Chasing Down An Epidemic
Fulbright Scholar Dr. Marie-Huguette Kingbo (M.P.H. ‘12) uses the power of data to improve patient monitoring and protect babies from HIV in her native Ivory Coast.
written by Kathleen Joyner
As an epidemiologist in the West African country of Ivory Coast, Marie-Huguette Kingbo keeps her mind focused on health research and data. But her heart is with its children.
“My dream is ensuring that no baby in Cote d’Ivoire is born with HIV,” said Kingbo.
She acknowledges that’s a formidable task.
The Ivory Coast, also known as Côte d’Ivoire, is one of the countries most affected by HIV/AIDS in West Africa, with a prevalence of 3.2 percent, according to a 2015 UNAIDS report on the global AIDS epidemic.
About 460,000 people in the Ivory Coast are living with HIV, according to data from the Joint United Nations Programme on HIV and AIDS — 29, 000 are children ages 14 and younger. There is a feminization of the epidemic (4.6 percent for women and 2.7 percent for men aged 15 to 49), according to the 2012 Demographic Health Survey. This is especially challenging for a country recovering from a civil war that ended less than a decade ago.
“The country was severely damaged by the war,” Kingbo said.
The violence forced thousands to flee to neighboring countries or remote regions of the Ivory Coast, where they had little access to food and health services.
Kingbo spent the first 10 years of her health career as a doctor, five of those years in the pediatric emergency unit of a public hospital in Abidjan, a major urban center in Ivory Coast. There, she took care of children suffering from anemia, malaria, diarrheal diseases and respiratory infections. She also cared for children with HIV, most of them 5 or younger.
In 2011, Kingbo earned a Fulbright scholarship and enrolled at the School of Public Health. After graduating with her Master of Public Health degree in epidemiology in 2013, Kingbo returned to her home country, where she works for Fondation Ariel Glaser.
Kingbo is a technical adviser of operational research, which means she is a professional problem-solver. She tracks HIV data to identify areas that need more research and suggests ways to improve patient monitoring. One issue that Kingbo is focused on is postpartum care.
“Many children born to women with HIV are not being systematically monitored and followed up on during the postpartum period and are thus missing out on life-saving services,” she said.
According to data from health centers supported by Fondation Ariel Glaser, the organization identified 310 infants born to HIV-positive pregnant women between October 2015 and September 2016. But 46 percent, of those babies are lost in care. They are not coming in hospitals to receive antiretroviral drugs, putting them at serious risk of developing deadly infections.
Tracking and services are critical for infants who contracted HIV from their mothers before or during birth. But they are also important for infants who did not contract the disease because they will lessen the risk of transmission later on, Kingbo said. About 150,000 infants worldwide are infected with HIV after birth through breastfeeding, according to the World Health Organization (WHO).
Until recently, WHO recommended that women with HIV not breastfeed, or stop breastfeeding as soon as they could, Kingbo said. That meant more babies being fed formula. However, infant formula is not always affordable for mothers in developing countries, and studies have shown children fed formula in places without access to clean water and secure food supplies face higher mortality rates due to diarrhea, malnutrition and other diseases.
“Many Ivorian women reported that financial barriers and associated stigma or fear of disclosure prohibited adherence to these guidelines,” Kingbo said. “As one interviewed woman summarized it, ‘Imagine a woman who doesn’t want to tell her mother-in-law or relatives and friends that she is HIV-positive. She will be asked by the mother-in-law and the community why she gives formula milk to the baby.’”
Despite the struggles, Kingbo said she believes she and her country have come out stronger.
In the time that Kingbo has worked for Fondation Ariel Glaser, more mothers and children have stayed connected to health services and received life-saving antiretroviral medications. The foundation’s patient retention rate has improved from 78 percent to 83 percent from October 2015 to September 2016.
“What I have learned is that Cote d’Ivoire is a very resilient country,” she said. “And what I have learned about myself is that I should never give up trying to do what I really want to do in life.”