Name: Emmaculate Lemnyuy Fondzeyuf

Matricle Number: UBa20H0031

Course title: Normal and abnormal New-born

Course Code: NUSH5101

Question

Describe the process of preventing mother to child transmission of HIV in Cameroon, begin

from ANC through delivery and postpartum

Discuss medication used and when they are given laboratory investigations and when they

are done, and recommended nutritional guide for mother and baby
Antenatal care

1. During the first ANC, all pregnant women should be tested for HIV. The healthcare

providers must create awareness of HIV/AIDs/STIs, mother to child transmission

and how to avoid it, the procedure for testing for HIV, and the advantages and

disadvantages of doing so, provide support services and family planning. The test

has to be repeated three months later for HIV negative pregnant women.

2. Initiate ART in all HIV positive pregnant women as early as possible based on HIV

diagnosis Administer Cotrimoxazole in preparation for ART initiation Initiate ART

(TDF+3TC+EFV).In case of intolerance to EFV, replace with NVP and in case of

intolerance to TDF, replace with AZT If the client is already on ART when pregnancy

occurs, continue with the same treatment

3. Encourage safe sexual behaviour

4. Test for and treat any condition (such as urinary and cervicovaginal infections) that

may raise the risk of mother to child transmission.

5. Provide counselling for infant feeding

6. Check for anaemia and if present prescribe more iron and folate.

7. Advise expectant mothers should bring their partners along for HIV testing.

Labour and Delivery

1. Routinely ask about the HIV status of all pregnant women in the delivery room with

undocumented status or with negative status older than 3 months.

2. Follow up to prevent any circumstance that might raise the risk of mother to child

transmission of HIV by increasing foetal mother blood exchanges. In order for this to

happen; utilize the partograph; stay away from artificial rupture of membrane, stay

away from episiotomy; stay away from foetal trauma (manoeuvres, instrumental

delivery), Make sure the infant is well received

3. Initiate ART for any HIV+ woman in the labour room

Postpartum period

1. After giving birth, immediately remove the infant from the mother's blood and secretions
by bathing the baby in a warm sterile solution.

2. Give the infant a prophylactic dose of nevirapine and initiate safe breastfeeding. If the

mother is HIV+, start her on ART right away. If the infant is not breastfed, give him or her

nevirapine for six weeks; if not, give it to them for twelve weeks.

3. Encourage all mothers who are unsure of their status to get a free HIV test at the hospital

within 72 hours of giving birth.

4. Initiate ART in HIV breastfeeding women. Before initiating ART, healthcare providers

should always carry out therapeutic education and assessment of factors likely to impair the

quality of treatment. The mother should take ART and Cotrimoxazole, the exposed child

should take NVP as from birth until 6 weeks and start Cotrimoxazole at 6 weeks and should

be vaccinated according to the EPI calendar

Medications given

Anti-Retroviral (ARV) therapy

Anti-retroviral drugs reduce viral replication and can reduce mother to child transmission by

either reducing the plasma viral load in pregnant women or post exposure prophylaxis in the

new-born. There are several protocols approved by WHO which include

1. Option A

For mother

Triple ARV that is started as soon as diagnosis is confirmed and continued throughout life

It is started during the antepartum period as early as 14 weeks of gestation

It is also given intrapartum at a single dose of Nevirapine (NVP) at onset of labour and first

dose of lamivudine/zidovudine (AZT/3TC)

For Infant

Daily NVP from birth to 1 week and beyond for breastfeeding mothers or if the mother is not

breastfeeding NVP for 4wks

2. Option B

Triple ARV is started from 14weeks to the intrapartum period and through child birth and if
the woman is breastfeeding, till 1 week after breastfeeding

For infant

Daily NVP or AZT syrup 2mmm/kg daily for 4-6 weeks regardless of infant feeding method

3. Option B+

Triple ARV started as soon as diagnosed throughout life with no cessation

Treatment regimens

If intolerance to Tenofovir: Give AZT/3TC twice daily + Efavirenz 600mg once daily;

If intolerance to Efavirenz: Give TDF (300mg)/3TC (300mg) once daily + NVP 1 tablet twice

daily or TDF/3TC once daily + Lop/r 200/50mg 2 tablets twice daily.

For infant

NVP/AZT syrup from birth till 4-6 weeks regardless of infant feeding methods

NVP dosages for the exposed child

Age Daily intake

From birth to 6 weeks 10mg in single dose(1ml)

Weight: 2000 to 2499g 15mg in a single (1.5ml

Weight ≥ 2500g

In a new-born with a low birth weight (<2000 g), start with 2 mg/kg (0.2 ml/kg) daily until it

reaches 2000g

1ml = 10 mg of NVP

Laboratory Testing

Diagnosis of HIV In Children

1. 6weeks; by PCR testing

2. Between 9-18months; first by serology and confirmation by PCR of positive serology

3. Above 18months; by serology

Recommended Nutritional guide

For Mother

1. Eat balanced diet with the right amounts of the different classes of food

2. Eat more during meal times or eat small frequent meals

3. Eat snacks between meals

4. Eat plenty of fruits and vegetables with every meal

5. Drink enough water every day at least 8glasses or 1.5l

6. Avoid taking tea or coffee with meals as they interfere with iron absorption and thus

anaemia

7. Iron sand folic acid supplements should be taken to prevent anaemia

8. Iodized salt should be used to prevent iodine deficiency

9. Vitamin A should be taken to build the baby’s immune system

For Baby

Before 6 months

Exclusive breastfeeding protected with ARVs (NVP) or replacement feeding up to 6 months

is recommended

Between 6 and 12 months

Breastfeeding is continued in addition to balanced complementary feeding. Milk is an

essential nutrient for infant feeding at this age and infant must receive at least half a litre

daily in addition to its complementary food.

Above 12 months

Breastfeeding should be stopped and replaced by any other whole milk for children born to

HIV positive mothers whose status is not known this is to prevent the child’s exposure to an

additional risk of contracting HIV infection. The child is also adapted to his or her family’s

food
For infected children mothers they should be breastfeed to enable the baby receive the

nutritional benefits of breast milk.