Over the recent years, there has been a slow progress providing healthcare to children infected by HIV/AIDS in Nigeria. Research indicates that, at least 30% of the children living with HIV/AIDS on a global scale die before they are one year old and most of them die before they have received anti-retroviral drugs and other treatments on AIDS related complications. The slow progress has been attributed to the political as well as social and cultural factors regarding HIV/AIDS in Nigeria.
According to the traditions of Nigerians, discussions on sex related matters is seen as very private and therefore, it is very hard to hold successful sex education. The paper will discuss various aspects of HIV/AIDS among children in Nigeria such as how the disease progress once the baby is infected, diagnoses and treatment. Healthcare on children living with AIDS in Nigeria will also be compared with the global perspective standards as well as the roles of the health providers including the role of alternative medicine.
HIV/AIDS among children in Nigeria has become a matter of concern by the UNICEF because of the slow progress in handling as well as reducing the great impact AIDS is having on children. Research has shown that, very little has been done to support the children in terms of medical care as well as treatment of the infected children. Even after several campaigns have been conducted, very little achievements have been done in comparison with the laid down aims and objectives prior to the campaigns. However, the prevalence rate among children has been on decline since 2001 where it reduced from 5.8% to 4.4 percent four years down the line. In spite of the decline, control of the disease is still far from being achieved. (Brown, 2003)
Epidemiology/Impact on global health
Research has shown that, more than 30% of infected children on a global scale are likely to die before they reach one year while 50% of the children die Of HIV/AIDS and the related complications before reaching two years. Majority of such cases on children before teen age live with the status without receiving any treatment on the anti-retroviral because they are not diagnosed and so their chances of living are very slim. A Survey on the accessibility of anti-retroviral by these children reveals that, very few of them receive the treatments despite the starting of the national program on the pediatric on the treatment of the disease in 2004.
Only a small percentage of the children get access to basic anti-biotic in order for them to keep off opportunistic infections which according to the results of the research, they are not very effective. It is recommended that, every child who is infected by the disease should be put under co-trimoxazole which should be administered freely. The recommended practice in Nigeria and at global level is that, new born children are supposed to be prevented from the infections of the HIV virus by ensuring that, there is no mother-to-child transmission especially during birth. Research indicates that, more than 90% of the infected children in Nigeria aged below thirteen years are infected by their mothers either during delivery or during breastfeeding if the mother is positive. Nigerian government established about 230 sites to offer health services on prevention of mother-to-child infection of the virus. (Fawzi, 2003)
A few years back, there were only about 60 sites and therefore this has been advancement. The great challenge in this area is that, even though the government has ensured a continuous progress to fighting against mother-to child transmission, only about 1% of expectant mothers are able to undergo the voluntary counseling and testing services. For the few mothers who access the services, they are not accompanied by their husbands and therefore, chances of the mothers being infected even after undergoing the services still exist. It is recommended that, both partners are tested immediately after the wife conceives and shortly before the mother delivers.
In Nigeria, a recent program was launched as the universal program to ensure all the infected mothers access the preventive measures as well as get treated and receive adequate care and support. It is demanded that, if an expectant mother has tested positive for the virus, she must receive the prevention of mother-to-child transmission services regardless of her location in the country. It is expected that, if this program is properly adhered to, the number of children turning HIV positive will reduce by a large margin in Nigeria. (Uwakwe, 2000)
Political, social and cultural aspects of HIV/AIDS in Nigeria among children
When the first case of HIV was observed in Nigeria in 1985, the government was reluctant to respond to its transmissions until in 1991 when the situation was accessed by the ministry of health. At that time, already 1.8% of Nigerians had been infected with the virus. The situations became of primary concern to the Nigerian government in 1999 when Olusegun Obasonjo took over the presidency with the main focus being on its treatment and prevention as well as extended care for the infected and affected children. This followed a creation of a committee into matters of AIDS in 2001 with implementation of an emergency plan. However, even with the good intentions from the government in handling the epidemic, only about 7% of the expectant mothers accessed the treatment to reduce the risks of transmitting the virus to the unborn. (Flaskerud, 1994)
The traditions of Nigeria country regard matters of sex with high privacy and therefore, any discussion involving sex is strongly avoided and for many years, there has not been sex education consequently increasing the spread of the virus.
The information regarding sexual health has not been accurate because of the existing myths as well as misconceptions about HIV. Transmission rates have therefore increased among children through their mothers and these children are stigmatized as well as discriminated because of their status. Over the recent years, health care for the children infected with the HIV virus has not been on progress because of political instability and corruption among the entrusted officers in addition to the Nigerian mismanaged economy. Research has indicated that, most areas in the country do not have provision for basic health care for the children and it is therefore hard for the children to be diagnosed early enough as well as being given proper treatments. (Puthanakit, 2005)
Disease trajectory/symptoms/signs and diagnosis
HIV infection is in most cases hard to diagnose if the child is very young because even when the baby is infected, in the early months everything appears normal with no single sign that can lead to diagnoses of HIV infection. This is possible because when a child is born to a positive mother, there are antibodies to HIV from the mother to the child’s bloodstream even before the child is born and they can last for 18 months.
These antibodies are a reflection of the mother status and therefore it would not be important to test for the HIV status of the new born before the first 18 months are over. For the last few years in Nigeria, doctors are conducting a high accurate test of blood among infants aged as young as 6 months and below where some techniques such as polymerase chain reaction has a capacity to detect even very small dosage of HIV virus. Physicians also culture the blood of the infants using another procedure to diagnose the presence of the virus. (Brown, 2003)
Illnesses among infected new born follows two general pattern according to the report given by the researchers. Some children develop serious complications related to HIV even before their first birthday and they comprise of 20% where most of them succumb to the complications before they reach the age of 4. The rest of the HIV positive children undergo the disease progression at a slower rate and they can even reach school entry age without developing serious complications and the immunity may even proceed to adolescence. The factors that cause these variations are the main focus in the research about pediatric AIDS. (Fawzi, 2003)
Among the signs and symptoms exhibited by children who are positive include lack of weight gain and their growth rate is not normal. They are characterized by poor development of the important stages of their motor skills and poor mental development resulting to poor crawling and talking as well as walking. As the complications progress, most of the children suffers neurological problems and perform poorly in school besides other symptoms of brain disorder. Opportunistic infections develop among such children just as it happens to adults. Usual infections that are found in normal healthy children are more frequent and severe among children who are HIV positive. They include seizures, pneumonia, diarrhea and colds that are recurrent and can make a child to stay in hospitals for an extended period. (Uwakwe, 2000)
In Nigeria, doctors use unique medical concern while treating pediatric of HIV infection that are different from the basic concerns used for adults. The techniques vary depending on the child’s age and drug metabolism as well as whether the child requires special formulations that are appropriate for him/her through adolescence. Antiretroviral are used as a potent combination to ensure maximum suppression of viral replication. Researchers who are linked with the National Institute of Allergy and Infectious Diseases (NIAID) are focused towards improving the treatments using the already available drugs while at the same time looking for new medicines.
This is expected to enable the doctors in administering the most efficient initial therapy as well as modifying the regimens that have failed in order to determine the antiretroviral needs among children undergoing advanced complications related to HIV. Priority is also being given to the assessment of the already existing strategies using a long term approach. This is aimed at finding out sustained benefits of the antiretroviral as well as monitoring potential adverse effects of any form of treatment.
Alternative medicines are also being explored as research has indicated that, herbal medicines are becoming prominent as a result of some children responding more positively compared to the convectional drugs. However, health providers using herbal medicines have to liaise with convectional health providers for proper test to be conducted before such drugs are administered to avoid HIV children developing resistance to future treatment and also to ensure professional health standards are observed. At global level it is estimated that, more than 14 million children aged below 15 years live with the virus that cause AIDS most being from most affected countries. About 80% of them are from sub-Saharan Africa. (Flaskerud, 1994)
International treatment approach
An international conference on AIDS indicates that, children have not been receiving adequate response regarding AIDS and policies are being reviewed in favor of children who are living with the virus. According to UNAIDS, more than 2 million children below 14 years were infected in 2007 which was an increase by 8 folds since 1990. The main focus in reviewing policies is to meet the actual needs of infected children whether they are the actual victims or orphans. (Brown, 2003)
US treatment perspective among children living with AIDS
Research shows that, UNICEF as well as WHO are offering programs through guidance to build a framework that can be used to scale up treatment in pediatrics. This is targeted towards assisting mangers of health at national level especially in areas that have scarce resources to manage the high burden of HIV as far as its scaling up is concerned. This would improve prevention measures and enhance methods of diagnoses as well as continuous care in treatment of children living with the virus. It would also ensure drugs such as co-trimoxazole prophylaxis are affordable for the children from resource-limited areas to standardize the accessibility in both developed and undeveloped countries globally. (Fawzi, 2003)
The role of the health provider with an international health perspective
Health providers attend millions of children living with HIV/AIDS in developing countries from the perspective of global pandemic, maximizing their reaching of young children. They are expected to make a significant contribution in providing adequate treatment to the children as well as preventing new infections in the near future. They also provide moral support to the children to enable them overcome the stigma associated with HIV/AIDS as they grow up. Their focus is on maximizing the benefits of the already existing management of HIV/AIDS situation as they provide better alternative methods of controlling the pandemic. (Brown, 2003)
HIV/AIDS does not only affect the infected children but also impacts on the affected children as a result of their parents dying of the disease living them orphaned. A large number of children are also living with infected guardians who are almost dying. Consequently, the children undergo acute psychological distress partly because of hard economic status and the resulting stigma along with associated social discrimination. The situation becomes worse when the child undergoing these problems suffers malnutrition risking their very chance to survive.
Brown L. (2003): Interventions to Reduce HIV/AIDS Stigma: Guilford Publications pp. 34-38.
Fawzi W. (2003): Micronutrients and Human Immunodeficiency Virus Type 1. Disease Progression among Adults and Children: University of Chicago Press pp. 59-64.
Uwakwe C. (2000): HIV/AIDS education for student nurses: Blackwell Synergy pp. 47-54.
Flaskerud J. (1994): HIV/AIDS: A Guide to Nursing Care: Saunders Limited pp. 89-93.
Puthanakit T. (2005): highly active antiretroviral therapy in HIV-infected children: University of Chicago Press pp. 19-23.