Onah H E, Ibeziako N, Nkwo P O, Obi S N, Nwankwo T O
Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Enugu, Nigeria.
J Obstet Gynaecol. 2008 Apr;28(3):276-9. doi: 10.1080/01443610802042639.
This study assessed voluntary counselling and testing (VCT) uptake, nevirapine use and infant feeding options among the pregnant women seen in a tertiary care centre in Enugu, South-east Nigeria, with the aim of identifying gaps (if any) in the prevention of mother-to-child transmission (PMTCT) implementation in the hospital. It was a prospective study of all antenatal clinic attendees and those who delivered at the University of Nigeria Teaching Hospital, Enugu, within a 7-month period (1 March to 30 September 2005). During the 7-month period, 635 pregnant women accessed the PMTCT services in the hospital. With respect to VCT, 25 (3.9%) of the antenatal clinic attendees had only group counselling, while 610 (96.1%) others had both group and individual pre-test counselling. A total of 87 (13.7%) of the 635 women tested were HIV positive. Some 426 (67.1%) women had post-test counselling carried out. Twenty (23.0%) of the 87 HIV-positive women had their infection diagnosed prior to the current pregnancy, while 67 (77.0%) had the disease diagnosed during the index pregnancy. Eight (9.2%) of them had previously had anti-retroviral therapy with nevirapine. Twelve (13.8%) of the women were on antiretroviral therapy in the index pregnancy - two on highly active antiretroviral therapy (HAART) and 10 on nevirapine. A total of 41 (47.1%) of the 87 HIV-positive women had delivered as at 30 September 2005. Ten of them had antiretrovirals administered to them during the antenatal period. The remaining 31 had antiretrovirals administered to them on arrival at the labour ward for delivery. Of the 41 women who delivered, 39 had intra-partum nevirapine, while the 2 women on HAART took their usual daily dosage. Regarding mode of delivery, one-third of the women had a caesarean section and two-thirds had vaginal delivery. Ten (24.4%) of the 41 women had episiotomy, while seven of the remaining 31 women who did not receive episiotomy sustained varying degrees of perineal tear. There was no maternal death. All the 41 live born babies received nevirapine syrup at birth. A total of 86 (98.9%) out of the 87 HIV-positive women had infant feeding counselling. All chose exclusive breast-milk substitutes for their babies. There was one twin delivery, giving a total of 42 babies delivered. One of the babies was a stillbirth. The rest survived the neonatal period. It was concluded that the VCT uptake at the University of Nigeria Teaching Hospital, Enugu, is high. The majority of the women and their babies received peripartum nevirapine and at delivery all the women chose to do exclusive formula-feeding. The main gaps identified by the study were that most of the women delivered vaginally and there were delays in obtaining HIV test results. It remains to be seen how these variables will affect the vertical transmission rate.
本研究评估了在尼日利亚东南部埃努古一家三级护理中心就诊的孕妇中自愿咨询检测（VCT）的接受情况、奈韦拉平的使用情况以及婴儿喂养方式，目的是找出该医院预防母婴传播（PMTCT）实施过程中存在的差距（如有）。这是一项对所有产前门诊就诊者以及在7个月期间（2005年3月1日至9月30日）于埃努古的尼日利亚大学教学医院分娩的产妇进行的前瞻性研究。在这7个月期间，635名孕妇在该医院接受了PMTCT服务。关于VCT，25名（3.9%）产前门诊就诊者仅接受了集体咨询，而其他610名（96.1%）则同时接受了集体和个体检测前咨询。在接受检测的635名女性中，共有87名（13.7%）HIV检测呈阳性。约426名（67.1%）女性接受了检测后咨询。87名HIV阳性女性中有20名（23.0%）在本次怀孕前被诊断出感染，而67名（77.0%）在本次索引妊娠期间被诊断出患病。其中8名（9.2%）曾接受过奈韦拉平抗逆转录病毒治疗。12名（13.8%）女性在索引妊娠期间接受抗逆转录病毒治疗——2名接受高效抗逆转录病毒治疗（HAART），10名接受奈韦拉平治疗。截至2005年9月30日，87名HIV阳性女性中共有41名（47.1%）分娩。其中10名在孕期接受了抗逆转录病毒药物治疗。其余31名在进入产房分娩时接受了抗逆转录病毒药物治疗。在分娩的41名女性中，39名接受了产时奈韦拉平治疗，而2名接受HAART治疗的女性服用了她们平时的每日剂量。关于分娩方式，三分之一的女性进行了剖宫产，三分之二进行了阴道分娩。41名女性中有10名（24.4%）进行了会阴切开术，其余31名未接受会阴切开术的女性中有7名出现了不同程度的会阴撕裂。没有产妇死亡。所有这41名活产婴儿在出生时都接受了奈韦拉平糖浆。87名HIV阳性女性中有86名（98.9%）接受了婴儿喂养咨询。所有女性都为其婴儿选择了纯母乳替代品。有1例双胎分娩，共分娩42名婴儿。其中1名婴儿为死产。其余婴儿度过了新生儿期。研究得出结论，埃努古尼日利亚大学教学医院的VCT接受率较高。大多数女性及其婴儿在围产期接受了奈韦拉平治疗，并且在分娩时所有女性都选择了纯配方奶喂养。该研究发现的主要差距在于大多数女性进行了阴道分娩，并且获取HIV检测结果存在延迟。这些变量将如何影响垂直传播率仍有待观察。
