www.idosr.

org Senyonga
©IDOSR PUBLICATIONS
International Digital Organization for Scientific Research ISSN: 2579-0811
IDOSR JOURNAL OF BIOCHEMISTRY, BIOTECHNOLOGY AND ALLIED FIELDS 8(3): 87-100, 2023.
https://doi.org/10.59298/IDOSR/JBBAF/23/18.5796

HIV Sero-Status and Risk Factors of Sero-Positivity of HIV Exposed

Children Below Two Years of Age at Mityana General Hospital in
Mityana District, Uganda

Lubuye Denis Senyonga

Faculty of Clinical Medicine and Dentistry Kampala International University

Western Campus Uganda.

ABSTRACT
The aim of this study was to identify the factors linked to HIV serostatus and the risks
of HIV positivity among children under two years old exposed to HIV at Mityana
General Hospital in Mityana district, Uganda. This was a cross-sectional descriptive
survey utilizing quantitative data from administered questionnaires and routine
service data obtained from the mother’s HIV care card and the exposed infant clinical
chart. Data analysis was performed using Epi Info version 7.2.4 for entry and Stata
version 16 for analysis. Descriptive statistics characterized both infant and mother
traits. Logistic regression was employed to determine the factors associated with HIV
serostatus. Among the 102 mother–infant pairs recruited, most mothers were between
25–34 years old (53/102, 52.0%), married (67/102, 65.7%), had attained at least primary
education (49/102, 48.1%), and were involved in farming for their livelihood (89/102,
87.3%). The HIV prevalence among the infants stood at 8.8%. In the bivariate analysis,
factors such as place of delivery (OR = 4.6, 95% CI: 1.340-9.413, p = 0.003), normal
delivery (OR = 4.7, 95% CI:0.682-5.522, p= <0.001), poor adherence to ART (OR=3.11,
95% CI: 0.983-8.344, p=0.026), and the mothers’ level of education (OR=6.2, 95% CI:
3.00-14.476, p= <0.001) were associated with HIV-positive outcomes in infants below
two years old. This study underscores that 8.8% of children under 2 years attending
Mityana General Hospital are HIV-infected due to exposure from their mothers. Factors
contributing to this burden include maternal non-adherence to ART, delivery in
facilities lacking PMTCT protocols, maternal education levels, and the absence of
prophylaxis administration to exposed infants, collectively propagating HIV
transmission among these infants.
Keywords: Pediatric HIV, Mother-to-child transmission, HIV serostatus, Infants below
2 years.

INTRODUCTION
Children infected with Human clinically reported in 1981 in the United
Immunodeficiency Virus (HIV) as States and the following year The New
infants, when their immune systems are York Times published an alarming
still immature, can experience very article about the new immune system
rapid, uninhibited viral multiplication disorder, which, by that time, had
and disease progression. Early immune affected 335 people, killing 136 of them
depletion occurs when the CD4 cell [7]. Between 1981 and 1983, there were
count drops and the viral load increases 5,660 AIDS cases in the US compared to
[1, 2]. HIV is a virus that attacks cells only 17 for the entire of Africa,
that help the body fight infection, suggesting that the US was the
making a person more vulnerable to epicenter and origin of HIV and AIDS
other infections and diseases [3, 4]. It is [8]. AIDS has since then become a global
spread by contact with certain bodily epidemic with evidence of the number
fluids of a person with HIV, most of people living with HIV globally rising
commonly during unprotected sex, or from 37.2 million people in 2017 to
through sharing injection drug 37.9 million people in 2018 [9]. The
equipment [5, 6]. Acquired Immune statistics further indicate that Eastern
Deficiency Syndrome (AIDS) was first and Southern Africa are the most
87
www.idosr.org Senyonga
affected by the epidemic with an accounting for 93% [14]. Uganda has
estimated 20.6 million people living made remarkable progress towards the
with HIV as of 2018 [10]. Worldwide, an elimination of vertical transmission of
estimated 180,000 new pediatric HIV [15]. However, some bottlenecks
infections occurred in 2017 (UNAIDS, remain in ensuring wider access to and
2018), with East and South Africa utilization of services across the PMTCT
contributing to 59% of all pediatric HIV cascade and there are still several
infections globally, and in Uganda challenges in scaling up PMTCT
alone, 5.3% of infants were exposed to services in the Uganda public
HIV [11]. Despite the recommendation healthcare sector [16]. These relate to
of WHO that mother-to-child coverage at different steps of the
transmission (MTCT) of HIV should be PMTCT cascade, and the quality of
prevented using lifelong treatment with PMTCT services rendered at the health
antiretroviral (ARVs) for all pregnant facilities [17]. Pediatric cases of HIV are
HIV-infected women, exclusive becoming a growing problem in Uganda
breastfeeding during the first 6 where MTCT is still a concern as HIV
months, and unrestricted duration of progresses much faster in children than
breastfeeding [12]. Despite the it does in adults and if a positive infant
tremendous contribution of preventive is left untreated for 2 years, they face a
mother-to-child transmission (PMTCT) 50% mortality rate [18]. Unless these
programs in the 21 global priority children are promptly commenced on
countries, 3 out of 10 pregnant women lifelong antiretroviral treatment (ART),
living with HIV did not receive ARVs to HIV-positive infants invariably record
prevent MTCT of HIV, and 4 out 10 HIV- their highest mortality in the first three
positive women or their infants did not months of life [19]. There is no data
receive ARVs during breastfeeding to concerning serostatus of HIV-exposed
prevent MTCT of HIV in 2013 [13]. In infants at Mityana General Hospital in
2018 alone, figures from WHO indicate Mityana District and children are
that an estimated 100,000 pregnant continuing to die despite PMTCT and
women living with HIV in Uganda eMTCT implementation in all districts
needed antiretroviral for preventing of Uganda. Thus, this study was
mother-to-child transmission but only designed to determine the prevalence
94,800 of those pregnant women of HIV seropositivity and associated
received antiretroviral (excluding single factors among exposed children below
dose Nevirapine) for preventing 2 years of age attending care at Mityana
mother-to-child transmission General Hospital in Mityana District.
METHODOLOGY
Study Design the Kampala–Mityana–Mubende–Fort
This was a cross-sectional study that Portal Road. Mityana is about halfway
was conducted at Mityana General between Kampala and Mubende, along
Hospital in Mityana District involving an all-weather tarmac highway that
HIV-positive mothers and exposed links Uganda's capital with the city of
infants aged 2 years and below coming Fort Portal in the Western Region. The
from surrounding communities geographical coordinates of Mityana are
serviced by the hospital. A cross- 0°23'58.0"N, 32°02'36.0"E
sectional study research design was (Latitude:0.399444,
used because the method enables data Longitude:32.043333). The average
collection from a relatively large elevation of the town is 1,209 meters
number of different categories of (3,967 ft) above mean sea level.
respondents at a particular time with (https://en.wikipedia.org/wiki/Mityana
the exposure and outcome being .... Accessed on the 20th of April 2021).
measured at the same time and there is Study Population
no need to follow up with the study The study focused HIV HIV-exposed
participants. children below 2 years of age and their
Area of Study mothers attending care at Mityana
Mityana is approximately 70 kilometres General Hospital in Mityana District.
(43 mi), by road, west of Kampala, Target Population
Uganda's capital and largest city. This The study targeted children below 2
is approximately 80.5 kilometres (50 years exposed to HIV and their mothers
mi), by road, east of Mubende, along living in Mityana and neighboring
88
 www.idosr.org Senyonga
districts. Sampling Techniques
Inclusion Criteria A non-probability convenient
HIV seropositive mothers (18 years of consecutive sampling technique was
age and above) with children aged 2 used to recruit the study participants
years and below whose HIV status is whereby HIV seropositive mothers
already known and who can give bringing in HIV-exposed children below
consent will participate in the study. 2 years of age that met the inclusion
Exclusion Criteria criteria after consent were enrolled into
 HIV seropositive mothers with the study. The convenience sampling
children aged 2 years and below technique is mostly used in clinical
whose HIV status is not known. studies and with this sampling
 HIV seropositive mothers with children technique, the researcher recruits
aged 2 years and below that are less participants who are easily accessible in
than 18 years without emancipated a clinical setting [21].
minor status because of ethical issues Data Collection Methods
of consent. Data was collected from the study
participants by the principal
 Exposed infants who were critically ill investigator and his research
and infants whose parents were assistants. HIV-positive mothers with
unwilling to give their consent were children below 2 years accessing any
excluded from the study. services at Mityana General Hospital
Sample size Calculation who met the study criteria were
Sample size is the mathematical recruited into the study by seeking
process of deciding how many subjects their informed consent after
should be studied before a study thoroughly explaining to them the
begins. The formula by Charan & and benefits of the research and how it will
Biswas [20] was used to calculate the be carried out. Consenting HIV-positive
sample size for the study. mothers who already know their
children’s HIV status were administered
with questionnaires. The
questionnaires sought to determine the
Where; risk factors responsible for the HIV
n = Minimum sample size serostatus of the children involved in
Z = The table value for standard normal the research. All respondents were
deviation corresponding to 95% given ample time to fill in the
significance level (=1.96) questions. Assistance was given to any
P = Prevalence of characteristic being respondents who found difficulty in the
estimatedd = Margin of error, set at 0.05 interpretation of scientific
The sample size of this study was terminologies. A record review tool was
calculated using the estimated developed to collect relevant data from
proportion of 6.5 % or 0.065 based on a the Early Infant Diagnosis of HIV
study done in rural parts of Western register to determine the prevalence of
Uganda by Kahungu et al. [11] who HIV among HIV-exposed children.
found that 6.5% of HIV-exposed Data Collection
children were HIV positive. Questionnaires were the main data
collection tools. A self-administered
structured close-ended questionnaire
constructed in line with the objectives
of the study and informed by a
literature review was used in this study.
An interviewer-administered
questionnaire was appropriate to
ensure that questionnaires were
answered accurately. The questionnaire
was divided into 4 sections as follows:
Data was collected from 102 infant- Section A, which was to capture the
mother pairs, 10% more than the socio-demographic characteristics,
calculated sample size which was a Section B was to capture the prevalence
consideration for any missing data. of HIV seropositivity among the HIV
exposed children, Section C addressed
89
www.idosr.org Senyonga
the infant risk factors of HIV the researcher inferred that the
seropositivity among the study instruments were reliable for use and
participants then Section D dealt with were later used to carry out the study.
the maternal risk factors of HIV Data Quality Control
seropositivity. The principal investigator and research
Pretesting of data collection tool. assistants ensured that only
In this study, the questionnaire was participants who met the inclusion
pre-tested for its content and face criteria were allowed to fill out the
validity which involved HIV-exposed questionnaire after obtaining informed
children receiving care from the ART consent from them. The questionnaire
clinic of Kampala International was pretested in a similar population at
University Teaching Hospital, after Kampala International University
approval from the faculty of clinical Teaching Hospital in Western Uganda to
medicine and dentistry. Data collected ensure clarity of questions. Wrongly
during the pre-test study was excluded stated questions were corrected.
from the main study. The responses Questionnaires were checked for
from the pilot study were used to completeness upon being returned to
improve the clarity, reliability, and the principal investigator or his
relevance of the questionnaire. research assistants. Assistance was
Validity of instruments sought from the researcher’s
Leung [22] proclaims that validity supervisor at every stage of
typically implies the use of suitable development of this study where
tools, processes, and data.In this study, necessary. Research assistants were
the validity of the instrument was used trained on the research protocol and
to measure the degree to which the data collection tools before the start of
items were representative of the data collection. After data collection,
specific areas covered by the study. each completed tool was checked for
Before the instruments were completeness, accuracy, and
administered to data collectors, they consistency, and incomplete tools were
were first examined by colleagues given back to the research assistant for
taking a similar program as the completion concerning the routine
researcher’s. They were then patient records. Where information was
scrutinized by the supervisor to ensure not available on any of the source
that the terms used in the questionnaire documents, it was reported as not
and interview were precisely defined documented.
and properly understood. Validity was Data Analysis
established by the researcher by Quantitative data was entered in Epi
revealing areas causing confusion and Info version 7.2.4 and analyzed using
ambiguity and led to reshaping of the Stata version 16. Descriptive statistics
questions to be more understandable was used to describe infant and mother
by the respondents and to gather characteristics. The measures included
uniform responses across various proportions for categorical variables,
respondents. The content Validity percentiles, and ranges for continuous
Index was calculated based on variables like age. Age for both infant
judgment by at least two and mother were categorized before
knowledgeable people (Judges). When generating percentiles. The primary
the result was 0.7 and above, the outcome variable was categorized as
instrument was deemed valid for use. “0” for HIV-negative and “1” for HIV-
Reliability of data collection tool positive. Prevalence among exposed
During the pre-test, the sequence of the infants was calculated as the number of
question and time of data collection HIV-positive infants divided by the total
was considered accordingly. Data number of exposed who received their
obtained from a pre-determined final HIV test results. Final infant HIV
questionnaire was used to determine status was determined by either a PCR
the Cronbach’s coefficient alpha. An or rapid HIV test as appropriate to the
index of more than 0.8 was considered infants’ age and breast-feeding option.
to indicate that the items in the The HIV test was considered final if the
questionnaire are reproducible and PCR was done before 18 months of age
consistent. After realizing that but six weeks after cessation of
instruments produced similar results, breastfeeding or a rapid test was done
90
 www.idosr.org Senyonga
at 18 months of age but at least six into a full logistic regression model. A
weeks after stopping breastfeeding. multivariable logistic regression
Data was modeled using logistic modeling strategy was used to evaluate
regression to evaluate factors confounding and develop a final model.
associated with HIV serostatus among Any variable with a P-value of <0.05 was
exposed children attending the considered statistically significant.
hospital. At the bivariate level, HIV final Ethical considerations
status was analyzed against all the Ethical clearance was obtained from the
independent variables, and the Faculty of Clinical Medicine and
resulting Odds ratios were used as Dentistry and the hospital
measures of association. All administration of Mityana General
independent variables with a P-value of Hospital. Informed consent was also
<0.2 at the bivariate level were entered sought from the study participants.

RESULTS
Socio-demographic characteristics of mothers
Table 1: Characteristics of mothers
Variables Frequency (N = 102) Percentage %
Age in years 16–24
28 27.4
25 -34 53 52.0
35–44 21 20.6
Marital status
Married 67 65.7
Separated/Divorced 8 7.8
Single 13 12.7
Widowed 5 4.9
Not documented 9 8.9
Use of ART before pregnancy
Yes 26 25.5
No 76 74.5
WHO Stage at enrollment I
56 62.9
II 20 22.5
III 10 11.2
IV 3 3.4
CD4 at enrolment
Average CD4 (52 Observations) 464 NA
Pregnancy status at ART start
Pregnant 62 60.8
Lactating 16 15.7
None 16 15.7
Not documented 8 7.8
Level of education
None 18 17.7
Primary 49 48.1
Secondary 28 27.2
Tertiary 7 7.0
Source of income Farmers 89 87.3
Business 3 3.2
Employed (private/self) 8 7.6
Civil servant 2 1.9
a
N-less than 647 because of missing values during data collection

The study recruited 102 mother–infant 49/102 (48.1%), and were farming as a
pairs. The majority of the mothers source of livelihood 89/102 (87.3%).
53/102 (52.0%) were aged between 25– Those who were enrolled in ART before
34 years, married 67/102 (65.7%), had pregnancy were 26/102 (25.5%) while
at least attained a primary education the majority of the subjects were

91
 www.idosr.org Senyonga
pregnant when they were enrolled in WHO stage I 56/102 (62.9%) and the
ART 62/102 (60.8%). The majority of the average CD4 count of the mothers was
mothers were enrolled on ART while at 464 as shown in Table 1.
Table 2: Characteristics of infants
Variables Frequency (N = 102) Percentage %
Age at registration (in months)
<1 month 14 13.7
1 – 6 months 44 43.1
7 – 12 months 21 20.6
13 – 18 months 17 16.7
19 - 24 months 6 5.9
Sex
Female 56 54.9
Male 46 45.1
Place of delivery
Health facility-Public & PNFP 76 77.5
Private clinics 21 20.6
Unknown 5 4.9
Mode of delivery
Cesarean section 11 10.8
Normal vaginal delivery 78 76.5
Not documented 13 12.7

The majority of the infants were female 56 (54.9%), most of them born in
enrolled aged 1–6 months 44 (43.1%) a public or nonprofit private health
while 14 (13.7%) were less than one facility 76 (77.5%) by normal mode of
month. The majority of the infants were delivery 78 (76.5%) as shown in Table 2.

Table 3: HIV prevalence among exposed infants

Variables N=102 HIV+ve (n) Prevalence %
Overall prevalence 102 09 8.8

Sex Female 56 6 10.7

Male 46 3 6.5
Place of delivery
Health facility-Public & PNFP 76 5 6.6
Private clinics 21 2 9.5
Unknown 5 2 40.0
Mode of delivery
Cesarean section 11 1 9.1
Normal vaginal delivery 78 4 5.12
Not documented 13 4 30.8
Marital status
Married 67 8 11.9
Separated/Divorced 8 - -
Single 13 1 7.7
Widowed 5 - -
Not documented 9 - -
Level of education
None 18 2 11.1
Primary 49 6 12.2
Secondary 28 1 3.6
Tertiary 7 - -
Source of income
Farmers 89 8 8.9
Business 3 - -
Employed (private/self) 8 1 12.5
Civil servant 2 - -

92
 www.idosr.org Senyonga
All exposed infants had their HIV Status from unknown/undocumented places
determined and of the 102 infants, 9 (40.0%) through undocumented
(8.8%) were HIV positive. By category, methods (30.8%), and married parents
HIV prevalence was highest among (11.9%) as shown in Table 3.
female infants (10.7%), infants born

Bi and Multivariate analysis of maternal factors associated with HIV-positive

serostatus
Table 4: Unadjusted and adjusted maternal factors associated with HIV-positive
serostatus
Characteristics N +VE Crude OR (95% CI) P-value Adjusted OR (95% CI) P-value
AOR
Place of delivery
Health facility-Public & PNFP 76 5 1
Private clinics 21 2 3.2 (1.080-6.500) <0.001 1.9 (0.838-17.109) 0.045
Unknown 5 2 4.6 (1.340-9.413) 0.003
Mode of delivery
Cesarean section 11 1 1
Normal vaginal delivery 78 4 4.7 (0.682-5.522) <0.001 1.3 (0.500-8.116) 0.058
Not documented 13 4 2.6 (1.820-8.885) 0.0042
WHO staging atenrollment

I 56 4 1
II 20 3 1.23(0.503-3.038) 0.578
III 10 2 1.12(0.319-3.97) 0.594
IV 3 0
Duration of ART before
delivery
>6 months 155 1 1
<6 months 192 8 5.7 (0.688 - 46.423) 0.107 4.1(0.471-35.775) 0.201
ART Adherence
Good 367 1 1
Fair 28 6 0.72 (0.092 - 5.585) 0.668
Poor 28 2 3.11 (0.983-8.344) 0.026 4.5(0.411-49.398) 0.218
Appointments kept
Yes 347 1 1
No 106 7 1.7 (0.663 - 3.782) 0.812
CD4a
<350 38 2 1
350 - 499 12 5 1.5 (0.131 - 12.808) 0.412
>500 cells 25 3 2.8 (0.350 - 10.864) 0.346
Level of education
None 18 2 1 1
Primary 49 6 6.2 (3.00- 14.476) <0.001 2.1 (0.534 – 9.140) 0.154
Secondary 28 1 5.5 (2.112 - 14.001) <0.001 1.3 (0.378 – 10.056) 0.116
Tertiary 7 -
Source of income
Employed (private/self) 8 1 1
Farmers 89 8 5.3 (2.012 - 11.880) <0.001 1.5 (0.518 – 9.657) 0.112
Business 3 -
Civil servant 2 -

At bivariate analysis, the place of methods (probably part of those who

delivery was associated with HIV- attended undesignated facilities) were
positive status. Mothers who delivered twice likely to end up with an HIV
from undesignated health facilities positive baby (OR=2.6, 95% CI: 1.820-
were four times more likely to have an 8.885, p=0.004). Infants whose mothers
HIV-positive baby (OR = 4.6, 95% CI: had poor adherence to ART were thrice
1.340-9.413, p = 0.003), while those more likely to end up contracting HIV
who delivered at private clinics were (OR=3.11, 95% CI: 0.983-8.344,
thrice more likely to be HIV positive (OR p=0.026). Mother's level of education
= 3.2, 95% CI: 1.080-6.500, p = <0.001). was associated with HIV-positive status;
Mothers who had a normal delivery mothers with a primary level of
were four times more likely to have an education were six times more likely to
HIV-positive baby (OR = 4.7, 95% CI: have an HIV-positive baby (OR=6.2, 95%
0.682-5.522, p= <0.001) while those CI: 3.00- 14.476, p= <0.001) while
who delivered by undocumented those with secondary education were
93
www.idosr.org Senyonga
five times as likely (OR=5.5, 95% end up with an HIV-positive baby
CI:2.112 - 14.001, p= <0.001). Mothers (OR=5.3, 95% CI: 2.012 - 11.880, p=
who practiced farming to earn an <0.001) all as shown in Table 4.
income were five times more likely to

94
 www.idosr.org Senyonga
Bi and Multivariate analysis of infants’ factors associated with HIV-positive serostatus

Characteristics Number Positive Age Crude OR (95% Adjusted OR (95% CI) P-value
at CI) P-value
registration
(in months)
< 6 months 58 4 1 1
7 - 12 21 2 6.5 (3.12 - 16.00) 0.002 2. (0.74 – 9.10) 0.162
5
13 - 18 17 3 4.2 (1.50 – 10.54) 0.001 3. (0.42 – 13.13) 0.105
1
18 – 24 6 -
Infant ARVs for
prophylaxis
Received any form of ART 48 2 1 1
at birth
No ARVs at birth 29 3 7.1 (2.12 – 14.61) 0.001 4. (1.14 – 11.92) 0.003
0
Unknown 16 2 5.3 (2.67 – 11.45) 0.001 4. (0.88 – 2.58) 0.102
0
Not documented 9 2 9.1 (1.86 – 18.94) 0.002 7.0 (1.51–21.62) 0.075

Feeding methods at
registration
Exclusive breastfeeding 51 4 1 1
Replacement feeding 11 - 5.1 (1.18 - 15.44) 0.106 3.2 (0.50 – 15.57) 0.065
Mixed feeding 5 3 7.0 (1.98 - 17.43) 0.002 3.6 (0.50 – 10.12) 0.102
Complimentary feeding 14 1 4.0 (0.68 - 15.21) 0.000 2.8 (0. 12 - 5.28) 0.214
No longer breastfeeding 21 1 2.5 (1.52 - 13.91) 0.018 1.2 (0.05 - 1.82) 0.264
(NLB)
Table 5: Infants’ factors associated with HIV-positive serostatus

Results of bivariate analysis of infants’ Children who were mixed-fed were seven
factors associated with HIV status show times more likely to be HIV positive (OR
that the infants’ age at registration into = 7.0, 95% CI:1.98 – 17.43, p = 0.002) as
mother-baby care point was associated shown in Table 5. Results of multivariate
with HIV-positive serostatus. Infants who analysis of both maternal and infant
were registered at 7-12 months of age factors associated with HIV status show
were six times more likely to be HIV that two factors remained statistically
positive than those who registered early significant. Mothers who delivered at
(OR = 6.5, 95% CI: 3.12– 16.00, p=0.002). private clinics were twice as likely to have
Children who were registered at the age an HIV-positive baby (AOR = 1.9, 95% CI:
of 13 - 18 months were four times more 0.838-17.109, p = 0.045). Infants who
likely to be HIV positive (OR = 4.2, 95% CI: never received ARVs for prophylaxis at
1.50 – 10.54, p=0.001). Children who did birth were four times more likely to test
not receive any form of prophylaxis were HIV positive (AOR = 4.0, 95% CI: 1.14–
seven times more likely to be HIV positive 11.92, p = 0.003), all of this is displayed
(OR=7.1, 95% CI: 2.12 – 14.61, p=0.001) in Tables 4 and 5.
than those who received prophylaxis.

95
www.idosr.org Senyonga

DISCUSSION
The Mityana Hospital is a public hospital the HIV status of the infants [27]. At
that serves a large district of Uganda. It is bivariate analysis, the study established
a public hospital administered by the that the place of delivery was associated
Ugandan Ministry of Health. There is one with HIV-positive status. Mothers who
operating theatre. Wards are split into delivered from undesignated health
Female, Male, Obstetrics, and Pediatrics. facilities were four times more likely to
This kind of health service provision by have an HIV-positive baby (OR = 4.6, 95%
the hospital places it under the category CI: 1.340-9.413, p = 0.003), while those
that is covered by the country’s PMTCT who delivered at private clinics were
policy. However, despite the availability thrice more likely to be HIV positive (OR
of PMTCT services in Uganda since 2000, = 3.2, 95% CI: 1.080- 6.500, p = <0.001).
the country is still challenged with a high Mothers who had a normal delivery were
burden of pediatric HIV. In this study, we four times more likely to have an HIV-
have been able to establish that HIV positive baby (OR = 4.7, 95% CI: 0.682-
prevalence among HIV-exposed infants 5.522, p= <0.001). These findings are
under 2 years of age attending care at corroborated by a countrywide cross-
Mityana General Hospital was 8.8%. This sectional study in 2018 that reported that
finding is higher than the Uganda children delivered at private clinics were
national prevalence estimate in the same six times more likely to be HIV positive
category of children reported in a 2018 those delivered outside the health facility
study of 6.8% [23]. Our finding is still were seven times more likely to be HIV
higher than that of a very recent cross- positive than those delivered in health
sectional study across health centers in facilities [11]. Mothers who had a normal
Uganda among exposed infants which delivery were four times more likely to
reported a prevalence of 6.5% [11]. This have an HIV-positive baby (OR = 4.7, 95%
variation in prevalence in this study from CI: 0.682-5.522, p= <0.001). This finding
the recent studies in Uganda may be in our study contradicts the findings of 2
attributed to a greater impact of factors studies in Ethiopia that established an
that are associated with HIV association of normal delivery with
seropositivity among infants in the increased protection of infants from
communities serviced. This MTCT [28, 29]. Infants whose mothers
understanding is corroborated by similar had poor adherence to ART were thrice
studies in Rwanda and Kenya that more likely to end up contracting HIV
investigated similar objectives to our (OR=3.11, 95% CI: 0.983-8.344, p=0.026).
study [24, 25]. By category, HIV This finding is corroborated by studies
prevalence was highest among female both in Uganda and Zimbabwe. In Uganda
infants (10.7%), and infants born from mothers who never kept clinic
unknown/undocumented places (40.0%) appointments which point to poor
through undocumented methods adherence were 2 times more likely to
(30.8%). These findings are corroborated have a positive baby than those who kept
by findings from a study in Nigeria that appointments while in Zimbabwe
established a similar pattern of mothers with poor ART adherence were 5
prevalence among HIV-exposed infants, times more likely to end up with an HIV-
where, the females and those born in positive child [11, 30]. Mother's level of
undesignated places were higher than the education was associated with HIV-
rest [26]. A study in Tanzania among the positive status; mothers with a primary
same category of infants showed that level education were six times more likely
unprofessional procedures applied to have an HIV-positive baby (OR=6.2,
during delivery in undesignated delivery 95% CI: 3.00- 14.476, p= <0.001) while
places which most times don’t follow those with a secondary education were
PMTCT protocols were associated with five times as likely (OR=5.5, 95% CI: 2.112

96
www.idosr.org Senyonga
- 14.001, p= <0.001). The subject of p=0.001) than those who received
education concerning HIV infection prophylaxis. Children who were mixed-
among infants is one that was fed were seven times more likely to be
interrogated in an East African review and HIV positive (OR = 7.0, 95% CI: 1.98 –
was still significant, where the safety of 17.43, p = 0.002). This finding is in
children increased with an increase in the tandem with many other studies that
education status of their infected have shown that negating prophylaxis
mothers [31]. The reason for such an administration to infants highly exposes
association is that increased education them to HIV infection through their
helps a mother comprehend better the mothers [11, 23, 26, 34]. In the
prospects of PMTCT and thus act to save multivariate analysis of both maternal
the baby from risk [32]. Infants’ age at and infant factors associated with HIV
registration into mother-baby care point status, two factors remained statistically
was associated with HIV-positive significant. Mothers who delivered at
serostatus. Babies who were registered at private clinics were twice as likely to have
7-12 months of age were six times more an HIV-positive baby (AOR = 1.9, 95% CI:
likely to be HIV positive than those who 0.838-17.109, p = 0.045). Infants who
registered early (OR = 6.5, 95% CI: 3.12– never received ARVs for prophylaxis at
16.00, p=0.002). Children who were birth were four times more likely to test
registered at the age of 13 - 18 months HIV positive (AOR = 4.0, 95% CI: 1.14–
were four times more likely to be HIV 11.92, p = 0.003). We believe that the
positive (OR = 4.2, 95% CI: 1.50– 10.54, continued significance of multivariate
p=0.001). This pattern is similar to that analysis of these 2 factors is still justified
established in Ethiopia [33]. Children who by the interpretation advanced by
did not receive any form of prophylaxis Kahungu et al. [11] and Anígilájé et al.
were seven times more likely to be HIV [34].
positive (OR=7.1, 95% CI: 2.12 – 14.61,
CONCLUSIONS
Our study has been able to show that 8.8% establish the extent of the HIV burden
of children below 2 years old attending amongst infants in the community as our
Mityana General Hospital are infected study could have missed a good
with HIV as a result of exposure from percentage that wasn’t enrolled and
their infected mothers. This HIV burden receiving care from the hospital. Our
among infants is being propagated by study has shown that level of education
several factors that include non- is significantly associated with HIV
adherence to ART regimen by mothers, seropositivity at bivariate analysis,
delivery from facilities that don’t apply however when the model was adjusted, it
PMTCT protocols that may reduce the showed that increased education was a
risk for the baby, the education level of protective factor against the contraction
mothers and non-administration of of HIV by infants from mothers. We,
prophylaxis to exposed infants. therefore, recommend the design o f
Recommendations tailor-made education programs that
We recommend a community-based can help mothers from across all spheres
survey among the whole community to appreciate PMTCT.
serviced by Mityana General Hospital to
REFERENCES
1. Alum, E. U., Ugwu, O. P.C., Obeagu, E. content/uploads/2023/06/NIJRMS-
I. and Okon, M. B. Curtailing 32-28-31-2023-rm.pdf
HIV/AIDS Spread: Impact of Religious 2. Obeagu, E.I., Alum, E.U. and Obeagu,
Leaders. Newport International G.U. Factors Associated with
Journal of Research in Medical Prevalence of HIV Among Youths: A
Sciences (NIJRMS), 2023; 3(2): 28-31. Review of Africa Perspective.
https://nijournals.org/wp- Madonna University Journal of

97
www.idosr.org Senyonga
Medicine and Health Sciences, 2023; 10. UNAIDS. UNAIDS Fact Sheet Report.
3(1): 13-18. 2019; 1–476.
https://madonnauniversity.edu.ng/j 11. Kahungu, M. M., Kiwanuka, J.,
ournals/index.php/medicine Kaharuza, F., & Wanyenze, R. K.
3. Alum, E. U., Obeagu, E. I., Ugwu, O. Factors associated with HIV positive
P.C., Aja, P. M. and Okon, M. B. HIV sero-status among exposed infants
Infection and Cardiovascular attending care at health facilities: a
diseases: The obnoxious Duos. cross sectional study in rural
Newport International Journal of Uganda. BMC Public Health. 2018;
Research in Medical Sciences 18(139), 1–11.
(NIJRMS), 2023; 3(2): 95-99. https://doi.org/10.1186/s12889-
https://nijournals.org/wp- 018-5024-6.
content/uploads/2023/07/NIJRMS-3- 12. WHO. (2016). Consolidated
295-99-2023.pdf. guidelines on the use of
antiretroviral drugs for treating and
4. Alum, E. U., Obeagu, E. I., Ugwu, O. P. preventing HIV infection:
C., Samson, A. O., Adepoju, A. O., recommendations for a public health
Amusa, M. O. Inclusion of nutritional approach. World Health
counseling and mental health Organization.
services in HIV/AIDS management: A 13. UNAIDS. (2015). 2014 Progress
paradigm shift. Medicine. 2023; Report on the Global Plan towards the
102:41(e35673). elimination of new HIV infections
http://dx.doi.org/10.1097/MD.0000 among children by 2015 and keeping
000000035673. PMID: 37832059; their mothers alive. Joint United
PMCID: PMC10578718. Nations Programme on HIV/AIDS
5. Obeagu, E. I., Nwosu, D. C., Ugwu, O. (UNAIDS).
P. C. and Alum, E. U. Adverse Drug 14. WHO. Prevention of mother-to-child
Reactions in HIV/AIDS Patients on transmission Estimates by country.
Highly Active Antiretro Viral World Health Organization Global
Therapy: A Review of Prevalence. Health Observatory Data Repository,
Newport International Journal of 2019.
Scientific and Experimental Sciences 15. UNAIDS. Prevention GAP report 2016.
(NIJSES). 2023; 4(1):43-47. 16. UAC. (2018). UGANDA AIDS
https://doi.org/10.59298/NIJSES/20 COUNTRY PROGRESS REPORT JULY
23/10.6.1000 2017-JUNE 2018 Theme. “Enhancing
6. Alum, E. U., Ugwu, O. P. C., Obeagu, HIV Mainstreaming towards ending
E. I., Aja, P. M., Okon, M. B., Uti, D. E. AIDS as a Public Health threat in
Reducing HIV Infection Rate in Uganda by 2030.” Uganda AIDS
Women: A Catalyst to reducing HIV Commission, JUNE.
Infection pervasiveness in Africa. 17. Larsson, E. C., Thorson, A., Pariyo, G.,
International Journal of Innovative Conrad, P., Arinaitwe, M., Kemigisa,
and Applied Research. 2023; M., Eriksen, J., Tomson, G., &
11(10):01-06. DOI: Ekström, A. M. Opt-out HIV testing
10.58538/IJIAR/2048. during antenatal care: experiences of
http://dx.doi.org/10.58538/IJIAR/20 pregnant women in rural Uganda.
48 Health Policy and Planning. 2012;
7. CDC, C. for D. control and P. (2019). 27(1), 69–75.
About HIV/AIDS. 18. WHO. Manual on Paediatric HIV Care
8. Okuonzi, S. Origin of HIV/Aids - and Treatment for District Hospitals
Thirty years of the untold story. New (First, Issue Imci). World Health
Vision, 2011. Organization, 2011.
9. UNAIDS. GLOBAL STATISTICS 19. Potty, R. S., Sinha, A.,
FactSheet_2015_UNAIDS. Global Sethumadhavan, R., Isac, S., &
Statistics-2015; 2016; 8–13.

98
www.idosr.org Senyonga
Washington, R. Incidence, prevalence transmission of HIV in Kenya: A
and associated factors of mother-to- cross-ectional analysis of the
child transmission of HIV, among national database over nine years.
children exposed to maternal HIV, in PLoS ONE. 2017; 12(8), 1–15.
Belgaum district, Karnataka, India. https://doi.org/10.1371/journal.pon
BMC Public Health. 2019; 19(386), 4– e.0183860.
13. 26. Okechukwu, A. Burden of HIV
20. Charan, J., & Biswas, T. Review Infection in Children with Severe
Article How to Calculate Sample Size Acute Malnutrition at the University
for Different Study designs in of Abuja Teaching Hospital
Medical Research? Indian Journal of Gwagwalada, Nigeria. Journal of HIV
Psychological Medicine. 2013; 35(2), for Clinical and Scientific Research.
121–126. 2015; 2, 055–061.
https://doi.org/10.4103/0253- https://doi.org/10.17352/2455-
7176.116232. 3786.000015.
21. Setia, M. S. Methodology series 27. Gamell, A., Luwanda, L. B.,
module 5: Sampling strategies. Kalinjuma, A. V., Samson, L.,
Indian Journal of Dermatology. 2016; Ntamatungiro, A. J., Weisser, M.,
61(5), 505. Gingo, W., Tanner, M., Hatz, C.,
22. Leung, L. Validity, reliability, and Letang, E., & Battegay, M. Prevention
generalizability in qualitative of mother-to-child transmission of
research. Journal of Family Medicine HIV Option B+ cascade in rural
and Primary Care. 2015; 4(3), 324. Tanzania: The One Stop Clinic model.
23. Kiyaga, C., Urick, B., Fong, Y., Okiira, PLoS ONE. 2017; 12(7), 1–15.
C., Nabukeera-Barungi, N., Nansera, https://doi.org/10.1371/journal.pon
D., Ochola, E., Nteziyaremye, J., e.0181096.
Bigira, V., Ssewanyana, I., Olupot- 28. Kassaw, M. W., Abebe, A. M., Abate, B.
Olupot, P., Peter, T., Ghadrshenas, A., B., Getu, M. A., & Zemariam, A. B.
& Vojnov, L. Where have all the Mother to child HIV transmission and
children gone? High HIV prevalence association among exposed infants
in infants attending nutrition and after option B+ guideline
inpatient entry points: Journal of the implementation in the Amhara
International AIDS Society. 2018; regional state referral hospitals,
21(2), 1–7. Ethiopia. International Journal of
https://doi.org/10.1002/jia2.25089. Infectious Diseases. 2020.
24. Mugwaneza, P., Wa Shema, N. U., https://doi.org/10.1016/j.ijid.2020.
Ruton, H., Rukundo, A., Lyambabaje, 03.006.
A., Bizimana, J. de D., Tsague, L., 29. Tsehay, A. K. Factors associated with
Wagner, C. M., Nyankesha, E., Muita, HIV-positive sero-status among
J., Mutabazi, V., Nyemazi, J. P., exposed infants attending care at
Nsanzimana, S., Karema, C., & health facilities in Bahir Dar
Binagwaho, A. Under-two child administration, Ethiopia: Evidence
mortality according to maternal HIV from medical records Factors
status in Rwanda: Assessing associated with HIV-positive sero-
outcomes within the National PMTCT status among exposed infants attend.
Program. Pan African Medical Journal. Cogent Medicine. 2019; 6(1),1–9.
2011; 9, 1–13. https://doi.org/10.1080/2331205X.
https://doi.org/10.4314/pamj.v9i1. 2019.1623754.
71215. 30. Ngwende, S., Gombe, N. T., Midzi, S.,
25. Mwau, M., Bwana, P., Kithinji, L., Tshimanga, M., & Shambira, G.
Ogollah, F., Ochieng, S., Akinyi, C., Factors associated with HIV infection
Adhiambo, M., Ogumbo, F., Sirengo, among children born to mothers on
M., & Boeke, C. Mother-to-child the prevention of mother to child

99
www.idosr.org Senyonga
transmission programme at 33. Desta, M. L., Saravanan, M., Hilekiros,
Chitungwiza Hospital, Zimbabwe, H., Kahsay, A. G., Mohamed, N. F.,
2008. BMC Public Health. 2013; Gezahegn, A. A., & Lopes, B. S. HIV
13(1181), 1–8. prevalence and risk factors in infants
31. Belachew, A., Tewabe, T., & Malede, born to HIV positive mothers,
G. A. Prevalence of vertical HIV measured by dried blood spot real-
infection and its risk factors among time PCR assay in Tigray, Northern
HIV exposed infants in East Africa: a Ethiopia. BMC Pediatrics. 2019; 19(1),
systematic review and meta-analysis. 1–8.
Tropical Medicine and Health. 2020; https://doi.org/10.1186/s12887-
48(1). 019-1636-y.
https://doi.org/10.1186/s41182- 34. Anígilájé, Emmanuel Adémólá, Dabit,
020-00273-0. O. J., Ageda, B., Hwande, S., & Bitto,
32. Huan, Z., Chow, E. P. F., Zhao, Y., T. T. AIDS & Clinical Research the
Yang, W., Maozhi, T., Li, L., Xue, T., Prevalence and Predictors of HIV
Xi, L., Yi, Z., Ailing, W.,Lo, Y. R., & Lei, Infection among Children of Mothers
Z. Prevention of mother-to-child HIV who Missed Prevention of Mother to
transmission cascade in China: A Child Transmission of HIV
systematic review and meta- Interventions in Makurdi, Nigeria.
analysis. Sexually Transmitted Journal of AIDS & Clinical Research.
Infections. 2016; 92(2), 116–123. 2013; 4(11), 4–10.
https://doi.org/10.1136/sextrans- https://doi.org/10.4172/2155-
2014-051877. 6113.1000249.

CITE AS: Lubuye Denis Senyonga (2023). HIV Sero-Status and Risk Factors of Sero-
Positivity of HIV Exposed Children Below Two Years of Age at Mityana General Hospital
in Mityana District, Uganda. IDOSR JOURNAL OF BIOCHEMISTRY, BIOTECHNOLOGY
AND ALLIED FIELDS 8(3): 87-100. https://doi.org/10.59298/IDOSR/JBBAF/23/18.5796

100