Factors Influencing Utilization Of Prevention Of Mother To Child Transmission (PMTCT) Services Among Pregnant Women Attending Ante-Natal Clinic

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Factors Influencing Utilization Of Prevention Of Mother To Child Transmission (PMTCT) Services Among Pregnant Women Attending Ante-Natal Clinic


Abstract


This study sought to assess the factors influence the utilization of PMTCT services among pregnant women in antenatal clinic in University of Calabar Teaching Healthcare (UCTH), Calabar. The specific Objectives of the Study were: to assess the level of knowledge about PMTCT services, determine the socio-economic factors influencing utilization of PMTCT services and to identify the cultural/religion factors influencing utilization of PMTCT services among pregnant women in UCTH. Three research questions were raised and a hypothesis formulated to guide the study as follows: There is no significant relationship between level of knowledge and utilization of PMTCT services among women. The study was a descriptive research where 85 pregnant women who attended antenatal clinic in UCTH were selected through the purposive sampling technique. Data were collected by administering questionnaire. Data were analyzed using frequency tables and percentages, the findings of the study revealed that: Majority of the respondents have good knowledge about PMTCT services. The socio-economic factors influencing utilization of PMTCT services among pregnant women were: stigmatization and discrimination by healthcare personnel; dependence of women on their husbands to make healthcare decisions; distance to PMTCT facilities; unavailability of PMTCT services and attitude of health personnel (nurses) towards people living with HIV. Cultural/religious beliefs do not hinder utilization of PMTCT services. The hypothesis was tested for significance at 0.05 level and 1 degree of freedom, using the Chi-Square (X2) analysis. The result showed that the calculated value 55.45 is higher than the critical value (3.84). Thus, the null hypothesis was rejected, indicating that there is significant relationship between level of knowledge and utilization of PMTCT services among women. Based on the findings, conclusion was drawn. It was recommended amongst others that: there is need for involvement of the stakeholders in the healthcare system in bridging the gap between knowledge and utilization of PMTCT services among women.


Table of Contents


  • Title Page
  • Certification
  • Dedication
  • Acknowledgement
  • Abstract
  • Table of Contents
  • List of Tables

Chapter One

Introduction

  • 1.1 Background of the Study
  • 1.2 Statement of Problems
  • 1.3 Purpose of the Study
  • 1.4 Objectives of the Study
  • 1.5 Research Questions
  • 1.6 Hypothesis
  • 1.7 Scope of the Study
  • 1.8 Significance of the Study
  • 1.9 Limitations
  • 1.10 Operational Definition of Terms

Chapter Two

Literature Review

  • 2.1 Theoretically
  • 2.1.2 Knowledge About Prevention of Mother to Child Transmission (PMTCT) Among Pregnant Women
  • 2.1.3 Factors Influencing Utilization of PMTCT 12 2.2 Conceptual Framework

Chapter Three

Methodology

  • 3.1 Research Design
  • 3.2 Research Setting
  • 3.3 Research Population
  • 3.3.1 Target Population
  • 3.3.2 Accessible Population
  • 3.4.1 Sample Size
  • 3.4.2 Sampling Technique
  • 3.5 Instruments for Data Collection
  • 3.6.1 Validity of the Instrument
  • 3.6.2 Reliability of the Instrument
  • 3.7 Method of Data Collection
  • 3.8 Method of Data Analysis
  • 3.9 Ethical Considerations

Chapter Four

Data Analysis and Results

  • 4.1 Sociodemographic Variables
  • 4.2 Results for Research Questions
  • 4.3 Result of Research Hypothesis

Chapter Five

Discussion of Finding

  • 5.1 Discussion of Findings
  • 5.1.1 the Knowledge of Pregnant Women in UCTH About Prevention and Control of HIV/AIDS.
  • 5.1.2 Socioeconomic Factors Influencing Utilization of PMTCT Services Among Pregnant Women.
  • 5.1.3 Cultural/religion Factors Influencing Utilization of PMTCT Services Among Pregnant Women in UCTH.
  • 5.1.4 Relationship Between Level of Knowledge and Utilization of PMTCT Services Among Women
  • 5.2 Summary
  • 5.3 Conclusion
  • 5.4 Recommendations
  • References
  • Appendix I (Questionnaire)
  • Appendix Ii (Letter of Introduction)

List of Tables


  • Table 1: Sociodemographic Data
  • Table 2: Level of Knowledge About PMTCT Services Among Pregnant Women in UCTH
  • Table 3: Socioeconomic Factors Influencing Utilization of PMTCT Service in UCTH
  • Table 4: Cultural/ Religious Factors Influencing Utilization of PMTCT Service in UCTH
  • Table 5: Chisquare (X2 ) Analysis of the Relationship Between Level of Knowledge and Utilization of PMTCT Service

Chapter One


Introduction

1.1 Background of the Study

The greatest challenge to human kind in the 21st century is the epidemic of Acquired immune Deficiency Syndrome (AIDS).Human Immune Deficiency Virus (HIV) is the causative organism of AIDS which was first discovered in the year 1981. Despite years of campaigns, advocacy, control programmes and awareness exercises taken to curb HIV/AIDS spread, there is still a worrisome rate of increase of the infection. According to UNAIDS (2006), about 33.3 million people are estimated to live with Human immune Deficiency virus globally; 22.5 million of this population are from the sub-Saharan Africa.

Over 55% of these people living with HIV are women of reproductive age who become pregnant. HIV infection in women of reproductive age increase the epidemic of peri-natal HIV (UNAIDS, 2006). About 2.5million children live with HIV globally and 1.8million are from sub-Saharan Africa. Worldwide, over 1700 children become infected with HIV daily (UNAIDS 2006).

In Nigeria, about 69,400 children became infected with HIV through mother-to-child transmission in 2011. This has led to a rise in the total number of children living with HIV in the country to an unprecedented 440,000 (UNAIDS, 2012).

Majumali, (2011), opined that, Virtually all HIV infection in children occurs following mother to child transmission during the antenatal period (pregnancy), intranatal period (labour/delivery) and the post-natal period. Mother-to-child transmission of HIV is about 5-10% during pregnancy, 10-20% during labour and 10-15% during breastfeeding.

There is an estimation of about 20-45% chances of a baby born to an HIV positive mother to become infected without effective interventions to prevention of mother-to-child transmission. With effective interventions, such as use of antiretroviral drugs both for mother formula feeding etc., the risk of mother to child transmission has been shown to reduce by 5%. Primary preventive measures (prevention of new infections in parents, avoiding new pregnancies in HIV infected women) and secondary preventive measures (preventing transmission of HIV from an infected mother to her infant) are the three approaches in reducing mother to child transmission (MTCT) promoted by the World Health Organisation (WHO), (McIntyres $ Gray 2004).New approaches in preventing MTCT to <2% includes use of combined anti-retroviral prophylaxis, elective caesarean section and by avoiding prolonged breastfeeding or mixed feeding.

In Nigeria, despite these preventives measures of mother to child transmission, research has shown poor utilization of these services. Thus, the need for this study.


1.2 Statement of Problems

Mother to child transmission of HIV has a lot of impact on the health of the mother and infant including the economy of the country. MTCT increases the prevalence of HIV in infants thereby resulting in increased infant and maternal morbidity and mortality.

Despite the introduction of improved preventive services of MTCT of HIV over the years, HIV infections via MTCT (vertically/ perinatal transmission) is still on the increase in Nigeria. In 2011, about 440,000 infants were infected with HIV (UNAIDS, 2012).

During the researcher’s clinical experience in the antenatal clinic UCTH, it was observed that despite availability of this prevention of MTCT services, very few women utilized the services. For this reason, this pertinent question formed the birth rock of this study: What then are the factors that influence the utilization of prevention of mother to child transmission services?


1.3 Purpose of the Study

The purpose of the study is to ascertain the factors influencing the utilization of PMTCT services among pregnant women in antenatal clinic in UCTH.


1.4 Objectives of the Study

The specific objectives of the study are:

  1. To assess the level of knowledge about PMTCT services among pregnant women in UCTH.
  2. To determine the socio-economic factors influencing utilization of PMTCT services among pregnant women in UCTH.
  3. To ascertain the cultural/religion factors influencing utilization of PMTCT services among pregnant women in UCTH.

1.5 Research Questions

  1. What is the level of knowledge about PMTCT services among pregnant women in UCTH?
  2. To what extent do socio-economic factors influencing utilization of PMTCT services among pregnant women in UCTH?
  3. What are the cultural/religion factors influencing utilization of PMTCT services among pregnant women in UCTH?

1.6 Hypothesis

There is no significant relationship between level of knowledge and utilization of PMTCT services among women.


1.7 Scope of the Study

The study is delimited to pregnant women that attended antenatal clinic in University of Calabar Teaching Hospital.


1.8 Significance of the Study

It is very important that factors influencing the utilization of PMTCT services in a resource poor setting should be studied. It is important in the context of cross river state where health resources are unevenly distributed between rural and urban areas including distribution of health care providers.

Practically:

The findings of this study will be handy for cancelling purposes in ensuring increased utilization of PMTCT services.

Research:

The result of this study will increase the existing knowledge on utilization of PMTCT services and will also serve as research as a resource material for further research work.

Nurse / Midwife:

The findings of this study will help to improve the attitude of Nurses in delivery of PMTCT services to ensure its utilization by pregnant women thereby decreasing the rate of MTCT.

Government:

The findings of this study will help improve policies on findings and distribution of PMTCT services in both rural and urban areas to ensure its utilization.


1.9 Limitations

Major limitation was encountered during this study because the Teaching Hospital was on strike and many patients were not (accessed) reached. Also some respondents refused to divulge their information for confidential purposes.


1.10 Operational Definition of Terms

Factors:

Are variables that influence utilization of PMTCT services

Utilization:

Refers to the process of using PMTCT services

PMTCT Services:

Are services that aims at offering preventive measures towards mother to child transmission.

Ante Natal:

Refers a period from conception to the onset of labour


Chapter Five


Discussion of Finding

5.0 This chapter deals with the discussion of the findings that emanated from the study. The findings were discussed based on the research objectives and the research hypothesis.


5.1 Discussion of Findings

5.1.1 The knowledge of pregnant women in UCTH about prevention and control of HIV/AIDS.

The findings on table 2 revealed that majority of the respondents have good knowledge about PMTCT services. They are aware that PMTCT services stand as a tool for checking mother to child transmission of HIV; PMTCT services prevent the passing of HIV virus from a mother to her child during pregnancy, labour, delivery or breastfeeding; PMTCT services should not be utilized by pregnant women alone, excluding a non-pregnant woman; and that the basic components of PMTCT services include the use of anti-retroviral drugs, abstaining from sex without condom during pregnancy and avoiding breastfeeding of the baby after birth.

The findings agree with the Olugbenga-Bello, et al (2013) who found out that majority of the women used for their studies have a high level knowledge and awareness of MTCT (92.1%) and PMTCT (91.4%) respectively. Also, the finding agrees with Zoung-Kanyi, Yakana, Monebenimp, Chaby (2011), whose study revealed that women have some good knowledge on the Prevention of Mother-To-Child Transmission (PMTCT) of HIV. The finding however contradicts the views of Maputle and Jali (2008) and Umeobika, et al (2013), who opined that there is low level of knowledge about MTCT of HIV and AIDS infection through breastfeeding.

5.1.2 Socio-economic factors influencing utilization of PMTCT services among pregnant women.

The findings on table 3 revealed that the socio-economic factors influencing utilization of PMTCT services among pregnant women were: stigmatization and discrimination by healthcare personnel; dependence of women on their husbands to make healthcare decisions; distance to PMTCT facilities; unavailability of PMTCT services and attitude of health personnel (nurses) towards people living with HIV.

The findings corroborated with that of Rahmati-Najarkolaei (2010), who reported that negative attitude and practice in health care make pregnant women living with HIV/AIDS to either avoid or delay seeking care. Also, the finding corresponds with the report of Reis (2005), which suggested poor attitude of healthcare providers and lack of protection materials in the facility were the possible factors that affect pregnant women’s utilization of PMTCT services.

The findings are in consonance with that of the federal ministry of health (2010) which states that some PMTCT services are located in limited space within ANC clinics, and are often characterized by inadequate counselling and waiting spaces, which may compromise the confidentiality of clients and quality of the service provided to the clients. Also, the findings agree with Theuring (2009), who stated that gender inequalities affect participation of these pregnant women because some of them have to seek the consent of their spouse before attending.
In addition, the findings agree with Falnes (2010), who maintained that distance and residence of the pregnant women either in urban or rural areas influences access and utilization of PMTCT services. Women whose residence are far and those that are resident in rural areas were less likely to utilize PMTCT services.

5.1.3 Cultural/religion factors influencing utilization of PMTCT services among pregnant women in UCTH.

The findings of the study revealed that cultural/religious beliefs do not hinder utilization of PMTCT services. Majority of the respondents indicated that their cultural beliefs, traditions, religious leaders (Pastors/Imams) and members of their religions do not prohibit them from utilizing PMTCT services.

The findings correspond with Danforth et al (2009), who stated that the use of health care services (PMTCT services) among pregnant women is perceived as modernity and often welcomed by most societies. In some cultures in some African countries, including Nigeria, PMTCT services caesarean delivery is considered as an acceptable method of delivery. However, the findings did not agree with Busza et al, (2012) whose finding revealed that pressures from mother, mother-in-laws and other relatives on pregnant women regarding method of delivery, choice of infant feeding influences utilization of PMTCT services among mothers, who feel guilty and ashamed of themselves.

5.1.4 Relationship between level of knowledge and utilization of PMTCT services among women.

The findings of the study revealed that there is no significant relationship between level of knowledge and utilization of PMTCT services among women. The finding agrees with Zoung-Kanyi, et al (2011), who found out that women have some good knowledge on the Prevention of Mother-To-Child Transmission (PMTCT) of HIV and highly utilized PMTCT services. It disagrees however with Olugbenga-Bello, et al (2013), who found out that despite high level awareness and good knowledge about MTCT and PMTCT of HIV/AIDS among the respondents, their attitude towards utilizing PMTCT services was poor.


5.3 Summary

The purpose of the study was to ascertain the factors influencing the utilization of PMTCT services among pregnant women, attending antenatal clinic in University of Calabar Teaching Healthcare (UCTH), Calabar. The specific Objectives of the Study were: to assess the level of knowledge about PMTCT services, determine the socio-economic factors influencing utilization of PMTCT services and to identify the cultural/religion factors influencing utilization of PMTCT services among pregnant women in UCTH. Three research questions were raised and a hypothesis formulated to guide the study as follows: There is no significant relationship between level of knowledge and utilization of PMTCT services among women.

The study was a descriptive research where the researcher selected 85 pregnant women attending antenatal clinic in UCTH, Calabar through the purposive sampling technique. Data were collected by administering questionnaires. The data collected through the questionnaire were presented using frequency tables and percentages, while the hypothesis formulated to guide the study was tested for significance at 0.05 level, using the Chi-Square (X2) analysis. The findings of the study revealed that:

  1. Majority of the respondents have good knowledge about PMTCT services.
  2. The socio-economic factors influencing utilization of PMTCT services among pregnant women were: stigmatization and discrimination by healthcare personnel; dependence of women on their husbands to make healthcare decisions; distance to PMTCT facilities; unavailability of PMTCT services and attitude of health personnel (nurses) towards people living with HIV.
  3. Cultural/religious beliefs do not hinder utilization of PMTCT services.
  4. There is no significant relationship between level of knowledge and utilization of PMTCT services among women.

5.3 Conclusion

Good knowledge about PMTCT services influences utilization of such services among pregnant women living with HIV. However, pregnant women in some cases as shown in some research (Ikobi, 2009) do not have adequate knowledge about PMTCT services as a result, they do not effectively utilize such services. In this study however, it was revealed that pregnant women had good knowledge about PMTCT services. Some socio-economic factors such as stigmatization and discrimination by healthcare personnel; dependence of women on their husbands to make healthcare decisions; distance to PMTCT facilities; unavailability of PMTCT services and attitude of health personnel (nurses) towards people living with HIV were found to affect the rate of utilization of such services among some of the women. In order to effectively prevent MTCT of HIV, Adequate measures should be put in place to improve knowledge and utilization of PMTCT among women.


5.4 Recommendations

Based on the findings of the study, the researcher recommends that:

  1. There is need for the involvement of the stakeholders in bridging the gap between knowledge and utilization of PMTCT services among women.
  2. A revised health education programme for pregnant women living with HIV should be implemented to enlighten women on the need to utilize PMTCT services.
  3. Health personnel should always encourage women living with HIV to utilize PMTCT services to prevent mother to child transmission of the virus.
  4. Health personnel should avoid discrimination of women living with HIV and to show them positive attitude to that will encourage them to continue to utilize PMTCT services.
  5. The government should provide PMTCT centres in rural areas so as to provide access to PMTCT facilities to all, especially among women resident in rural areas. This will serve as an encouragement to rural pregnant women to utilize the PMTCT services.
  6. Government should implement the policy on penalizing those discriminating and stigmatizing people women living with HIV. This will encourage women to utilize PMTCT services without fear of discriminating and stigmatizing.
  7. Infant feeding counseling needs to be improved and access to portable water for formular feeding should be made available.

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