Emergency obstetric patients in developing countries and prevalence of HIV infection

Abstract

The availability of VCT for HIV for booked antenatal patients offers a unique opportunity for best obstetrics practice but not for patients presenting with emergencies and unknown HIV status. Health workers who attend to such patients are at higher risk of acquiring HIV infections. Between 1M March 2005 and 30th September 2007, unbooked emergency obstetric patients in the labour ward of a teaching hospital who consented were tested using double rapid immune diagnostic technique and confirmed by Western Blot. HIV-positive patients were post-test counseled and offered single-dose nevirapine tablet (200mg) in labour with syrup given to the baby at birth at 2mg/kg followed by syrup zidovudine for 6 weeks. The results showed that 275 (89.0%) of the 309 women per-test counseled agreed to testing. The mean age of clients was 27.7 years (± 4.4 SD). The mean gestational age at presentation was 36.4 weeks (± 4.2 weeks). Primigravidae constituted 37.5% of the patients. Twenty-one (7.6%) of these consenting patients were HIV positive. In conclusion, the HIV prevalence of 7.6% among these unbooked obstetric patients is higher than the 4.7% among our booked antenatal patients and the National prevalence of 4.4%. This poses a substantial risk of transmission of HIV to attending health workers considering the readiness with which needle prick accidents can occur in emergency situations.