|Year : 2012 | Volume
| Issue : 1 | Page : 13-15
Prevalence of HIV among rural pregnant women attending antenatal clinics at Pravara Rural Hospital, Loni, Maharashtra, India
Purushottam A Giri1, Vidyadhar B Bangal2, Deepak B Phalke1
1 Department of Community Medicine (PSM), Rural Medical College and Pravara Rural Hospital, Loni, Dist. Ahmednagar, Maharashtra, India
2 Department of Obstetrics and Gynaecology (OBGY), Rural Medical College and Pravara Rural Hospital, Loni, Dist. Ahmednagar, Maharashtra, India
|Date of Web Publication||21-May-2012|
Purushottam A Giri
Department of Community Medicine (PSM), Rural Medical College, Loni, Maharashtra - 413 736
Source of Support: None, Conflict of Interest: None
Background: Many antenatal clinics (ANC)-based HIV surveillance systems in India have limited coverage of remote rural sites, a weakness that compromises adequate estimation, monitoring, and development of effective preventive and care programs. To address this void in rural area of western Maharashtra, we conducted antenatal clinic-based sentinel surveillance to know the prevalence of HIV infection among rural pregnant women. Materials and Methods: A cross-sectional study was carried out at ANC clinic, Dept. of Obstetrics and Gynaecology of Pravara Rural Hospital, Loni, Maharashtra. A total of 12,171 pregnant women from rural area accepted HIV testing after counseling who attending ANC clinic in Pravara Rural Hospital, Loni, during January 2008 to December 2011 were included in the study. Data were entered in Microsoft excel and percentage and proportion was calculated. Results: In the present study, out of 12171 pregnant women from the rural area accepted HIV testing after counseling who attending ANC clinic, only 50 (0.41%) were HIV positive and remaining 12, 221 (99.59%) were HIV negative. The study showed that the prevalence of HIV among pregnant women was 0.41%. Out of the 50 HIV positive pregnant women studied majority, 32 (64.0%), were primigravidas and 18 (36.0%) were multigravidas. Conclusion: In our study all 12171 pregnant women from the rural area accepted HIV testing after counseling and prevalence of HIV was found to be 0.41%. The need of the hour is to provide universal access to these services by involving the NGO's and the private sector.
Keywords: ANC clinic, HIV, prevalence, rural pregnant women
|How to cite this article:|
Giri PA, Bangal VB, Phalke DB. Prevalence of HIV among rural pregnant women attending antenatal clinics at Pravara Rural Hospital, Loni, Maharashtra, India. Int J Health Allied Sci 2012;1:13-5
|How to cite this URL:|
Giri PA, Bangal VB, Phalke DB. Prevalence of HIV among rural pregnant women attending antenatal clinics at Pravara Rural Hospital, Loni, Maharashtra, India. Int J Health Allied Sci [serial online] 2012 [cited 2019 Sep 20];1:13-5. Available from: http://www.ijhas.in/text.asp?2012/1/1/13/96413
| Introduction|| |
Surveillance of human immunodeficiency virus (HIV) infection among pregnant women attending antenatal care clinics (ANC) has been the mainstay system of monitoring of HIV epidemic in India. Several studies from the 1990s showed that ANC-based prevalence estimates approximated prevalence levels in the population of men and women aged 15--49 years. However, the validity of prevalence estimates based on National ANC surveillance systems will depend on how accurately the selected sentinel sites represent the whole population.  UNAIDS states that mother to child transmission is the largest source of HIV infection in children below the age of 15 years. According to NACO, it is estimated that about 30,000 infants acquire HIV infection each year. The joint technical mission on PPTCT (2006) estimated that out of 27 million annual pregnancies in India, 189,000 occur in HIV positive pregnant women.  As per the United Nations Development Group, HIV prevalence among 15- to 24-year-old pregnant women is defined as "the percentage of pregnant women aged 15-24 whose blood samples test positive for HIV." This indicator addresses Goal 6 of the Millennium Development Goals, to combat HIV/AIDS, malaria, and other diseases. , The prevalence rates of HIV are far higher in developing countries where STD treatment is less accessible. More than half of all new HIV infections occur among people under the age of 25 years, and almost 11.8 million youth are living with HIV or AIDS. The virus spreads in India mainly through the heterosexual route. Sexual behaviors and choices are an intensely private matter and difficult to change.  Hence this study was conducted to know the prevalence of HIV infection among rural pregnant women.
| Materials And Methods|| |
A cross-sectional study was carried out in the ANC clinic of Pravara Rural Hospital (PRH), Loni. A predesigned and pretested questionnaire was used to collect data from all rural pregnant women who were attending ANC clinic during January 2008 to December 2011 by purposive sampling. A total sample size of 12,171 women who attended ANC clinic in this duration was included in the analysis. PRH is a tertiary level health care center attached as a teaching hospital of Rural Medical College, Loni, that caters to the needs of the Ahmednagar district and comes under the aegis of Pravara Medical Trust. The criteria for selecting pregnant women include all pregnant women aged between 15 and 49 years attending ANC clinic for the first time during the current pregnancy during the surveillance period. Pregnant women who did not avail ICTC services of PRH were excluded from the study. At the ANC clinic the women were counseled for HIV testing. Under the department of Obstetrics and Gynecology, there is ICTC center; the counselor is appointed by the Maharashtra state AIDS control society (MSACS), who does the counseling for the pregnant women. The HIV screening test was done by using a rapid HIV test. Any serum found reactive by the first assay was retested using a second assay based on different antigen preparations and/or a different test principle using an anti-HIV test. Gynecologists conducted a semistructured interview whose schedule comprised clinical examination and obstetric history. After obtaining informed consent from the pregnant women, blood was drawn for the following investigations: 1. HIV screening test and 2. Blood grouping and Rh typing. The ethics committee of the institute approved the study. Data were entered in Microsoft Excel and percentage and proportion were calculated.
| Results|| |
During the study period, a total of 14,694 pregnancies occurred, out of which 12,171 availed ICTC services form Pravara Rural Hospital, Loni.
It was seen from [Table 1] that, out of the total 12171 pregnant women from the rural area who accepted HIV testing after counseling and attended the ANC clinic, only 50 (0.41%) were HIV positive and remaining 12,221 (99.59%) were HIV negative.
|Table 1: HIV status of rural pregnant women (study population) in 4 years (2008-2011)|
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As observed from [Table 2], out of the 50 HIV positive pregnant women who availed ANC clinics, 21 (42.0%) were in the age group of 24-28 years, followed by 17 (34.0%) in the age group of 18-23 years, 7 (14.0%) in the age group of 29-34 years and 5 (10.0%) in the age group of more than 35 years.
For parity wise [Table 3] shows that out of the 50 HIV positive pregnant women studied, majority 32 (64.0%) were primigravidas and 18 (36.0%) were multigravidas.
| Discussion|| |
In our study all 12,171 women from the rural area accepted HIV testing after counseling and prevalence of HIV was found to be 0.41%. This study provides a comprehensive sentinel surveillance of HIV in these remote rural regions of western Maharashtra. Similarly a study done by Ashtagi et al. at KEM, Hospital Belgaum, the prevalence of HIV among pregnant women attending the ANC clinic was 0.70%,  while a study by Gupta et al. done in North India revealed that the prevalence of HIV was found to be 0.88%.  A study by Parameshwari et al. conducted at Government Hospital, Namakkal district, showed that all 7866 women from the rural area accepted HIV testing after counseling and prevalence of HIV was found to be 0.77%.  In a study done by Celentano at Sewagram, Maharashtra, 98% pregnant women accepted HIV testing and prevalence of HIV was found to be 1.23%.  A reflection of the relatively general low exposure to sources of infection rather than the absence of risks factors that is also evident elsewhere. This area had limited accessibility in the last decade, due to poor infrastructure, hence less traffic and reduced mobility. Last but not the least reason could be that all high risk group women might not come to this hospital. This might have been among the factors that limited the sources and spread of infection.
In the present study, out of those 50 HIV positive pregnant women 17 (34%) were aged 18-23 years, 21 (42%) aged 24-28 years, 7 (14%) aged 29-34 years, and 5 (10%) aged more than 35 years. Similarly a study done by Ashtagi et al. revealed that, out of 716 pregnant women who availed PPTCT services, 360 (50.28%) were in the age group of 21-25 years, 209 (29.19%) in the age group of 15-20 years, 133 (18.58%) in the age group of 26-30 years, and 14 (1.95%) in the age group of 31-35 years.  There is strong prevailing tradition of early marriages in the rural area. Majority of women complete their family below 28 years of age. These are the possible reasons for high HIV seroprevalence among the young age group.
Young women are more vulnerable to the HIV epidemic than men. Of the 11.8 million HIV-infected youth worldwide, over seven million are female. The virus is more easily passed to young women because of their immature vaginal tracts and easily torn tissues; meanwhile, gender inequities in many countries prevent young women from negotiating safer sexual practices including condom use. 
Among HIV-positive pregnant women in the present study, majority, 32 (64%), were primigravidas while 18 (36%) were multigravidas. Similarly a study done by Ashtagi GS et al. revealed that, out of 716 pregnant women studied, majority 457 (63.83%) were multigravidas and 259 (36.17%) were primigravidas.  The percentage of primigravidas coming for institutional delivery is significantly more than multigravidas as there is a strong belief in the community that delivery process is safe among multigravidas so they preferred delivery at home.
| Conclusion|| |
During the study period, a total of 14,694 pregnancies occurred; out of which 12,171 of them availed ICTC services form Pravara Rural Hospital, Loni. The need of the hour is to provide universal access to these services by involving the NGOs and the private sector. Utilization of the PPTCT services can be improved by creating awareness among the pregnant women regarding the need and benefits of getting tested. Development of programs with an integrated approach to inducing behavioral change and promoting use of condoms may reduce the infectivity of HIV transmitters and the susceptibility of HIV exposed persons. In this era of AIDS, there is a need to express care and compassion rather than fear, hostility or alienation.
| Acknowledgments|| |
We express our deep sense of gratitude to the Management, Pravara Medical Trust and The Principal, Rural Medical College Loni, Maharashtra, India. We also acknowledge the help and support of Professor and Head, Department of Obstetrics and Gynecology and Medical Interns - Neha Deshpande, Rohini Jadhav, and Dnyanada Mhatre.
| References|| |
|1.||Yahya-Malima KI, Olsen BE, Matee MI, Fylkesnes K. The silent HIV epidemic among pregnant women within rural Northern Tanzania. BMC Public Health 2006;6:109. |
|2.||Ashatagi GS, Metgud CS, Walvekar PR, Naik VA. Prevalence of HIV among Rural Pregnant Women Attending PPTCT Services at KLE Hospital, Belgaum. Al Ameen J Med Sci 2011;4:45-8. |
|3.||UNDG. Indicators for Monitoring the Millennium Development Goals. New York: The United Nations; 2003. Retrieved from http://hdr.undp.org on Dec. 12, 2011. |
|4.||The World Bank Group: HIV Prevalence among Women Aged 15-24. Millennium Development Goals 2004. Available from: http://ddpext.worldbank.org/ext/GMIS/gdmis.do?siteId=2&contentId=Content_t18&menuId=LNAV01HOME1 [Last accessed on 2011 Dec 08]. |
|5.||Dobson R. AIDS-dramatic surge in ex-soviet union, no respite worldwide, new data show. Bull World Health Organ 2001;79 : 78. |
|6.||Gupta S, Gupta R, Singh S. Seroprevalence of HIV in pregnant women in North India. BMC Infect Dis 2007;7:133. |
|7.||Parameshwari S, Jacob MS, Vijaykumari JJ, Shalini D, Sushil MK, Shivkumar MR. A programme on prevention of mother to child transmission of HIV at Government hospital. Tiruchegonda taluk, Namakkal district. Indian J Com Med 2009;34:261-3. |
|8.||Celentano DD. Is HIV screening in the labour and delivery unit feasible and acceptable in low income setup. PLOS Med 2008;5:e107. |
|9.||Joint United Nations Programme on HIV/AIDS (UNAIDS). 2006 Report on the Global AIDS Epidemic. Geneva, Switzerland: UNAIDS; 2006. |
[Table 1], [Table 2], [Table 3]
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