BY EBELE ORAKPO
PROFESSOR Jennifer Tyndall is an Associate Professor of Natural and Environmental Sciences at the American University of Nigeria in Yola. In this chat with Vanguard Learning, she speaks on her research in public health with particular interest in HIV/AIDS and maternal and infant mortality. Excerpts:
Malaria in pregnancy:
According to Tyndall, malaria and HIV/AIDS in pregnant women are very dangerous and adequate care must be taken to prevent them.
“One of the studies I undertook was malaria in pregnant women; also their genotype, whether they are AS or SS because a lot of people don’t know their genotype. Another area of focus is HIV/AIDS. I look at the pre- peri- and post-natal stages of pregnancy and study the outcome of the mothers and infants to put things in perspective in terms of how many miscarriages she’s had, whether or not she has had Caesarean section (CS); whether she is HIV positive or not and whether she is on Prevention of Mother-to-Child Transmission of HIV (PMTCT) program or not. If we see her in the antenatal stages early enough, she will go into PMCT programme,” she said.
“A lot of mothers do not attend antenatal clinics regularly. Some come in the 23rd week and sometimes when they are ready to give birth. Another major issue particularly in rural areas is the lack of facilities; lack of qualified medical personnel – properly trained midwives and medical doctors in case of complications like pre-enclampsia which is basically hypo-pressure which leads to leaky placenta and problems in delivery. If she is HIV positive, we have to find out early enough so she can have the relevant anti-retro viral treatment before giving birth.
There was the case of a child in the US who was actually HIV positive at birth but having given the right anti-retro viral therapy, he was allegedly found to be HIV negative. He actually had his serum converted from positive to negative.
“It’s not only the therapy itself in terms of drugs but the right counseling in terms of behavior, particularly in this area where you have a polygamous set up. One wife or even the husband might be HIV-positive so it is a big problem in terms of counseling and the acceptance.”
Dealing with HIV in pregnancy: “Just having a simple cold, lack of proper nutrition, hygiene and also a person’s mental psyche (feeling depressed and so not likely to eat properly or take their drugs regularly at the right time) and drinking/eating properly, will worsen the case.
If they are HIV positive, using the relevant prophylaxis and condoms, or being sure they remain in a monogamous relationship, or in the case of a polygamous setting, letting the other wives know who may be at risk, goes a long way. Awareness and counseling for the HIV-positive person, ensuring they get their T-cell counts; if it is low, it means low immunity, so they are followed up and drug regimen possibly changed,” she said.
“Knowing the HIV strain – whether HIV1 or HIV 2, is very important because they are resistant to certain drugs, particularly HIV2. So knowing the strains will aid a good public health physician in its treatment. HIV1 is more dangerous because it spreads more rapidly, HIV2 does not spread as rapidly.” She advised that rather than collecting all the drugs at once, patients should collect them bimonthly and go back if they have complications.
“Breastfeeding is one of the risk factors but it is actually better when you are HIV positive to do exclusive breastfeeding (EBF) because when you mix it with formula especially in areas without clean water, the child is more prone to diarrhoeal diseases. Mother-to-child transmission in utero is quite low and highest during delivery but through the milk is higher than in utero, so the highest risk factors are during delivery.
So if a mother is HIV positive, we transfer her to a hospital where they do CS because that reduces the risk of mother-to-child transmission (mtct). But as soon as the baby is born, with the right facilities, the baby is taken straight from the table and given a drip with the relevant anti-retroviral drugs. That is the key because the child has a better chance of survival. As I said earlier, making sure that during pregnancy, the HIV positive mother takes the anti-retroviral drug to significantly reduce mtct.
Asked if it is advisable for an HIV positive mother to breastfeed an HIV negative child, Professor Tyndall said: “In that case, that is taken on the advisement of the midwife and the doctor because if she is living in an area where there is no running water and she is giving the child formula, the risk factors are higher. More children die of diarrhoeal disease than anything else in the world.
The child can develop a good immune system with breast milk and overcome other diseases that affect children like pneumonia, meningitis, measles etc. These are things that the child is more prone to, not necessarily the HIV itself. So having the right nutrients and breast milk, particularly the colostrum, is very rich and will set the child up in terms of a good profile of nutrition, long-term but people don’t realise that. Other factors can come into play and outweigh the risk factors of HIV transmission in terms of the child’s survival.
Over 300,000 Nigerians die of malaria every year according to reports. “The key factors about malaria is the lack of proper management of the disease. First of all, in terms of vector control, simple implementation of having bed nets for children under-five years and all pregnant women, is of great benefit. Pregnant women and children in malaria-endemic areas like Adamawa should be using bed nets. Apart from acting as a physical barrier to the mosquito, it also acts as a chemical barrier if the mosquito comes in because it is insecticide-treated.
“Early diagnosis and treatment is key; also detecting the type of malaria and species of mosquito. There are two main types of malaria p[arasites: Plasmodiun falciparum which is the deadly form and Plasmodium malariae. So having a transient fever, that is Plasmodium malariae, is not very dangerous unless it is a long-term infection.
But Plasmodiun falciparum is dangerous because once the paracetamia level gets very high, it can go to the brain. It can cause severe infections throughout the body including the kidney so it has to be properly managed. What is happening is as a result of people not taking the right drugs in the right amount and for the right number of days. That is what leads to drug resistance. So the parasites still grow even though you are taking the drug.
People should take anti-malaria drugs to prevent the growth of the parasite. Those in endemic areas should not take it long-term but expatriates and tourists should take prophylaxis so the drug is in their system to make the parasite uncomfortable and won’t start multiplying and growing to a point where they become deadly to the infected person.
Don’t allow accumulation of water around your homes where the mosquito can breed. A part of your environment is a part of your health. We need more community participation in cleaning up the environment, not just waiting for government. If you come down with malaria, government will not come around to take care of you. AUN plays a very good part here. President Ensign has been very supportive of community events and students going out as part of their curriculum, helping the community because we are a global village. What happens in your backyard is going to affect another person in another country. So people need to be aware of that,” she said.