Skip to main content
Top
Published in: BMC Public Health 1/2013

Open Access 01-12-2013 | Research article

Factors associated with HIV infection among children born to mothers on the prevention of mother to child transmission programme at Chitungwiza Hospital, Zimbabwe, 2008

Authors: Stella Ngwende, Notion T Gombe, Stanley Midzi, Mufuta Tshimanga, Gerald Shambira, Addmore Chadambuka

Published in: BMC Public Health | Issue 1/2013

Login to get access

Abstract

Background

Zimbabwe is one of the five countries worst affected by the HIV/AIDS pandemic with HIV infection contributing increasingly to childhood morbidity and mortality. Among the children born to HIV positive mothers participating in the PMTCT programme, 25% tested positive to HIV. We investigated factors associated with HIV infection among children born to mothers on the PMTCT programme.

Methods

A 1:1 unmatched case–control study was conducted at Chitungwiza Hospital, Zimbabwe, 2008. A case was defined as a child who tested HIV positive, born to a mother who had been on PMTCT programme. A control was a HIV negative child born to a mother who had been on PMTCT programme. An interviewer-administered questionnaire was used to collect data on demographic characteristics, risk factors associated with HIV infection and immunization status.

Results

A total of 120 mothers were interviewed. Independent risk factors associated with HIV infection among children included maternal CD4 count of less than 200 during pregnancy [aOR = 7.1, 95% CI (2.6-17)], mixed feeding [aOR = 29, 95% CI (4.2-208)], being hospitalized since birth [aOR = 2.9, 95% CI (1.2-4.8)] whilst being exclusively breast fed for less than 6 months [aOR = 0.1 (95% CI 0.03-0.4)] was protective.

Conclusions

HIV infection among children increased if the mother’s CD4 count was ≤200 cells/μL and if the child was exposed to mixed feeding. Breastfeeding exclusively for less than six months was protective. We recommended exclusive breast feeding period for the first six months and stop breast feeding after 6 months if affordable, sustainable and safe.
Literature
2.
go back to reference UNAIDS: UNAIDS report on the global AIDS epidemic, 2012. 2012, Geneva: UNAIDS UNAIDS: UNAIDS report on the global AIDS epidemic, 2012. 2012, Geneva: UNAIDS
3.
go back to reference Dorebaum A, Cunningham CK, Gelber RD, Culnane M, Mofeson L, Britto P, et al: Two dose intrapartum/newborn nevirapine and standard antiretroviral therapy to reduce perinatal HIV transmission; A randomised trial. JAMA. 2002, 288 (2): 189-198. 10.1001/jama.288.2.189.CrossRef Dorebaum A, Cunningham CK, Gelber RD, Culnane M, Mofeson L, Britto P, et al: Two dose intrapartum/newborn nevirapine and standard antiretroviral therapy to reduce perinatal HIV transmission; A randomised trial. JAMA. 2002, 288 (2): 189-198. 10.1001/jama.288.2.189.CrossRef
4.
go back to reference World Health Organization: Towards universal access, scaling up priority HIV AIDS interventions in the health sector. 2008, WHO World Health Organization: Towards universal access, scaling up priority HIV AIDS interventions in the health sector. 2008, WHO
5.
go back to reference De Cock KM, Fowler MG, Mercier E, de Vinci I, Saba J, Hoff E, Alnwick DJ, et al: Prevention of Mother to child HIV transmission in resource poor countries: translating research into policy and practice. JAMA. 2000, 283 (9): 1175-1182. 10.1001/jama.283.9.1175.CrossRefPubMed De Cock KM, Fowler MG, Mercier E, de Vinci I, Saba J, Hoff E, Alnwick DJ, et al: Prevention of Mother to child HIV transmission in resource poor countries: translating research into policy and practice. JAMA. 2000, 283 (9): 1175-1182. 10.1001/jama.283.9.1175.CrossRefPubMed
6.
go back to reference Zimbabwe National Statistics Agency (ZIMSTAT) and IF International: Zimbabwe Demographic and Health Survey 2010–11. 2012, Calverton, Maryland: ZIMSTAT and ICF International Inc. Zimbabwe National Statistics Agency (ZIMSTAT) and IF International: Zimbabwe Demographic and Health Survey 2010–11. 2012, Calverton, Maryland: ZIMSTAT and ICF International Inc.
8.
go back to reference Ioannidis JP, Abrams EJ, Ammann A, et al: Perinatal transmission of human immunodeficiency virus type 1 by pregnant women with RNA virus loads <1000 copies/ml. J Infect Dis. 2001, 183 (4): 539-545. 10.1086/318530.CrossRefPubMed Ioannidis JP, Abrams EJ, Ammann A, et al: Perinatal transmission of human immunodeficiency virus type 1 by pregnant women with RNA virus loads <1000 copies/ml. J Infect Dis. 2001, 183 (4): 539-545. 10.1086/318530.CrossRefPubMed
10.
go back to reference Piwoz EG, Illiff PJ, Tavengwa NV, Gavin L, Marida ET, Lunney K, et al: An education and counselling program for preventing breastfedding associated HIV transmission in Zimbabwe: design and impact on maternal knowledge and behaviour. J Nutr. 2005, in press Piwoz EG, Illiff PJ, Tavengwa NV, Gavin L, Marida ET, Lunney K, et al: An education and counselling program for preventing breastfedding associated HIV transmission in Zimbabwe: design and impact on maternal knowledge and behaviour. J Nutr. 2005, in press
13.
go back to reference Coustoudis A, Pillay K, Spooner E, Kuhn L, Coovadia HM: Influence of infant feeding patterns on early mother to child transmission of HIV-1 in Durban South Africa; A prospective cohort study. South African Vitamin A Study Group. Lancet. 1999, 354 (9177): 471-476. 10.1016/S0140-6736(99)01101-0.CrossRef Coustoudis A, Pillay K, Spooner E, Kuhn L, Coovadia HM: Influence of infant feeding patterns on early mother to child transmission of HIV-1 in Durban South Africa; A prospective cohort study. South African Vitamin A Study Group. Lancet. 1999, 354 (9177): 471-476. 10.1016/S0140-6736(99)01101-0.CrossRef
14.
go back to reference Coovadia HM, Rollins NC, Bland RM, Little K, Coutsoudis A, Bennish ML, Newell ML: Mother to child transmission of HIV-1 during exclusive breast feeding in the first six months of life: an intervention cohort study. Lancet. 2007, 369 (9567): 1107-1116. 10.1016/S0140-6736(07)60283-9.CrossRefPubMed Coovadia HM, Rollins NC, Bland RM, Little K, Coutsoudis A, Bennish ML, Newell ML: Mother to child transmission of HIV-1 during exclusive breast feeding in the first six months of life: an intervention cohort study. Lancet. 2007, 369 (9567): 1107-1116. 10.1016/S0140-6736(07)60283-9.CrossRefPubMed
15.
go back to reference Illif PJ, Piwoz EG, Tavengwa NV, Zunguza CD, Marinda ET, Nathoo KJ, et al: Early exclusive breast feeding reduces the risk of postnatal HIV-1 transmission and increases HIV free survival. AIDS. 2005, 19 (7): 699-708. 10.1097/01.aids.0000166093.16446.c9.CrossRef Illif PJ, Piwoz EG, Tavengwa NV, Zunguza CD, Marinda ET, Nathoo KJ, et al: Early exclusive breast feeding reduces the risk of postnatal HIV-1 transmission and increases HIV free survival. AIDS. 2005, 19 (7): 699-708. 10.1097/01.aids.0000166093.16446.c9.CrossRef
16.
go back to reference Coovadia H, Kindra G: Breastfeeding to prevent HIV transmission in infants: balancing pros and cons. Curr Opin Infect Dis. 2008, 21 (1): 11-15. 10.1097/QCO.0b013e3282f40689.CrossRefPubMed Coovadia H, Kindra G: Breastfeeding to prevent HIV transmission in infants: balancing pros and cons. Curr Opin Infect Dis. 2008, 21 (1): 11-15. 10.1097/QCO.0b013e3282f40689.CrossRefPubMed
17.
go back to reference Hovarth T, Madi BC, Iuppa IM, Kennedy GE, Rutherford GW, Read JS: Interventions for preventing late postnatal mother to child transmission of HIV. Cochrane Database Syst Rev. 2009, CD006734-10.1002/14651858.CD006734.pub2, 1 Hovarth T, Madi BC, Iuppa IM, Kennedy GE, Rutherford GW, Read JS: Interventions for preventing late postnatal mother to child transmission of HIV. Cochrane Database Syst Rev. 2009, CD006734-10.1002/14651858.CD006734.pub2, 1
18.
go back to reference Chasela CS, Hudgens MD, Jamieson DJ, et al: Maternal or infant antiretroviral drugs to reduce HIV −1 transmission. N Engl J Med. 2010, 362: 2271-2281. 10.1056/NEJMoa0911486.CrossRefPubMedPubMedCentral Chasela CS, Hudgens MD, Jamieson DJ, et al: Maternal or infant antiretroviral drugs to reduce HIV −1 transmission. N Engl J Med. 2010, 362: 2271-2281. 10.1056/NEJMoa0911486.CrossRefPubMedPubMedCentral
19.
go back to reference Kilewo C, Karlsson K, Ngarina M, et al: Prevention of mother to child transmission of HIV-1 through breastfeeding by treating mothers with triple antiretroviral therapy in Dar es Salaam, Tanzania; the MITRA Plus study. J Acquired Immune Defic Syndr. 2009, 52: 406-416. 10.1097/QAI.0b013e3181b323ff.CrossRef Kilewo C, Karlsson K, Ngarina M, et al: Prevention of mother to child transmission of HIV-1 through breastfeeding by treating mothers with triple antiretroviral therapy in Dar es Salaam, Tanzania; the MITRA Plus study. J Acquired Immune Defic Syndr. 2009, 52: 406-416. 10.1097/QAI.0b013e3181b323ff.CrossRef
20.
go back to reference Peltier CA, Ndayisaba GF, Lepage P, et al: Breastfeeding with maternal antiretroviral therapy or formula feeding to prevent HIV postnatal mother to child transmission in Rwanda. AIDS. 2009, 23: 2415-2423. 10.1097/QAD.0b013e32832ec20d.CrossRefPubMedPubMedCentral Peltier CA, Ndayisaba GF, Lepage P, et al: Breastfeeding with maternal antiretroviral therapy or formula feeding to prevent HIV postnatal mother to child transmission in Rwanda. AIDS. 2009, 23: 2415-2423. 10.1097/QAD.0b013e32832ec20d.CrossRefPubMedPubMedCentral
21.
go back to reference Shapiro RL, Hughes MD, Ogwu A, et al: Antiretroviral therapy regimens in pregnancy and breastfeeding in Botwsana. N Engl J Med. 2010, 362: 2282-2294. 10.1056/NEJMoa0907736.CrossRefPubMedPubMedCentral Shapiro RL, Hughes MD, Ogwu A, et al: Antiretroviral therapy regimens in pregnancy and breastfeeding in Botwsana. N Engl J Med. 2010, 362: 2282-2294. 10.1056/NEJMoa0907736.CrossRefPubMedPubMedCentral
22.
go back to reference Embree JE, Njenga S, Datta P, Nagelkerke NJD, Ndinya-Achola JO, Mohammed Z, et al: Risk factors for postnatal mother-child transmission of HIV-1. AIDS. 2000, 14: 2535-2541. 10.1097/00002030-200011100-00016.CrossRefPubMed Embree JE, Njenga S, Datta P, Nagelkerke NJD, Ndinya-Achola JO, Mohammed Z, et al: Risk factors for postnatal mother-child transmission of HIV-1. AIDS. 2000, 14: 2535-2541. 10.1097/00002030-200011100-00016.CrossRefPubMed
23.
go back to reference Bethesda MD: Nutrition in pediatric HIV infection: setting the research agenda. Workshop. 1996, 126: 103- Bethesda MD: Nutrition in pediatric HIV infection: setting the research agenda. Workshop. 1996, 126: 103-
24.
go back to reference Landesman SH, Kalish LA, Burns DN, Minkoff H, Fox HE, Zorrilla C, et al: Obstetrical factors and the transmission of human immunodeficiency virus type 1 from mother to child. N Eng J Med. 1996, 334: 1617-1623. 10.1056/NEJM199606203342501.CrossRef Landesman SH, Kalish LA, Burns DN, Minkoff H, Fox HE, Zorrilla C, et al: Obstetrical factors and the transmission of human immunodeficiency virus type 1 from mother to child. N Eng J Med. 1996, 334: 1617-1623. 10.1056/NEJM199606203342501.CrossRef
26.
go back to reference Semba RD, Kumwenda N, Hoover DR, Taha TE, Quinn TC, Mtimavalye L, et al: Human immunodeficiency virus load in breast milk, mastitis and mother to child transmission of HIV type 1. J Infect Dis. 1999, 180: 93-98. 10.1086/314854.CrossRefPubMed Semba RD, Kumwenda N, Hoover DR, Taha TE, Quinn TC, Mtimavalye L, et al: Human immunodeficiency virus load in breast milk, mastitis and mother to child transmission of HIV type 1. J Infect Dis. 1999, 180: 93-98. 10.1086/314854.CrossRefPubMed
27.
go back to reference Breastfeeding HIV Infant Transmission Study Group: Late postnatal transmission of HIV-1 in breastfed children: an individual patent data meta-analysis. J Infect Dis. 2004, 189: 2154-2166.CrossRef Breastfeeding HIV Infant Transmission Study Group: Late postnatal transmission of HIV-1 in breastfed children: an individual patent data meta-analysis. J Infect Dis. 2004, 189: 2154-2166.CrossRef
28.
go back to reference Garcia PM, Kalish LA, Pitt J, Minkoff H, Quinn TC, Burchett SK, Kornegay J, Jackson B, Moye J, Hanson C, Zorrilla C, Lew JF: Maternal levels of plasma human immunodeficiency virus type 1 RNA and the risk of perinatal transmission. Women and Infants Transmission Study Group. N Engl J Med. 1999, 341 (6): 394-402. 10.1056/NEJM199908053410602.CrossRefPubMed Garcia PM, Kalish LA, Pitt J, Minkoff H, Quinn TC, Burchett SK, Kornegay J, Jackson B, Moye J, Hanson C, Zorrilla C, Lew JF: Maternal levels of plasma human immunodeficiency virus type 1 RNA and the risk of perinatal transmission. Women and Infants Transmission Study Group. N Engl J Med. 1999, 341 (6): 394-402. 10.1056/NEJM199908053410602.CrossRefPubMed
29.
go back to reference Coutsoudis A, Pillay K, Kuhn L, Spooner E, Tsai WY, Coovadia HM, South African Vitamin A Study Group: Method of feeding and transmission of HIV-1 from mothers to children by 15 months of age: prospective cohort study from Durban, South Africa. AIDS. 2001, 15: 379-387. 10.1097/00002030-200102160-00011.CrossRefPubMed Coutsoudis A, Pillay K, Kuhn L, Spooner E, Tsai WY, Coovadia HM, South African Vitamin A Study Group: Method of feeding and transmission of HIV-1 from mothers to children by 15 months of age: prospective cohort study from Durban, South Africa. AIDS. 2001, 15: 379-387. 10.1097/00002030-200102160-00011.CrossRefPubMed
30.
go back to reference Lehman DA, Farquhar C: Biological mechanisms of vertical human immunodeficiency virus (HIV-1) transmission. Rev Med Virol. 2007, 17 (6): 381-403. 10.1002/rmv.543.CrossRefPubMed Lehman DA, Farquhar C: Biological mechanisms of vertical human immunodeficiency virus (HIV-1) transmission. Rev Med Virol. 2007, 17 (6): 381-403. 10.1002/rmv.543.CrossRefPubMed
31.
go back to reference Kuhn L, Aldrovandi GM, Sinkala M, Kankasa C, Semrau K, Mwiya M, Kasonde P, Scott N, Vwalika C, Walter J, et al: Effects of early, abrupt weaning on HIV-free survival of children in Zambia. N Engl J Med. 2008, 359 (2): 130-141. 10.1056/NEJMoa073788.CrossRefPubMedPubMedCentral Kuhn L, Aldrovandi GM, Sinkala M, Kankasa C, Semrau K, Mwiya M, Kasonde P, Scott N, Vwalika C, Walter J, et al: Effects of early, abrupt weaning on HIV-free survival of children in Zambia. N Engl J Med. 2008, 359 (2): 130-141. 10.1056/NEJMoa073788.CrossRefPubMedPubMedCentral
32.
go back to reference Thea DM, Aldrovandi G, Kankasa C, Kasonde P, Decker WD, Semrau K, Sinkala M, Kuhn L: Post-weaning breast milk HIV-1 viral load, blood prolactin levels and breast milk volume. AIDS. 2006, 20 (11): 1539-1547. 10.1097/01.aids.0000237370.49241.dc.CrossRefPubMedPubMedCentral Thea DM, Aldrovandi G, Kankasa C, Kasonde P, Decker WD, Semrau K, Sinkala M, Kuhn L: Post-weaning breast milk HIV-1 viral load, blood prolactin levels and breast milk volume. AIDS. 2006, 20 (11): 1539-1547. 10.1097/01.aids.0000237370.49241.dc.CrossRefPubMedPubMedCentral
33.
go back to reference Becquet R, Bland R, Leroy V, Rollins NC, Ekouevi DK, Coutsoudis A, Dabis F, Coovadia HM, Salamon R, Newell M-L: Duration, pattern of breastfeeding and postnatal transmission of HIV: pooled analysis of individual data from West and South African cohorts. PLoS ONE. 2009, 4 (10): e7397-10.1371/journal.pone.0007397.CrossRefPubMedPubMedCentral Becquet R, Bland R, Leroy V, Rollins NC, Ekouevi DK, Coutsoudis A, Dabis F, Coovadia HM, Salamon R, Newell M-L: Duration, pattern of breastfeeding and postnatal transmission of HIV: pooled analysis of individual data from West and South African cohorts. PLoS ONE. 2009, 4 (10): e7397-10.1371/journal.pone.0007397.CrossRefPubMedPubMedCentral
34.
go back to reference Kumwenda NI, Hoover DR, Mofenson LM, Thigpen MC, Kafulafula G, Li Q, Mipando L, Nkanaunena K, Mebrahtu T, Bulterys M, et al: Extended antiretroviralprophylaxis to reduce breast-milk HIV-1 transmission. N Engl J Med. 2008, 359 (2): 119-129. 10.1056/NEJMoa0801941.CrossRefPubMed Kumwenda NI, Hoover DR, Mofenson LM, Thigpen MC, Kafulafula G, Li Q, Mipando L, Nkanaunena K, Mebrahtu T, Bulterys M, et al: Extended antiretroviralprophylaxis to reduce breast-milk HIV-1 transmission. N Engl J Med. 2008, 359 (2): 119-129. 10.1056/NEJMoa0801941.CrossRefPubMed
35.
go back to reference Zumla A, Chintu C, Luo C: Common childhood illnesses and HIV infection in Africa. S Afr Med J. 1994, 84 (5): 296-298.PubMed Zumla A, Chintu C, Luo C: Common childhood illnesses and HIV infection in Africa. S Afr Med J. 1994, 84 (5): 296-298.PubMed
36.
go back to reference Rouzioux C, Costagliola D, Burgard M, et al: Estimated timing of mother-to-child human immunodeficiency virus type 1 (HIV-1) transmission by use of a Markov model. Am J Epidemiol. 1995, 142: 1330-1337.PubMed Rouzioux C, Costagliola D, Burgard M, et al: Estimated timing of mother-to-child human immunodeficiency virus type 1 (HIV-1) transmission by use of a Markov model. Am J Epidemiol. 1995, 142: 1330-1337.PubMed
37.
go back to reference Mofenson LM: Mother-child HIV-1 transmission: timing and determinants. Obstet Gynecol Clin North Am. 1997, 24: 759-784. 10.1016/S0889-8545(05)70343-0.CrossRefPubMed Mofenson LM: Mother-child HIV-1 transmission: timing and determinants. Obstet Gynecol Clin North Am. 1997, 24: 759-784. 10.1016/S0889-8545(05)70343-0.CrossRefPubMed
38.
go back to reference The European Collaborative Study: Risk factors for mother-to-child transmission of HIV-1. Lancet. 1992, 339: 1007-1012. 10.1016/0140-6736(92)90534-A.CrossRef The European Collaborative Study: Risk factors for mother-to-child transmission of HIV-1. Lancet. 1992, 339: 1007-1012. 10.1016/0140-6736(92)90534-A.CrossRef
40.
go back to reference Read J, et al: The mode of delivery and the risk of vertical transmission of human immunodeficiency virus type 1 — a meta-analysis of 15 prospective cohort studies. N Engl J Med April. 1999, 340: 977-987.CrossRef Read J, et al: The mode of delivery and the risk of vertical transmission of human immunodeficiency virus type 1 — a meta-analysis of 15 prospective cohort studies. N Engl J Med April. 1999, 340: 977-987.CrossRef
41.
go back to reference Siegfried N, van de Merwe L, Brocklehurst P, Sint TT: Antiretrovirals for reducing risk of mother to child transmission of HIV infection. Cochrane Database Syst Rev. 2011, 7: CD003510 Siegfried N, van de Merwe L, Brocklehurst P, Sint TT: Antiretrovirals for reducing risk of mother to child transmission of HIV infection. Cochrane Database Syst Rev. 2011, 7: CD003510
42.
go back to reference Wade NA, Birkhead GS, Warren BL, et al: Abbreviated regimens of zidovudine prophylaxis and perinatal transmission of the human immunodeficiency virus. N England J Med. 1998, 339: 1409-1414. 10.1056/NEJM199811123392001.CrossRef Wade NA, Birkhead GS, Warren BL, et al: Abbreviated regimens of zidovudine prophylaxis and perinatal transmission of the human immunodeficiency virus. N England J Med. 1998, 339: 1409-1414. 10.1056/NEJM199811123392001.CrossRef
43.
go back to reference Shaffer N, Butlerys M, Simmonds RJ: Short courses of zidovudine and perinatal transmission of HIV. N Engl J Med. 1999, 340: 1042-1043.PubMed Shaffer N, Butlerys M, Simmonds RJ: Short courses of zidovudine and perinatal transmission of HIV. N Engl J Med. 1999, 340: 1042-1043.PubMed
44.
go back to reference Taha TE, Kumwenda NI, Gibbons A, et al: Short post-exposure prophylaxis in newborn babies to reduce mother to child transmission of HIV-1. NAZ randomised clinical trial. Lancet. 2003, 362: 1171-1177. 10.1016/S0140-6736(03)14538-2.CrossRefPubMed Taha TE, Kumwenda NI, Gibbons A, et al: Short post-exposure prophylaxis in newborn babies to reduce mother to child transmission of HIV-1. NAZ randomised clinical trial. Lancet. 2003, 362: 1171-1177. 10.1016/S0140-6736(03)14538-2.CrossRefPubMed
45.
go back to reference Kuhn L, Stein Z: Infant survival, HIV infection, and breastfeeding alternatives in less developed countries. Am J Public Health. 1997, 87: 926-931. 10.2105/AJPH.87.6.926.CrossRefPubMedPubMedCentral Kuhn L, Stein Z: Infant survival, HIV infection, and breastfeeding alternatives in less developed countries. Am J Public Health. 1997, 87: 926-931. 10.2105/AJPH.87.6.926.CrossRefPubMedPubMedCentral
46.
go back to reference WHO collaborative study team on the role of breastfeeding on the prevention of infant mortality: Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis. Lancet. 2000, 355: 451-455.CrossRef WHO collaborative study team on the role of breastfeeding on the prevention of infant mortality: Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis. Lancet. 2000, 355: 451-455.CrossRef
Metadata
Title
Factors associated with HIV infection among children born to mothers on the prevention of mother to child transmission programme at Chitungwiza Hospital, Zimbabwe, 2008
Authors
Stella Ngwende
Notion T Gombe
Stanley Midzi
Mufuta Tshimanga
Gerald Shambira
Addmore Chadambuka
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2013
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-13-1181

Other articles of this Issue 1/2013

BMC Public Health 1/2013 Go to the issue