Knowledge And Attitude Of Pregnant Women Towards The Utilization Of Mother To Child Transmission Services (A Case Study Of Pregnant Women Attending ESUT Teaching Hospital Parklane)

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Knowledge And Attitude Of Pregnant Women Towards The Utilization Of Mother To Child Transmission Services (A Case Study Of Pregnant Women Attending ESUT Teaching Hospital Parklane)


Abstract


After implementing prevention of mother-to-child transmission of HIV (PMTCT) program in Nigeria, there are significant improvements especially in terms of service provision. Most of health facilities are providing PMTCT services are providing PMTCT services. However there are some challenges that prevent maximum utilization of PMTCT services by HIV positive pregnant women and postnatal mothers. The aim of this study was to determine utilization of PMTCT services among HIV positive women at ESUT teaching hospital Parklane. A cross sectional study was conducted among 126 HIV positive women who were attending antenatal clinic and postnatal clinic at ESUT teaching hospital Parklane. Participants were recruited to participate in the study after obtaining their consent. The data on which this thesis is based was generated from structured interviews. The interviews focused on socio-demographic characteristics, retention of PMTCT clients into care, level of PMTCT knowledge, social support HIV positive women receive from different groups of people and women‟s satisfaction with the services.

Most of the participants had high knowledge about PMTCT services. About 87.3% knew that HIV positive women can infect her baby during pregnancy, delivery or breastfeeding. Almost all all participants (99.2%) knew that exclusive breastfeeding (EBF) is one of the ways to prevent their babies from being infected with HIV.

Many of the participants admitted to have received social support from health care workers (99.2%), husbands/partners (93.7%) and PLHIV within the health facility (67.5%). This motivated them to effectively utilize PMTCT services.
Women also reported that they were satisfied with the PMTCT services provided especially counseling on ARV use as well as counseling on disclosure of HIV status to the husbands/partners. Among 63 participants who were very satisfied with counseling on disclosure which was provided by health care workers, 63.2% had higher knowledge about PMTCT.


Table of Content


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

Chapter One:

Introduction

  • 1.1 Background of the Study
  • 1.2 Statement of the Problem
  • 1.3 Objective of the Study
  • 1.4 Research Questions
  • 1.5 Research Hypothesis
  • 1.6 Significance of the Study
  • 1.7 Scope of the Study
  • 1.8 Limitation of the Study
  • 1.9 Definition of Terms
  • 1.10 Organisations of the Study

Chapter Two:

Review of Literature

  • 2.1 Conceptual Framework
  • 2.2 Theoretical Framework
  • 2.3 Empirical Review

Chapter Three:

Research Methodology

  • 3.1 Research Design
  • 3.2 Population of the Study
  • 3.3 Sample Size Determination
  • 3.4 Sample Size Selection Technique and Procedure
  • 3.5 Research Instrument and Administration
  • 3.6 Method of Data Collection
  • 3.7 Method of Data Analysis
  • 3.8 Validity of the Study
  • 3.9 Reliability of the Study
  • 3.10 Ethical Consideration

Chapter Four:

Data Presentation and Analysis

  • 4.1 Data Presentation
  • 4.2 Analysis of Data
  • 4.3 Answering Research Questions
  • 4.4 Test of Hypotheses

Chapter Five:

Summary, Conclusion and Recommendation

  • 5.1 Summary
  • 5.2 Conclusion
  • 5.3 Recommendation
  • References
  • APPENDIX
  • QUESTIONNAIRE

Chapter One


Introductions

1.1 Background to the Study

Mother-to-child transmission (MTCT) is by far the largest source of HIV infection in children below the age of 15 years. An estimated 200 million women around the world become pregnant each year, of which about 2.5 million are HIV-positive (UNAIDS, 2002:5f.). At least half a million infants and children have already died from AIDS, undermining child survival gains made in earlier years through comprehensive child health programmes (UNICEF, 2003:8). Based on annual antenatal surveil- lance, approximately 34.5% of pregnant women be- tween 25 and 29 years were HIV-positive, and about 29.5% of pregnant women aged 30 to 34 were living with the virus in South Africa in 2001.

Prevention of mother to child transmission of HIV (PMTCT) is an intervention to prevent transmission of HIV from a mother living with HIV to her infant during pregnancy, labor and breast feeding (WHO, 2012). Prevention of mother to child transmission of HIV (PMTCT) starts when a mother goes to the clinic for her first antenatal visit, she is offered routine HIV counseling and voluntary testing. If the mother takes the test and is found to be HIV positive, she will have the chance to join the PMTCT program free of charge. All HIV positive pregnant or postnatal women are supposed to start ARV treatment which will reduce the risk of HIV transmission to the baby and protect the mother’s health during and after pregnancy (WHO, 2013).

Prevention of mother to child transmission of HIV program in Tanzania (PMTCT) was first established in 2000. The main focuses of PMTCT program are pregnant women and those of reproductive age as well as their sexual partners, children, families and communities. The PMTCT program aims to prevent HIV infection in children, giving babies the chance to be HIV free and provide women and their families with access to HIV prevention, testing, care, treatment and support. The global 2015 PMTCT targets are: to reduce overall mother to child transmission of HIV to less than 5%; 90% of mothers receive prenatal ARV; 90% of breast feeding infant-mother receive ARV (WHO, 2010)

There have been remarkable efforts and successes in the Prevention of Mother-to Child Transmission of HIV (PMTCT) strategies and programs in Tanzania. The number of health facilities providing PMTCT services increased from 1311 (28%) in 2007 to 4603 – 99% (out of 4647) in December 2011 (MOHSW, 2012).

Most of the people in Nigeria have knowledge of PMTCT. The country’s HIV/AIDS and Malaria Indicator Survey (2011/2012) results shows that 64% of women and 55% of men know that HIV can be transmitted by breastfeeding and the risk of MTCT can be reduced by the mother taking special drugs during pregnancy.

HIV positive pregnant mothers and postnatal mothers require not only access to quality ANC services, safe delivery and breastfeeding but also mothers must be able to access and utilize all the services and be retained in care from the beginning to the end. In order to have effective PMTCT programs there are a number of factors that can influence maximum utilization of PMTCT services. These include individual factors such as adequate PMTCT knowledge among HIV positive women and their partners, ability to disclose HIV status especially to male partners and partner‟s involvement (UNAIDS, 2000). There are also health systems factors such as appropriate counseling, appropriate follow up of PMTCT clients, adequate number of RCH staff. Finally there are Socio-cultural factors like stigma and discrimination related to HIV within families and community, and availability of community support for PLWHA (Gulaid and Kiragu, 2010)

In reality some women do not follow different stages that a woman must progress through to complete a PMTCT program i.e. offered counseling and testing during antenatal visits; Provision of ARVs prophylaxis (currently option B+); counseling for safer infant feeding options, pediatric care for exposed children; mother-child follow up and linkage to care and treatment clinics (CTC).


1.2 Statement of the Problem

Nigeria has made a good progress especially on scaling up PMTCT sites from 1311 in 2007 to 4603 in December 2011 – (MOHSW, 2012). With the availability of PMTCT services there are individual factors, health system and socio-cultural factors that influence utilization of such services by women. Pregnancy is a very short time period, and the diagnosis of HIV often comes as a total shock. Most of pregnant women usually go to health facility so as to start antenatal clinic for making follow up of their pregnancy, but few if any, plan to take an HIV test. When a woman is diagnosed as HIV positive, she develops fear of disclosing such an HIV status to her partner, infecting her new borne as well as fear of stigma and discrimination from family and the community. In that stressful period, a woman is expected to make crucial decisions and retain a large amount of health information and make decisions that have far reaching consequences on her health, the health of her baby and family.

There is a wide gap between a woman‟s willingness to prevent her new born from HIV infection and actual utilization of available PMTCT services. A study which was conducted by Elizabeth Glaser Pediatric AIDS Foundation (EGPAF 2010) showed that about one- third of HIV positive woman in low and middle income countries utilize prevention of mother to child transmission of HIV (PMTCT) services. According to the DMO of Kibaha urban district the utilization of PMTCT services was only 55% of women who were diagnosed with HIV. Why was this so? How can these women be motivated to utilize the available PMTCT services? Is it adequate information about PMTCT, or social support from different sources or the extent of satisfaction with the services provided by health care workers? It was for that reason this study was conducted.


1.3 Objective of the Study

The broad objective of this study is to determine the knowledge and attitude of pregnant women towards the utilization of mother to child transmission services:a case study of pregnant women attending ESUT teaching hospital Parklane.

Specifically, the study aims:

  1. To determine the level knowledge of PMTCT among HIV positive pregnant mothers and postnatal mothers at ESUT teaching hospital Parklane.
  2. To determine the retention of HIV positive pregnant women and postnatal mothers into PMTCT care for 12 months after enrolment.
  3. To identify sources of support for HIV positive women attending PMTCT services at ESUT teaching hospital Parklane.
  4. To determine the extent to which HIV positive women are satisfied with PMTCT services at ESUT teaching hospital Parklane

1.4 Research Questions

  1. What is the participants‟ knowledge about PMTCT at ESUT teaching hospital Parklane
  2. What are the retention rates of PMTCT clients from enrolment up to 12 months after enrollment at PMTCT clinic at ESUT teaching hospital Parklane.
  3. What type of support and from whom do PMTCT clients at ESUT teaching hospital Parklane receive.
  4. To what extent HIV positive women are satisfied with the provided PMTCT services at ESUT teaching hospital Parklane.

1.5 Hypothesis of the Study

  • Ho: The knowledge of basic PMTCT information is not based on the demographic distribution of the pregnant women attending ESUT teaching hospital Parklane
  • Hi: The knowledge of basic PMTCT information is based on the demographic distribution of the pregnant women attending ESUT teaching hospital Parklane

1.6 Significance of the Study

It is crucial that factors influencing the utilisation of PMTCT services in a resource poor setting should be studied. This is particularly important in the context of Nigeria where health resources are unevenly dis- tributed between rural and urban areas, including distribution of health providers. Certain health institutions in the rural areas still lack basic resources for provision of good health care.

In Nigeria an evaluation of PMTCT in pilot sites found that it is feasible to implement PMTCT but that there are also numerous operational challenges for es- tablishing and expanding a PMTCT programme under routine health service conditions.

In some part this is due to supply side issues such as overburdened staff. But in a major part, there is a lack of demand for women to accept all the services that make up PMTCT programmes. The medical recommendations made in PMTCT programmes are often difficult for women to implement as they are overshadowed by community norms, values and beliefs. Women’s decision to participate fully in a PMTCT programme is influenced by the opinions of their partners, as well as other family and community members. Also, this decision is influenced by women’s perceptions and fear of possible negative reactions by others. Partners, parents, in-laws, and other relatives have varying degrees of influence about testing, disclosure and drug treatment, and often have significant authority over infant feeding. And if women are able to decide on their own to adhere to all of the recommended practices, they are going against social norms. A clear example is the issue of infant feeding, in which neither one of the recommended behaviours for HIV positive women – breast milk substitutes or exclusive breastfeeding and then early weaning are normative practices. It has therefore been dif- ficult to reach most pregnant women with the full pack- age of PMTCT interventions (Rutenberg, Baek, Kalibala & Rosen, 2003:3).


1.7 Scope of the Study

This study will Hiv positive pregnant women attending Anta-Natal after delivery at ESUT teaching hospital Parklane.


1.8 Limitation of the Study

This work was carefully researched, but due to financial problem and power failure, the work could not go the way I planed. This work will serve as a basis for those that will carry out further research

Financial Constraints:

Financial constraints tend to impede the students ability to get all the materials needed for the study but with the materials available the researcher was able to get meaningful information concerning the research topic above

Time Constraints:

The researcher being a student will be involved with departmental activities like seminar presentation and attendance to class, but the researcher was able to meet up with the time allocated for the completion of the research work.


1.9 Definition of Terms

Transmission:

The action or process of transmitting something, or the state of being transmitted.

HIV:

HIV (human immuno deficiency virus) is a virus that attacks cells that help the body fight infection, making a person more vulnerable to other infections and diseases.

Child Health:

Child health is a state of physical, mental, intellectual, social and emotional well-being and not merely the absence of disease or infirmity.

Maternal:

This refers to a mother, especially during pregnancy or shortly after child birth.


1.10 Organization of the Study

This research work is organized in five chapters, for easy understanding, as follows.

  • Chapter one is concern with the introduction, which consist of the (overview, of the study), historical background, statement of problem, objectives of the study, research hypotheses, significance of the study, scope and limitation of the study, definition of terms and historical background of the study.
  • Chapter two highlights the theoretical framework on which the study is based, thus the review of related literature.
  • Chapter three deals on the research design and methodology adopted in the study.
  • Chapter four concentrate on the data collection and analysis and presentation of finding.
  • Chapter five gives summary, conclusion, and recommendations made of the study.

Chapter Five


Summary, Conclusion and Recommendations

5.1 Summary

It was observed that there was a strong commitment from health care workers who were providing various PMTCT services to HIV positive pregnant and postnatal women who went for care at ESUT teaching hospital Parklane. PMTCT knowledge was observed to be a contributing factor for utilization of the services by study participants.

Husbands/partners support their wives to utilize PMTCT services but they were not participated in the services. From this study, it was observed that all women who were attending PMTCT clinic at ESUT teaching hospital Parklane had a fairly high level of knowledge about PMTCT which is very important factor for women to access and utilize the services. The main source of PMTCT information for the study participants were health care workers. The finding suggests that frequency use of PMTCT services leads to high level of knowledge about PMTCT not only to the participants but also to their families and community. As a result many women will be informed about PMTCT which will lead to the increase of number of women who utilize the services. Similar results have been reported by Komunami et al (2007), that spreading information on HIV especially mother to child transmission – MTCT are significant factors of HIV test acceptance among women which is the entry point of PMTCT services.

Interestingly the level of PMTCT knowledge was negatively related to the level of education of the study participants. This finding may suggest that PMTCT clients with high level of education do not want to mix together with other clients during health education sessions at the PMTCT clinic. These women developed relationships with some of health care workers who assisted them to get ARV whenever they came at the hospital. It is possible this was among the reasons these women missed an opportunities to learn about important PMTCT information which are provided during health education sessions.

Results of this study show that out of 176 women who were enrolled into PMTCT services, only 71.6% were retained after twelve months. Out of 83 Pre-ART clients 63.9% were retained after 12 months and out of 93 ART clients 78.5% were retained after 12 months. This finding shows that PMTCT clients who are using ARV are more likely to retain into services that those who have not started to use ARV. The finding may suggests that early initiation of ARV to HIV positive women at PMTCT is not only efficiency in preventing mother to child transmission of HIV but also an important factor to retain women into PMTCT services. Same results were reported by Toit et al (2011) that many clients on ART (94%) were retained in ART services compared to less than half (43%) of those who on Pre-ART.

The study participants mainly received support from Health care workers, partners and fellow PLHIV at the hospital. This indicates that these three groups of people are very important to support women to utilize PMTCT services. Partners seem to be very supportive although they do not want to attend clinic with their wives/partners. There is a need to develop strategies which can effectively involve them in PMTCT program in order to have good results. A study which was conducted by Carter (2002) suggests that active involvement of male partners in PMTCT services is crucial to the effectiveness of programs.

PLHIV/Peers at the health facility are important to encourage women to utilize PMTCT services. Findings from this study showed that 66% of women receive support from their fellow PLHIV. This is probably due to that fact that women feel free to discuss about HIV issues with their fellow PLHIV whom they share the same experience. They tend to believe in PMTCT services through testimonies provided by PLHIV who have graduated from PMTCT and who have benefited from the services. The same was reported by Annelie te al (2011) that peer educators are recognized for being close to clients, they provide clients with an opportunity to individually talk to someone who was also living with HIV, who had a positive attitude about their situation and are willing to share personal stories of hope when educating and counseling clients.

Another finding showed that many participants were satisfied with provided PMTCT services. Participants with higher knowledge were very satisfied with PMTCT services provide by health care workers. This finding suggests that satisfaction with the services is determined by women‟s knowledge of PMTCT services. The higher level of PMTCT knowledge among clients leads to their satisfaction with the PMTCT services and hence increases utilization of services. Similar resulta were reported by Kalembo et al (2012) that the knowledge level of HIV positive women on ART and PMTCT are important factors in adherence to ART.


5.2 Conclusion

Basing on the results made from this study the following conclusion can be made. Knowledge about PMTCT was relatively high among the study participants and the main source was the health care workers. Most of the participants knew about exclusive breast feeding for an HIV exposed infant.

Retention of women into PMTCT services was 76.1% and the remaining were either transferred out, dead or defaulters. Women who were using ARV were more likely to retain in PMTCT services (78.5%) compared to women who had not yet started to use ARV (63.9%). Study participants received support mainly from health care workers, husbands/partners and their fellow PLHIV in the hospital. Very few women receive support from relatives, neighbors and friends.
Most participants were satisfied with the PMTCT services provided by health care workers. Most of them were very satisfied with the way counseling on ARV use and disclosure of HIV status to partners was provided.


5.3 Recommendation

  1. Since the knowledge of PMTCT was relatively high among the study participants, which was related to the effective utilization of PMTCT services, there is a need to educate all women of childbearing age about PMTCT so as to reduce the risk of HIV transmission from mother to child.
  2. As retention into PMTCT services was observed to be higher among those women who were using ARV that those who were not using ARV, there should be strategies for ensuring that all pregnant women be initiated on ARV as soon as they are diagnosed as HIV infected.
  3. From the study it was observed that husbands/partners were very supportive to their wives who are HIV positive. Health care worker should put strategies to involve them in PMTCT program so as to increase utilization of services by HIV positive pregnant and postnatal women.
  4. Participants mentioned that good assistance from HCWs and availability of PMTCT services as main factors influencing them to come for the services. Therefore there should be strategies to ensure that health care workers are equipped with the up to date information and PMTCT commodities should be available at the hospital.

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