HIV risk exposure among South African children in public health facilities

Abstract

The study investigates the risk exposure to HIV infection among South African children aged 2–9 years served by public health services. Together with their biological mothers, 3471 children and were recruited from inpatient and outpatient children in the Free State Province. Blood samples were taken by professional nurses and a history taken of exposure factors associated with HIV transmission. DNA testing was used to confirm biological maternity where the child was HIV-positive and the mother HIV-negative. Mother-child pairs were stratified by mother's HIV status. Exposure factors related to the child's HIV status were examined in each stratum using a chi-square test. Independent factors were then included in a multiple logistic regression model. Having an HIV-positive mother was strongly related to HIV infection in children (OR: 310; 95%CI: 148–781). However, seven HIV-positive children had HIV-negative mothers. Transmission in this group was significantly associated with breastfeeding by a non-biological mother (OR: 437; 95%CI: 53–5020), being fed with expressed breast milk from a milk room (OR: 37.6; 95%CI: 6.2–259.0), dental injection history (OR: 31.5; 95%CI: 4.5–189.4) and visits to a dentist (OR: 26.9; 95%CI: 4.4–283.5). Although mother-to-child-transmission is shown to be the primary mode of HIV transmission in South African children, the few HIV-positive children infected by other modes of transmission suggest a potential risk of non-vertical HIV infections. These infections can be prevented through education and improved infection-control procedures.

Keywords:

• HIV
• risk exposure
• children
• public health facilities
• South Africa

Acknowledgements

We acknowledge Dr Thabang Mosala for being a project manager for this study. We also acknowledge Dr Ivan Hutin of the World Health Organization (WHO) for his advice regarding the study design. We also acknowledge WHO, Dr George Schmid and David Gisselquist who participated in the design, analysis and comment on the paper. We appreciate the comments made by scientists at the Centers for Disease Control and Prevention: Dr. Robert Chen, Dr. Miriam Sabin and Dr. Dejana Selenic. The authors take full responsibility for the final analysis and writing of this paper. The support of the Free State Department of Health, the nurses who conducted the study and the participants who gave their time freely, all contributed to the conduct of this study. Funds from the Nelson Mandela Foundation made it possible for us to conduct the study.

Notes

1. The cross-sectional study was conducted concurrently with studies on infection control practices in maternity, pediatric and medical wards as well as dental facilities. The methodology for these studies differed. The children's study focused on children, while the remaining three focused on practices related to the provision of services, including milk room practices occurring in pediatric wards.