1.1 Introduction
Human Immunodeficiency Virus (HIV) is a chronic viral infection that attacks the body's immune system, particularly the CD4 cells, thereby weakening the individual's ability to fight infections and diseases. If untreated, HIV can progress to Acquired Immunodeficiency Syndrome (AIDS), which represents the most advanced stage of the infection and is associated with severe opportunistic illnesses and increased mortality (World Health Organization, 2021). HIV remains a major global public health concern, with millions of people living with the virus worldwide, and sub-Saharan Africa accounting for a significant proportion of the global burden (UNAIDS, 2022).
As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are significance of the study, scope of work, research hypothesis and questions, limitation of the study and definition of terms.
1.2 Background of Study
Human Immunodeficiency Virus (HIV) continues to pose a serious public health challenge globally, particularly in low- and middle-income countries. According to the World Health Organization, HIV weakens the immune system by destroying CD4 cells, thereby increasing vulnerability to opportunistic infections and diseases (WHO, 2021). Pregnant women represent a critical population in the epidemiology of HIV because of the risk of mother-to-child transmission (MTCT). UNAIDS reported that MTCT accounts for the majority of HIV infections among children, particularly in regions with limited access to comprehensive prevention services (UNAIDS, 2022). Transmission may occur during pregnancy, labour, delivery, or breastfeeding if appropriate preventive measures are not implemented. Consequently, antenatal care settings have become central to HIV surveillance and prevention strategies.
In Nigeria, HIV remains a major public health concern despite ongoing national and international efforts to curb its spread. The Federal Ministry of Health asserted that women of reproductive age constitute a significant proportion of people living with HIV, making antenatal clinics strategic points for identifying infected individuals and preventing vertical transmission (FMOH, 2019). The integration of routine HIV testing into antenatal care services has therefore been emphasized as a key intervention for reducing maternal and infant HIV-related morbidity and mortality.
Pregnant women constitute a particularly important population in HIV research because of the risk of mother-to-child transmission (MTCT) of the virus during pregnancy, labour, delivery, or breastfeeding. Without appropriate medical intervention, the likelihood of HIV transmission from an infected mother to her child is substantial; however, with effective prevention of mother-to-child transmission (PMTCT) interventions, this risk is significantly reduced (WHO, 2021). As a result, antenatal care settings have become strategic entry points for HIV screening, counseling, and early initiation of treatment for pregnant women.
Several studies have highlighted variations in HIV prevalence among pregnant women across different regions and health facilities. Researchers have stated that these variations are influenced by factors such as socio-economic status, level of awareness, cultural practices, access to healthcare services, and the effectiveness of prevention of mother-to-child transmission (PMTCT) programs (Avert, 2021). Such disparities underscore the importance of facility-based and location-specific studies to generate accurate and reliable data for planning and intervention.
Furthermore, scholars have affirmed that antenatal HIV prevalence data are often used as proxy indicators for assessing the general HIV burden within a community, particularly in settings where large-scale population surveys are infrequent (WHO, 2021). Reliable data from antenatal clinics enable health authorities to monitor trends, evaluate existing programs, and identify gaps in service delivery. Without such data, efforts aimed at controlling HIV transmission may be poorly targeted and less effective.
In the context of Delta State, Warri Central Hospital serves a diverse population of pregnant women from urban and semi-urban communities. However, there is limited published evidence on the prevalence of HIV among pregnant women attending antenatal care in this facility. Some authors contend that the absence of up-to-date, facility-specific data limits effective decision-making, resource allocation, and the strengthening of PMTCT services at the local level (Joint United Nations Programme on HIV/AIDS [UNAIDS], 2022). This study is set against the backdrop of the need for localized, evidence-based data on HIV prevalence among pregnant women attending antenatal care at Warri Central Hospital.
1.3 Statement of Problems
Investigation revealed that antenatal services are widely utilized by pregnant women from diverse socio-economic and educational backgrounds. However, there is insufficient documented evidence on the current prevalence of HIV among these women and how it reflects broader trends within the community. Without reliable data, assumptions are often made based on state or national averages, which may not accurately represent the situation within the hospital's catchment area.
On the other hand, socio-cultural factors, limited awareness, stigma, and fear of discrimination continue to influence the uptake of HIV testing and disclosure among pregnant women. These factors may contribute to under-detection or late diagnosis of HIV during pregnancy, thereby increasing the risk of adverse maternal and neonatal outcomes. If the true prevalence of HIV among antenatal attendees is not well understood, efforts to strengthen PMTCT services and reduce HIV-related maternal and infant morbidity and mortality may be undermined.
Furthermore, regular assessment of HIV prevalence among pregnant women is essential for monitoring progress toward national and global HIV control targets. The absence of recent empirical data from Warri Central Hospital limits the ability of stakeholders to assess whether existing interventions are effective or whether new strategies are required to address emerging challenges in HIV prevention among pregnant women. It is against this backdrop that this study seeks to determine the prevalence of HIV among pregnant women attending antenatal care.
1.4 Aim and Objectives of Study
The aim of this study is to determine the prevalence of HIV among pregnant women attending antenatal care at Warri Central Hospital, Delta State. To achieve this aim, the study has the following objectives:
- To examine the distribution of HIV prevalence among pregnant women based on selected demographic characteristics,
- To assess the prevalence rate of HIV among pregnant women attending antenatal care at Warri Central Hospital, and
- To evaluate the effectiveness of routine antenatal HIV screening practices within the hospital.
1.5 Research Questions
The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:
- What is the prevalence of HIV among pregnant women attending antenatal care at Warri Central Hospital?
- How does HIV prevalence among pregnant women vary based on selected demographic characteristics?
- How effective is routine HIV screening among pregnant women attending antenatal care at Warri Central Hospital?
1.6 Research Hypothesis
In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.
- H0: There is no significant prevalence of HIV among pregnant women attending antenatal care at Warri Central Hospital.
- H1: There is a significant prevalence of HIV among pregnant women attending antenatal care at Warri Central Hospital.
1.7 Significance of Study
The outcome of this research will provide accurate data on the prevalence of HIV among pregnant women attending antenatal care at Warri Central Hospital. Also, the study will benefit pregnant women by promoting early detection and timely management of HIV during pregnancy.
Furthermore, the study will support hospital management by guiding resource allocation and service planning. In addition, the study will aid policymakers by supplying local data necessary for strengthening HIV prevention programs.
Lastly, the study will contribute to academic institutions and researchers by expanding the existing literature on HIV prevalence among pregnant women in Nigeria.
1.8 Scope of Study
The scope of the research is focused on pregnant women attending antenatal care at Warri Central Hospital, Delta State, Nigeria. The study is limited to assessing HIV prevalence using antenatal clinic records and routine screening outcomes within the hospital during the study period.
1.9 Limitations of the Study
The study was limited to available hospital records, which restricted the depth of analysis. Some respondents were unwilling to provide complete information, and access to certain records was delayed due to administrative procedures within the hospital.
1.10 Definition of Terms
Human Immunodeficiency Virus (HIV):
HIV refers to a virus that attacks the immune system, specifically CD4 cells, thereby reducing the body's ability to fight infections. If untreated, HIV may progress to Acquired Immunodeficiency Syndrome (World Health Organization [WHO], 2021).
Prevalence:
Prevalence refers to the total number of existing cases of a disease within a specific population at a given time. In this study, it refers to the proportion of pregnant women who tested positive for HIV during antenatal care (UNAIDS, 2022).
Pregnant Women:
These are females who are carrying a developing fetus from conception until childbirth and are receiving antenatal care services at a health facility.
Antenatal Care:
Antenatal Care refers to the routine health services provided to pregnant women during pregnancy to ensure the well-being of both mother and fetus, including HIV testing and counseling (Federal Ministry of Health [FMOH], 2019).
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