Statement of the topic

Knowledge and practice towards prevention of mother to child transmission (PMTCT) of HIV in
Zambia.

1.0 INTRODUCTION

1.1 Background

The Human Immunodeficiency Virus (HIV) infection which causes the Acquired Immune-
Deficiency Syndrome (AIDS) continues to be a serious global problem. According to UNAIDS
(2011), an estimated 34 million people worldwide are infected with HIV, 52 percent of who are
women and more than two-thirds (68 percent) of the global HIV population live in the Sub-
Sahara African (SSA). Of these, 3.4 million are children under 15 years of age, 90 percent of
whom live in SSA (UNICEF, 2011). Worldwide, there are about 7,400 new infections and 5,500
HIV-related deaths daily. Over one thousand children below 15 years of age get infected with
HIV daily, 90 percent of who live in SSA, where HIV has its greatest toll (UNAIDS, 2011).
HIV is transmitted through sexual contact with an infected individual, through mother-to-child
transmission (MTCT), and through sharing of sharp instruments with an infected person and
transfusion of infected blood and blood-products. MTCT, which occurs when a mother passes on
the virus to her child during pregnancy, labour and breastfeeding, is responsible for an estimated
20 percent of all HIV infections and more than 95 percent of paediatrics HIV transmissions
(UNAIDS, 2010).
Every day there are nearly 1800 new HIV infections in children below 15 years of age, more
than 90% occurring in the developing world. Most (about 90 percent) of these infections are
associated with MTCT. In addition, every day 1400 children under 15 years of age die of an
HIV-related illness. In most developed countries HIV testing, use of antiretroviral drugs (ARVs)
and modification of feeding practices have greatly reduced the rate of mother to child
transmission (MTCT) of HIV though this is not the case in many African countries.
Prevention of mother-to-child transmission (PMTCT) aims at reducing the risk of a mother
infecting her child with HIV and starts with primary prevention of the infection in women of
childbearing age that are the main vehicles of pediatric HIV transmission. Modern PMTCT
strategies include testing for HIV during pregnancy, modified obstetric practices, preventive
anti-retroviral (ARV) drugs, and modified infant feeding practices. These strategies, which are
still limited both in scope and reach in most of Sub-Saharan Africa, where ironically, the
heaviest burden of maternal HIV infection and MTCT exist, have the potential of reducing the
MTCT risk down to only 2 to 5 percent (WHO, 2010).

In Zambia, the impact of AIDS has led to a reduction in the average life expectancy to 49 years.
This is 13 years less than before the pandemic. Zambia has a population of 13,092,666 (CSO et
al, 2011). The first case of AIDS was diagnosed in 1984. Zambia now has a generalized
epidemic, with HIV spreading throughout the population as opposed to being concentrated in
specific populations. Adult HIV prevalence peaked in the 1990s, and was estimated at 14.3
percent in the 2007 Zambia Demographic and Health Survey (ZDHS) with prevalence in women
higher than in men at 16.1 percent compared to 12.3 percent. Additionally, 16.4 percent of
pregnant women attending antenatal clinics are living with HIV (MOH, 2005).

The PMTCT services in Zambia were introduced in nearly all public health institutions. Proper
implementation of these services however, requires adequate knowledge and appropriate
practices on the part of individuals both men and women. The Zambia PMTCT programme
started as a pilot project in 1998 with collaboration between Ministry of Health and UNICEF. It
was initially in three sites, with each district including a hospital and a health center.
Based on the successes recorded by the project, the PMTCT programme was adopted by the
government in 2002. By October 2003, there were 74 PMTCT sites in six provinces of Zambia.
Without PMTCT interventions, an estimated 80,000 out of 500,000 annual deliveries are
exposed to HIV and 28,000 are born HIV positive annually. An estimated 120,000 children
under 15 years are living with HIV. In 2009, 69 percent of HIV infected pregnant women
received antiretroviral to reduce risk of mother to child transmission of HIV while 98.9 percent
of pregnant women received HIV testing and counseling in 2010 (MOH, 2011).

Previous studies conducted in Zambia have shown mixed levels of awareness regarding HIV and
its transmission routes including MTCT, but low levels of awareness regarding PMTCT.
Currently, in most parts of Zambia, information on MTCT and PMTCT is inadequate. Hence this
study will investigate the knowledge and practice towards PMTCT among men and women in
Zambia.
General objective of the study

The aim of this study will be to investigate the knowledge and practice towards prevention of
mother-to-child transmission of HIV in Zambia.

Research Question

What is the knowledge and practice towards prevention of mother-to-child transmission of HIV
in Zambia?

Specific objectives of the study:

The objectives of this study will be:

 To determine the knowledge of prevention of mother-to-child transmission of HIV

among men and women.
 To assess the practice of prevention of mother-to-child transmission of HIV among men
and women.