Prevention of mother-to-child transmission of HIV-1 is a major public health challenge in many resource-poor countries including Ethiopia. This study was based on a retrospective analysis of data from a routine PMTCT program in a referral hospital. According to this study, among HIV-exposed infants on follow up at the PMTCT clinic of Gondar University referral hospital, one-tenth of HIV-exposed infants got HIV-infected. We included only those infants whose mothers were tested HIV-positive and followed up until the infant’s HIV status was confirmed.
Compared to high income countries (<2%) [6, 7], and reports from India (6.5%) and South Africa (5.9%) [8, 9], in our study risk of MTCT was very high. This may be due to the universal use of highly active antiretroviral therapy for pregnant women, elective caesarean sections and avoidance of breastfeeding in developed countries . However, such preventive approaches are limited in poor countries due to poor funding, social and cultural norms .
Factor that put an infant to a higher risk of HIV transmission were; late enrolment to the follow up clinic, rural residence, home delivery, absence of maternal PMTCT interventions and mixed infant feeding practices. The reasons for the high relevance of these factors could be overlapping to one another. Firstly, infants born from rural mothers are prone for mixed feeding. Secondly, rural mothers are less likely to screen and enroll themselves to antenatal care or health institution delivery and thereby less likely to benefit from PMTCT interventions. As a result many women in resource-poor countries do not have access to prenatal care and often present with infection lately . All these health care disadvantages in the rural settings compared to the urban areas would put infants of rural mothers at a higher risk of MTCT of HIV and thereby mortality .
Similar to studies done so far in different corners of the world [9, 13, 14], if the mother received PMTCT interventions during pregnancy, the risk of MTCT of HIV was only 4.8%. The result of this study is in line with the widely accepted fact that providing ARVs to both the mother and the newborn prevents MTCT of HIV . In this study, the risk of MTCT was 40.5% among infants with no prophylaxis, 5.1% for infants who received sdNVP prophylaxis and 4.9% for infants who took combined (sdNVP + AZT) prophylaxis. The difference was significant between no prohylaxis and sdNVP groups. However, there was no statistical difference between sdNVP and combined (sdNVP + AZT) prophylaxis regimens. This is similar to previous studies reporting a higher benefit of ARV prophylaxis to exposed infants [5, 9, 13] especially with combined regimens. A cohort study in Abidjan, Côte d’Ivoire, reported a 72% reduction of MTCT  with ZDV + sdNVP compared to ZDV alone while another study reported an increasing drug number and duration would significantly decrease the risk of MTCT . However, this difference was not observed in the current study partly due to the lower sample size.
As we used secondary data from a PMTCT clinic, it was difficult to control for inconsistencies and missing values. Maternal HIV-1 viral load and duration of disease and child’s vaccine status were not systematically recorded and could not be taken into account. This study did not aim to differentiate when MTCT occurred i.e. pre-partum, intra-partum or post partum period. The fact that all potential factors were not included and assessed may affect generalization of predictors in this study. Despite these limitations, to the best of our knowledge, this study presented primary results of the effectiveness of routine PMTCT interventions in Gondar University referral hospital.