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HIV transmission from mother to child

The mother-to-child transmission (MTCT) is the largest source of HIV infection in children 15 years of age. TME also known as perinatal or vertical transmission occurs when HIV is transmitted from an HIV positive woman to her baby during pregnancy, childbirth or breastfeeding.
HIV and AIDS is one of the leading causes of death in children worldwide. According Labbok (2003) 580 000 deaths due to HIV and AIDS in children under 15 years of age, 500,000 are in Africa. 80-90% of these deaths are due to vertical transmission and 200,000 were secondary to breastfeeding.

Increase in the number of children with HIV infection, particularly in the most affected by the pandemic. In 2002, an estimated 3.2 million children under 15 were living with HIV and AIDS; A total of 800,000 were infected and 610 000 deaths. HIV and AIDS has been estimated to represent about 8% of deaths in children under 5 in sub-Saharan Africa. In areas where HIV prevalence among pregnant women has exceeded 35%, the contribution of HIV and AIDS, infant mortality was as high as 42%.

Everyone in 2001, 1.8 million women were infected with HIV and approximately 800,000 children were also infected, most of them through MTCT. Breastfeeding is an important mode of transmission during the postpartum period, representing nearly a third of all child transmission of HIV. In East Africa, it is estimated that 10-20% of women are HIV epidemic HIV positive2.With shows the evolution of women and youth, increasing HIV prevalence among women lead to increased transmission mother child.

Of great concern in this era of HIV theme breastfeeding. Besides being an intense personal concern, the issue of HIV transmission through breastfeeding is also of importance to public health, especially in countries where fertility rates and rates of HIV infection among Las pregnant women are high. It is now widely recognized that HIV is transmitted to infants during breastfeeding with an average of one in seven children born to mothers infected with HIV through breastfeeding up to 24 months. Effectiveness of HIV transmission through breast milk varies between 16-29%. About 30% of children are infected in the vertical, the relative frequency of transmission timing is as follows: 2% in early pregnancy, 3% at the end of pregnancy, 15% of labor 5 % in the early postpartum period, and 5% in the later postpartum period. Although WHO, UNICEF and other UN agencies currently recommend that HIV-positive mothers avoid breastfeeding if replacement feeding from birth is acceptable, feasible, affordable, sustainable and safe (AFASS), which is practically not possible adopt this policy resource limited countries like Uganda. Therefore, research is needed feasible.

In this article the results of research on vertical transmission of HIV through breastfeeding in particular are summarized.

Knowledge about the role of breastfeeding in HIV transmission from mother to child

So interventions in the prevention of MTCT take effect, it is important to know the level of knowledge, attitudes and practices of women in terms of transmission from mother to child HIV and breastfeeding. According to a cross-community based study conducted among mothers aged 16 to 40 years, Dar es Salaam, only 25% of the population knew that breastfeeding can lead to HIV transmission. Among women who knew HIV transmission through breastfeeding, 54.1% indicated that they will avoid breastfeeding while 45.9% defendant to continue breastfeeding. The main reason was the stigma. In general, knowledge and attitudes of vertical transmission and breastfeeding in developing countries are not well known. Therefore, it is necessary to educate the masses on this issue. Unlike developed countries, where the vertical transmission of HIV is known to most mothers, many ahs done in developing countries, where most women are completely ignorant of.

Prevention of mother to child transmission

Current interventions to reduce MTCT target the perinatal period, but its application in populations where breastfeeding is the norm this huge problem. Effective interventions used include reducing maternal viral load ARV therapy, avoid exposure to maternal secretions contaminated by a cesarean delivery, and avoidance of breastfeeding. Wash the birth canal with an antiseptic to reduce exposure to contaminated section also has some effect.
Several issues and challenges. For example, choice, availability, accessibility, durability and long-term safety of antiretroviral agents for use during pregnancy and early neonatal life, the issue of transmission in situations where alternatives to breastfeeding are not available.
The challenge is to find the most cost effective and feasible to achieve zero percent transmission of HIV from an infected mother to her child intervention.

The barriers to effective prevention of vertical transmission of HIV

Pregnant women face many difficult decisions, including decisions about HIV testing, treatment options and infant feeding. Partner of a male female (s), family, community and establishing more whole health care influence their decision and ability to take advantage of vertical transmission.
In developing countries, there is a lack of access to medicines in general and particular ARV drugs. Moreover, there is little access to health care for women before and after childbirth, counseling and HIV testing, and high stigma and discrimination against HIV positive women.
In the developed world, it is recommended that HIV-infected mothers not breastfeed, as formula feeding is safe, well accepted and readily available. Formula feeding requires clean water to prepare the milk or sanitation and can not afford formula, and therefore can not avoid breastfeeding.

What else is there to do?

HIV is a preventable disease. TMH is preventable through prevention, diagnosis and effective treatment, accessible, sustainable HIV for women, men and children. Structural interventions are also necessary to improve access to treatment for HIV treatments, clean water and formula. Education and empowerment of women in all countries are as essential as access to health care and nutrition of women and children, if they are HIV positive or HIV negative.
The socio-economic context of the SSA, exclusive breastfeeding of infants born to HIV-positive mothers is inevitable for the baby dies in the first days after birth. Replacement feeding is acceptable, unaffordable, unsustainable, dangerous and impossible in most of these countries. So the big question remains: “How nutritionists and other health professionals can make breastfeeding safer for every baby born to an HIV positive mother and improve complementary feeding for these children?
Therefore, there is no need for emergency research on improving local foods to be nutritionally balanced and safer for complementary feeding and replacement feeding these children.

conclusion

Reduce vertical transmission of HIV is difficult, especially in developing countries where mothers infected with HIV do not have access to antiretroviral treatment in the long term, infant formula or other strategies that prevent mothers in rich countries follow regularly.
Therefore, more research if reducing vertical transmission during breastfeeding is to be achieved is required. It is necessary to explore the optimal duration of breastfeeding, weaning and recommendations of ARVs leader for mothers and babies depending on local conditions.

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