections in Mombasa and Machakos counties also went up by 87 per cent and 60 per cent, to 139 and 128 cases, respectively.

The progress report shows that PMTCT coverage in these two regions was between 50 per cent and 79 per cent, falling below the regional average.

The main challenges affecting maternal and child healthcare in Kenya are severe in rural areas and include inadequately skilled health providers, distance to the health facilities, the burden of HIV/Aids, and insufficient facilities, equipment and supplies.

Seven counties among them Nairobi, Nyeri, Kiambu and Elgeyo Marakwet reported below five percent rate of mother-to-child transmission.

These counties were also amongst the 22 devolved units that reported a reduced number of new infections and more than 90 per cent PMTCT coverage.

Culture, Dr Githuka says, plays a major role in the coverage. He adds that the PMTCT coverage is adversely affected due to a lack of individual or cultural support.

“The reasons for low ANC attendance vary within counties and communities…Some of the cultural reasons for this are driven by stigma, myths and misconceptions. Some cultures, for instance, do not believe in exclusive breastfeeding for the first six months of life. “Mixed feeding is a risk factor for HIV transmission from mother to child,” he says.

In the region, Kenya lags behind its peers in coverage compared to countries such as Uganda, Botswana, Swaziland, Zimbabwe, Namibia and South Africa, according to the Southern and East Africa UNAids report.

The six have more than 90 per cent of pregnant women receiving ARTs to prevent mother-to-child transmission.

Scaling up early HIV diagnoses and treatment of pregnant mothers, increasing birth deliveries by skilled attendants, which currently stands at 62 per cent and encouraging antenatal clinic attendance would ensure that new infections are reduced further, the report notes. Growth in the coverage of early infant HIV diagnosis, currently at 53 per cent, would also improve the survival rate of infants beyond two years.