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To determine the feasibility of using short-course zidovudine (ZDV) to prevent mother-to-child transmission of human immunodeficiency virus (HIV) in a breastfeeding population in a rural area in Kenya, pregnant mothers attending clinics in seven health centers in western Kenya between 1996 and 1998 were requested to volunteer for participation in this study. The HIV-infected mothers were given a daily dose of 400 mg of ZDV starting at 36 weeks of gestation and another 300 mg every three hours intrapartum. After delivery, mothers and their children were followed-up and clinically monitored every 3–4 months for two years, and child and mother mortality rates were analyzed. Of the 825 mothers who consented, 216 (26.2%) were infected with HIV. Of those infected, 51 (23.6%) took the full prescribed dose, 69 (31.9%) took only the prenatal dose, and the remaining 96 (44.4%) did not take any dose. Failure to take ZDV was attributed mainly to delivery occurring earlier than expected, while non-compliance to the intrapartum dose was due to mothers giving birth at home and fear of traditional birth attendants. By the end of the second year, 75 HIV-exposed children (34.7%) and 33 HIV-infected mothers (15.3%) had died. The HIV-free survival of children at 24 months was significantly associated with mother survival (P < 0.001) and prenatal ZDV compliance (P < 0.003). Our findings suggest that implementation of programs for prevention of mother-to-child transmission of HIV in rural areas of Africa need to consider the various socioeconomic and cultural barriers that may prevent successful uptake of antiretroviral prophylaxes. Similarly, the rapid disease progression in mothers may eliminate the increase in child survival due to ZDV prophylaxis.
Received October 14, 2002. Accepted for publication February 12, 2003.
Acknowledgments: We thank all the mothers and children who volunteered for the program, and all participants of the Kenya Medical Research Institute–Japan International Cooperation Agency Project for their services. Special thanks are given to Dr. Takahashi Kurimura and Dr. Davy Koech for their technical advice. We dedicate this work to all volunteers who died in the course of our study and to our colleagues James Njoroge and Judith Aketch, who passed away during their service to this project. This work is published with the permission of the Director of the Kenya Medical Research Institute.
Financial support: This work was supported by Japan International Cooperation Agency and in part by the Toyota Foundation (grant no. D01-A-057), and International Scientific Research Program (grant no. 14256005) from Monbu-Kagakusho (Japan Ministry of Education and Science).
Authors’ addresses: Elijah M. Songok, Department of Viral Infection and International Health, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8640 Japan, Fax: 81-76-234-4237, E-mail: songok{at}med.kanazawau.ac.jp. Yoshihide Fujiyama, Department of Internal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu, 520-2192 Japan, Fax: 81-77-548-2219, E-mail: fujiyama{at}belle.shiga-med.ac.jp. Peter M. Tukei, Kenya Medical Research Institute, PO Box 54840, Nairobi, Kenya, Fax: 254-2-720-030, E-mail: ptukei{at}nairobi.mimcom.net. John M. Vulule, Kenya Medical Research Institute, PO Box 1578, Kisumu, Kenya, Fax: 254-35-22981. E-mail: jvulule{at}kisian.mimcom.net. Michael K. Kiptoo, Kenya Medical Research Institute, PO Box 54840, Nairobi, Kenya, Fax: 254-2-720-030, E-mail: mkiptoo{at}hotmail.com. Nicholas O. Adungo, Kenya Medical Research Institute, PO Box 3, Busia, Kenya, Fax: 254-33-622-410, E-mail: nadungo{at}kisian.mimcom.net. Kazuhiro Kakimoto, Bureau of International Cooperation, 1-21-1, Toyama, Shinjuku, 162-8655 Tokyo, Japan, Fax: 81-3-3205-7860, E-mail: kakimoto{at}sannet.ne.jp. Nobuyoshi Kobayashi, Kenya Medical Research Institute–Japan International Cooperation Agency Project, PO Box 54840, Nairobi, Kenya, Fax: 254-2-713-679, E-mail: kemrijica{at}nairobi.mimcom.net . Isaiah O. Genga, Kenya Medical Research Institute, PO Box 1578, Kisumu, Kenya, Fax: 254-35-22981, E-mail: igenga{at}kisian.mimcom.net. Solomon Mpoke, Kenya Medical Research Institute, PO Box 54840, Nairobi, Kenya, Fax: 254-2-720-030, E-mail: smpoke{at}nairobi.mimcom.net. Hiroshi Ichimura, Department of Viral Infections and International Health, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8640 Japan, Fax: 81-76-234-4237, E-mail: ichimura{at}med.kanazawa-u.ac.jp
Reprint requests: Hiroshi Ichimura, Department of Viral Infection and International Health, Graduate School of Medical Sciences, Kanazawa University. 13-1 Takaramachi, Kanazawa, 920-8640 Japan.
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