Treatment Seeking Behavior On HIV Among Pregnant Women Attending Antenatal Clinic In Turaki A Ward, Jalingo Taraba State

Treatment Seeking Behavior On HIV Among Pregnant Women Attending Antenatal Clinic In Turaki A Ward, Jalingo Taraba State

Abstract

The main aim of this study was to assess treatment seeking behavior on HIV among pregnant women attending antenatal clinic in Turaki A Ward, Jalingo Taraba State. This is a descriptive study which targeted pregnant mothers attending antenatal care at the clinic. One hundred and thirty (130) respondents were selected using simple random sampling technique. The research instrument was a questionnaire which consisted of two broad sections that addressed the research questions and objectives. The data was analysed using descriptive statistical method of mean, frequency and simple percentages for the research questions. The study concluded that the health sector needs to increase efforts to improve early and consistent ANC attendance by all pregnant women, with a particular emphasis on HIV-infected women. A comprehensive plan is critical for reduction of maternal mortality and increased effectiveness of PMTCT interventions for HIV-positive pregnant and breastfeeding women. Also, efforts are needed to improve the health-seeking behaviour of pregnant women living with HIV/AIDS at the clinic and the health services offered.It was recommended that there is a need for information, education and communication strategies promoting maternal health seeking behaviours should to be enhanced both at the health facility and community level.

Table of Content

Preliminary Page(s)

• Title Page
• Declaration
• Approval
• Dedication
• Acknowledgement
• Abstract
• Table of Content

Chapter One

1.0 Introduction

• 1.1 Background to the Study
• 1.2 Statement of Problem
• 1.3 Objectives of the Study
• 1.4 Research Questions
• 1.5 Research Hypothesis
• 1.6 Significance of the Study
• 1.7 Definition of Terms
• 1.8 Organization of Study

Chapter Two

2.0 Literature Review

• 2.1 Conceptual Review
• 2.2 Concept of Maternal Health Care Seeking Behaviours
• 2.3 Concept of Pregnancy Outcome
• 2.4 Role of ANC in Treatment Seeking Behavour Among HIV Pregnant Women
• 2.5 Theoretical Review

Chapter Three

3.0 Methodology

• 3.1 Research Design
• 3.2 Research Setting
• 3.3 Target Population
• 3.4 Sampling
• 3.5 Instruments for Data Collection
• 3.6 Validity of Instrument
• 3.7 Reliability of Instrument
• 3.8 Method of Data Collection
• 3.9 Method of Data Analysis

Chapter Four

4.0 Results and Discussion

• 4.1 Results
• 4.2 Discussion

Chapter Five

5.0 Summary, Conclusion and Recommendation

• 5.1 Summary
• 5.2 Conclusion
• 5.3 Recommendations
• References
• Appendix

Chapter One

1.0 Introduction

1.1 Background to the Study

A woman’s health care seeking behavior during pregnancy depends a great deal on her beliefs, culture, experience, educational level, financial status, attitude towards pregnancy, as well as her autonomy and decision-making power. Adele (2015) suggests issues of importance to include information about pregnancy the woman’s family communicated to her as a child and whether the pregnancy was planned or unplanned. Garba, Hellandendu, and Ajayi (2016) further explained that long before the advent of modern scientific medicine, most cultures have among their patterns of life, a body of beliefs and practices that centre on the recognition and treatment of complications of pregnancy and conduct of deliveries. Thus, an understanding of appropriate health care seeking behavior is very important in achieving the desired pregnancy outcome. Negative behavior is highly implicated in increased morbidity and mortality of mother and baby.

Osubor, Fatusi, and Chiwuzie (2016), suggests Maternal Health Care Seeking Behavior (MHCSB) to include the number of visits made to antenatal clinic (ANC) by pregnant women and their preference for place of delivery, and recently the prevalence and management of HIV in pregnancy. Jain, Nandan and Misra (2016) defined health seeking behavior as “a complex outcome of many factors operating at individual, family and community levels including their biosocial profile, past experiences with health services, availability of alternative health care providers, and the people’s perception regarding the efficacy and quality of the services”. Adele (2015) explains health seeking behaviour to be those activities undertaken by individuals in response to any discomfort felt. He further stated that in the developed countries like United States of America (USA), most women visit ANC early in pregnancy, comply with prenatal directives and are attended to by skilled health care providers when in labour. He also suggests that in the developing countries, especially in the rural sub-Saharan Africa, most women consider pregnancy a natural process and the services of skilled health care providers deemed not necessary. Rastogi (2012) observed low utilization of ANC among rural women in India due to lack of means of transportation, also because the women were often shy when discussing their health problems before a male professional. Rastogi suggests that women who had formal education up to secondary school level sought health care from skilled providers.

A majority of pregnant women living with HIV in the world are from sub-Saharan Africa, and it is estimated that only 68% of them received antiretroviral therapy prophylaxis during pregnancy and delivery in 2013.[1] The challenges associated with effective prevention of motherto-child transmission of HIV (PMTCT) and measuring its impact are numerous and multi-factorial, despite the notable HIV care advancements in this region.[1, 2] UNAIDS has targeted zero new HIV infections by 2030 including eliminating new HIV infections among infants born to HIV-positive mothers, and promoting the health status of mothers.[1, 3] To achieve these goals, the current recommendation by the World Health Organization (WHO), is to routinely test and treat all pregnant women with HIV as part of antenatal care.[4] The aim is to realize universal access to focused antenatal healthcare as well as promote healthy neonatal and maternal outcomes.

Typically, the PMTCT cascade begins from, and is integrated into, antenatal care (ANC) to ensure a high rate of case detection and optimal treatment coverage.[5–7] Through this integration, pregnant women attending ANC are routinely tested for HIV and those testing HIVpositive are supposed to be immediately provided with PMTCT interventions including HIV treatment. Unfortunately only 58% of women in Kenya are estimated to attend the minimum recommended four antenatal care visits, and 40% attend their first ANC visit after 6 months gestation.[8, 9] Evidence shows that HIV-positive women receiving combination antiretroviral prophylaxis during pregnancy, delivery and breastfeeding can reduce mother-to-child transmission to less than 5%.[10] In addition to PMTCT services which target pregnant women and offer a provider-initiated approach to HIV testing, there are a number of other strategies that provide pregnant women with opportunities to know their HIV status, including home-based counseling and testing (HBCT). [11, 12]

While testing uptake and HIV prevalence among pregnant women at the facility level is well documented through routine Ministry of Health and donor reporting requirements, as well as ANC-based HIV surveillance studies, [13] population-based HIV prevalence among pregnant women remains poorly described, particularly in sub-Saharan Africa. Home-based counseling and testing (HBCT) has been shown to be effective in promoting universal testing coverage in the general population and can enhance timely enrolment of HIV-infected persons into care. [11, 12, 14]
Jayaraman, Chandrasekhar and Gebreselassie (2018), stated that most of the pregnant women deliver at home without skilled health care providers, while only a few receive up to three antenatal visits. Woldemicael (2018) suggests that due to lack of transportation some pregnant women may not utilize ANC and other delivery services by skilled care providers in health facilities and therefore seek help from diverse fields.

Adamu (2015) suggests that MHCSB is the way mothers take care of their health and the unborn child so that they will reach the end of pregnancy very healthy with positive outcome. Yubia (2015) opined that in Nigeria, maternal health care seeking behavior is similar to that of other developing countries where negative health seeking behaviors shown by most mothers often lead to poor use of maternal health care services provided by skilled health care attendants with eventual negative pregnancy outcome. Yubia further explained that poor treatment seeking behaviors predispose them to complications that could be properly managed if detected early during ANC. The number of women attending ANC in southern Nigeria is higher than in the north. NDHS (2018) suggests that the percentage of births attended to by skilled health care providers range from 81.8% in the South East (SE) to9.8% in the North West (NW). Similarly, 90.1% of women in the NW are more likely to give birth at home compared to 22.5% in the South West (SW). Adamu (2015) suggests that this high attendance is associated with educational and economic empowerment of more women in the southern than in the northern Nigeria. The number of visits to ANC is a key determinant of whether a woman giving birth seeks institutional care or care at home under a skilled health care provider as against delivery at home under unskilled birth attendant. Adamu (2015) stated that a woman who attends ANC is more likely to deliver in a health facility. Young mothers (below 35years) are also more likely to make decisions on seeking health care than older mothers (above 35years) and to have institutional delivery. On the other hand, older mothers especially multipara who have never had any complications in pregnancy believe that safe delivery is a natural process so may not seek health care under skilled health care providers. Yubia (2015) opined that such women rely on their experience and help from fellow older mothers for care and delivery.

Rastogi (2012) suggests that pregnant women do not develop much complication if a skilled health care provider regularly visits them at home. Babalola and Fatusi (2019) suggest that the majority of maternal deaths and disabilities can be prevented through early and timely access to and utilization of quality maternal health care services. WHO (2017) stated that complications of pregnancy and childbirth are leading causes of maternal morbidities and mortality for women of reproductive age (15 – 49 years) in developing countries. Nigeria accounts for 10% of global maternal deaths and has the second highest mortality rates in the world. It also reported that for every woman that dies from pregnancy – related causes, 20 – 30 more will develop short-and long-term damage to their reproductive organs resulting in disabilities such as obstetric fistula, inflammatory diseases, and ruptured uterus.

1.2 Statement of Problem

Yubia (2011) suggests that maternal deaths occur due to poverty, cultural beliefs and practices of the people, ignorance and lack of basic maternal health services. He further explained that the situation is worse in developing countries due to poor health seeking behavior of the mothers such as poor utilization of health services, ignorance and the people’s illness behavior. Statistics show that in Nigeria, only 58% of women attended at least one ANC during pregnancy, 39% of births were attended to by a skilled health care provider, 35% of deliveries took place in a health facility and 43.7% received postnatal care (NDHS, 2018). In Nigeria, it is a common practice for a pregnant woman to register in the antenatal clinic and at the same time register with a traditional birth attendant in the community where she may finally deliver her baby leading to complications like sepsis, post-partum hemorrhage or even the death of the mother, the child or both. According to WHO (2017) this situation is common in most rural communities in Nigeria, where most of the pregnant women report to health facilities only in extreme emergencies, and/or when illness becomes prolonged and life threatening. According to WHO (2014), the most often tracked indicator for assessing the achievement of the reduction of maternal mortality rate is the proportion of births attended to by skilled health care providers globally.

New maternal HIV infection among pregnant women contributes significantly to mother–to– child transmission of HIV (MTCT) [1–3]. In 2019, new maternal HIV infection during pregnancy was reported to be the second major cause of perinatal HIV transmission globally [4]. In 2011, new maternal HIV infection accounted for an estimated 26% of vertically transmitted early infant HIV infections in South Africa [5]. Pregnancy constitutes a period of elevated risk for HIV acquisition [6]. A study by Thomson et al. showed the per-act probability of HIV acquisition increased by 2.8 during pregnancy compared to during non-pregnancy period [6]. In a meta–analysis of studies conducted between 2014 and 2018, the pooled HIV incidence among pregnant women in sub–Saharan African and other countries was reported to be 2.1 per 100–person years [95% prediction interval(prediction interval is a type of confidence interval used for prediction analysis): 0.7–6.5] [7]. The risk of MTCT in incident infections is increased from high maternal viral load during the early phase of HIV infection [8, 9]. Initiation of ART as early as possible in the course of new HIV infection can reduce maternal viral load and the risk of MTCT in newly acquired maternal HIV infection [10]. For this reason, the latest South African HIV testing guideline recommends that all pregnant women who test negative at initial antenatal care (ANC) testing should be offered repeat testing every 3 months throughout pregnancy and breastfeeding in order to ensure timely identification and treatment of new maternal HIV infections [11, 12]. Thus, the need to examine the treatment seeking behavior on HIV among pregnant women attending antenatal clinic in TurakiA Ward, Jalingo Taraba State.

1.3 Objectives of the Study

The main purpose of this study is to assess treatment seeking behavior on HIV among pregnant women attending antenatal clinic in Turaki A Ward, Jalingo Taraba State. Specifically, the following objectives will guide the study;

1. To determine the factors associated with recent HIV infection among pregnant women attending antenatal clinic in TurakiA Ward
2. To ascertain the types of health facility used by pregnant women with HIV for health care
3. To ascertain the treatment seeking behavior on HIV among pregnant women attending antenatal clinic in Turaki A Ward

1.4 Research Questions

The following questions were formulated to guide the study based on the research objectives;

1. What are the factors associated with recent HIV infection among pregnant women attending antenatal clinic in Turaki A Ward?
2. What are the types of health facility used by pregnant women with HIV for health care?
3. What are the treatment seeking behaviors on HIV among pregnant women attending antenatal clinic in Turaki A Ward?

1.5 Research Hypothesis

HO1: There is no significant relationship between treatment seeking behavior on HIV and pregnancy outcome among pregnant women attending antenatal clinic in Turaki A Ward, Jalingo Taraba State

1.6 Significance of the Study

This study will be of great significance to the pregnant women, the health sector and the community. Findings from the study will generate empirical data on how pregnant women seek routine health care during pregnancy, whether they book for Antenatal care, their time of booking, where they book, where they go to seek care especially when faced with problems in pregnancy, where they prefer to deliver, their preferred healthcare provider, HIV management and treatment and their pregnancy outcome. These findings will serve as basis for empowering pregnant women among nurses, midwives, and other health workers with a view to improving maternal health and reducing maternal morbidity and mortality through improved maternal health care services utilization through evidence-based health education. Lastly, this study will contribute to the existing body of literature and serve as a reference for future research in related fields.

1.7 Definition of Terms

Treatment Seeking Behavior:

The active pursuit of treatment by a person who has a disorder or who wishes to improve his or her general mental or physical functioning.

HIV:

(Human Immunodeficiency Virus) is a virus that attacks the body’s immune system. If HIV is not treated, it can lead to AIDS (acquired immunodeficiency syndrome). Learning the basics about HIV can keep you healthy and prevent HIV transmission.

Pregnant Women:

In this study, refer to women pregnant with child between the first and their trimester who have also been diagnosed with HIV attending antenatal care in TurakiA Ward, Jalingo Taraba State.

1.8 Organization of Study

The study comprises of 5 chapters. In chapter one, the concepts are introduced and the problem of the study is established with the research objectives and questions. Chapter two presents the literature review while chapter three presents the research methodology. The fourth chapter presents the results and discussion, and the last chapter presents the conclusion and recommendation.

Chapter Five

5.0 Summary, Conclusion and Recommendation

5.1 Summary

The primary objective of the study was to assess treatment seeking behavior on HIV among pregnant women attending antenatal clinic in Turaki A Ward, Jalingo Taraba State. A descriptive survey research design and 130 pregnant women were used as respondents. A self-designed questionnaire was developed according to the objectives of the study to guide in the generation of information. Socio-demographic characteristics of the respondents and the research question were analyzed using simple frequency and percentage. The results of this study indicate that women who know they are HIV-positive are not different from women who know they are HIV-negative when it comes to use of maternal health services. This finding refutes the study hypothesis—that knowledge of HIV-positive status stimulates use of maternal health services—and may have serious implications for PMTCT programmes and the overall fight to prevent maternal deaths. Poor adherence to the focused antenatal protocol by HIV-infected pregnant women reduces the effectiveness of PMTCT interventions and increases the likelihood of HIV transmission to the baby. Poor adherence to HIV treatment during pregnancy may also increase the chances of developing HIV drug resistance in the future. Other studies have found less use of PMTCT services than antenatal care services among HIV-positive women Perhaps this is a clear indication of the overriding effect of other demographic and social factors, such as household income and urban-rural residence, commonly identified by other studies as determinants of use of maternal health services.

5.2 Conclusion

The health sector needs to increase efforts to improve early and consistent ANC attendance by all pregnant women, with a particular emphasis on HIV-infected women. A comprehensive plan is critical for reduction of maternal mortality and increased effectiveness of PMTCT interventions for HIV-positive pregnant and breastfeeding women. Also, efforts are needed to improve the health-seeking behaviour of pregnant women living with HIV/AIDS at the clinic and the health services offered.

5.3 Recommendations

The following recommendations were made based on the findings of the study;

1. First, mothers should be encouraged to fully utilize the maternal and child health care services provided by within the state across all levels.
2. Second, there is a need for enlightenment campaign to be carried out to create awareness and knowledge to the pregnant women on the dangers of avoiding treatment for HIV and other complications in pregnancy.
3. Lastly, information, education and communication strategies promoting treatment seeking behaviours should be enhanced both at the health facility and community level. This will provide adequate health information and ensure the execution of health literacy campaigns to improve health and pregnancy outcome amongst the women.

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