Better Health for the African Mother and Child
Studies of reproductive health and follow up of mother-child pairs in high and medium HIV prevalent countries
A collaboration betweenThe Division of OB/Gyn, Rikshospitalet, University of Oslo,
Parirenyatwa Hospital, University of Zimbabwe,
Kilimanjaro Christian Medical Center, University of Tumaini, Tanzania,
Supported by Letten Foundation,
University of Oslo
Human immunodeficiency virus (HIV) is a global health problem of immense proportion, with 40 million people infected; nearly 58 % are women and 2.2 million are children. Sub-Saharan Africa is the most affected area in the world; appr. 70 % of all infected grown ups and more than 90 % of the infected children live there. Nine out of 10 of the HIV- infected children have acquired the disease through mother-to-child transmission (MTCT).
Sexually transmitted infections (STI) and reproductive tract infections (RTI) are major causes of morbidity of women in their reproductive years. HIV and STIs have a close bi-directional relationship. STIs may increase the risk of HIV transmission 3-5 fold and accelerate HIV disease progression, while HIV may increase the susceptibility to other STIs.
The project started 7 years ago as a study of prevention of mother- to-child transmission (PMTCT) of STIs, including HIV. The project was called “ Better health for the African Mother and Child” and is a cooperation between Universities and hospitals in Zimbabwe, Tanzania and Norway.
Pregnant women in the Moshi urban district in Tanzania (n=2654) and in Harare, Zimbabwe (n=1050) who were in their 3rd trimester were interviewed and screened for STIs and RTIs.
HIV-positive women were given a short course of antiretroviral treatment to reduce vertical transmission of HIV to the infants and maternal STIs were treated.
After delivery, mother-infant pairs of both HIV-positive and HIV- negative women have been followed up twice yearly – at present up to 6-7 years and they are planned to be followed also in school-age.
The incidence of HIV and lower genital tract infections and their risk factors have been determined in the mothers. For the infants, growth, neuro-developmental assessments and nutritional recordings have been undertaken.
Women have been invited to bring their partners for counseling and testing and the male involvement has also been studied.
Tanzania is regarded to have a medium prevalence of HIV; 7 % of the mothers included in our study were found to be infected. Majengo and Pasua primary health centres in the Moshi urban district in North-Eastern Tanzania have high attendance numbers and easy accessibility and all refer patients to the tertiary center at K.C.M.C. Hospital, the University of Tumaini.
Zimbabwe is one of the countries in the world with the highest HIV prevalence, 25% of the mothers in our study were found to be infected. St. Marys, Epworths and Seke North Makoni outpatient clinics are all located in densely populated easily accessible areas of Harare and all refer patients to the Parirenyatwa Hospital at the University of Zimbabwe.
The project is based and supervised from the referral hospitals at these Universities/hospitals. Ethical issues have been considered and agreements of cooperation between the different Universities have been signed.
Due to increased awareness and treatment of mother-to-child transmission of HIV, more HIV-positive children are surviving and living longer. Limited information is available about these children’s cognitive and behavioral development. Little is also known about risk factors predisposing women to acquire HIV, their reproductive choices and how they and their partners cope if infected with the disease.
Availability of HIV-positive and negative mother- child pairs from the PMTCT/STI study gives a unique opportunity to study many aspects of the HIV problem in well-defined cohorts in two countries with very different prevalence profiles of HIV. Valuable experience has been gained by organizing a study in the local sites; experience which will be used in future planning for personnel resources, ways of following up and technical issues for the forth-coming years.
The social component is important and women’s support groups including microcredit projects have been established.