Factors Influencing Utilization of Prevention of Mother to Child Transmission (PMTCT) Services Among Pregnant Women Attending Ante-natal Clinic in University of Calabar Teaching Hospital (UCTH)
Chapter One
Objectives of the study
The specific objectives of the study are:
- To assess the level of knowledge about PMTCT services among pregnant women in UCTH.
- To determine the socio-economic factors influencing utilization of PMTCT services among pregnant women in UCTH.
- To ascertain the cultural/religion factors influencing utilization of PMTCT services among pregnant women in UCTH.
CHAPTER TWO
LITERATURE REVIEW
This chapter deals with the review of related literature. The review is divided into the following: theoretical, empirical and conceptual review.
Theoretically
Prevention of mother to child transmission of HIV
According to UNAIDS (2012), PMTCT begins with the non-pregnant woman. Preventing mother-to-child transmission is achievable. Between 2009 and 2011, 409,000 new infections were averted among children UNAIDS (2012).
The success of preventing HIV transmission from mothers to their children requires multiple interventions not only during pregnancy, labour and breastfeeding, but among all women and girls. Without adequate comprehensive intervention, about a third of HIV positive women will transmit the virus to their children during pregnancy, labour and delivery and through breastfeeding (WHO 2012). To control vertical transmission various interventions have been developed since the discovery of MTCT. Preventive interventions aimed at reducing MTCT largely focuses on prevention of intra-partum and post-partum transmission of HIV.
Current effective interventions aimed at reducing MTCT includes use of antiretroviral to decrease maternal viral load, elective caesarean section (aimed at reducing exposure to maternal secretions during vaginal delivery) and the avoidance of breastfeeding (de cook, 2004).
Use of anti –retroviral prophylaxis
In developing countries, the use of antiretroviral medications in combination with other medication or alone lowers the risk of MTCT. There was a major breakthrough in prevention of vertical transmission of HIV in 1994 by the Paediatric AIDS clinical Trial Group. The breakthrough demonstrated Zidovudine monotherapy reduces the risk of MTCT in non-breastfeeding population (Connor, 2004). Zidovudine monotherapy is administered in the second and third trimesters of pregnancy and intravenously during delivery while given to infants at 6 weeks after birth. Also, combined therapy with two or more antiretroviral drugs is assumed to be effective in reduction of the risk of perinatal transmission than monotherapy. There is also the use of Highly active anti-retroviral therapy.
Option B+ is the latest treatment option recommended by the WHO or PMTCT (WHO, 2012). Unlike other treatment options, Option B+ recommends that all HIV positive pregnant women are placed onto a triple antiretroviral regimen for PMTCT, irrespective of their CD4 count and continuing for life. Option B+ reduces the risk of MTCT of HIV and all future pregnancies.
Modification of Obstetrical practices
Several obstetrical measures to prevent mother to child transmission should be implemented when possible.
The risk of MTCT of HIV will be increased following increase in maternal-to-foetal vaginal secretion exposure and maternal-to-foetal blood exposure.
Time of rupture of membranes should also be shortened following vaginal delivery;and progress of labour should be measured using the partograph to prevent prolonged labour which increases the risk of MTCT.
Avoiding instrumentations
Standard operating procedures during vaginal delivery for PMTCT should be adhered to such as avoidance of instrumentation e.g. forceps delivery, vacuum delivery, and episiotomies should be avoided.
Caesarean delivery
The secretions and fluids excreted in the birth canal during labour are known to infect the foetus as it passes through the birth canal. Delivery by elective caesarean section is efficacious in reducing mother to child transmission of HIV. Gray (2004) asserted that elective caesarean is a cost-effective intervention for the prevention of vertical transmission of HIV when safely available. In a wide range of circumstances even with the risk of 1% in vaginal deliveries, this is achievable with highly active antiretroviral therapy (Mrus 2011). However, incidence rates of postpartum morbidity after caesarean section delivery in women with advanced AIDS are higher than with vaginal delivery. Scheduled caesarean delivery is recommended at 38weeks for women with viral load of more than 1000 copies/mL (receiving ARV or not) and for women with unknown HIV viral load .
CHAPTER THREE
METHODOLOGY
This chapter deals with the method employed to carry out this study. The chapter was organized under the following heading; research design, research setting, target population, sampling techniques, instrument for data collection, validity and reliability of instrument, method of data collection, method of data analysis and ethical consideration.
Research design
The research design adopted for this study was the descriptive survey design used to determine factors influencing utilization of PMTCT services by pregnant women attending ante-natal clinic in UCTH from January to May
Research setting
The setting of this study is the University of Calabar Teaching Hospital. It was founded in the year 1979. It is a Teaching institution located at the south eastern part of Calabar. It was formally St Margeret hospital in Calabar south but moved to its permanent site on February, 2012. It has the responsibility of manpower development (teaching), treatment of patients at specialist level (clinical services) and promotion of scientific knowledge (research). The hospital is headed by the chief medical director. It’s made up of medical doctors, Nurses, pharmacist, medical laboratory scientist, radiographers and medical records department. The new site otherwise called the permanent site is quite a complex structure comprising different units such as the personnel and SERVICOM (where patients report any complaints they have), casualty unit, antenatal clinic, children outpatient department, children emergency department, eye clinic, ear, nose and throat (ENT) clinic, dental clinic, eye ward, department of family health, pharmacy and Nursing administration unit. It is situated behind the college of medical sciences, university of Calabar.
In antenatal clinic, there are 42 nurses, 15 ward assistants, 7 record rooms, 7 consulting rooms, 7 emergency rooms, 5 treatment rooms, 2 nurses room and 10 couches. They operate only morning duties and observe public holidays. The researcher chose this site because of her site of clinical experience.
Research population
Target population
The target population of this study included 896 pregnant women who attended antenatal clinic in UCTH, Calabar from January to May 2014.
Accessible population
The accessible population included 153 pregnant women who are HIV positive and attended antenatal from March to May, 2014.
CHAPTER FOUR
DATA ANALYSIS AND RESULTS
This chapter deals with data analysis and presentation of results. The results are presented under the following sub-headings: socio-demographic variable research questions and research hypothesis.
CHAPTER FIVE
DISCUSSION OF FINDING
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.
Discussion of Findings
The knowledge of pregnant women in UCTH about prevention and control of HIV/AIDS.
CHAPTER SIX
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.
Recommendations
Based on the findings of the study, the researcher recommends that:
- There is need for the involvement of the stakeholders in bridging the gap between knowledge and utilization of PMTCT services among women.
- A revised health education programme for pregnant women living with HIV should be implemented to enlighten women on the need to utilize PMTCT services.
- Health personnel should always encourage women living with HIV to utilize PMTCT services to prevent mother to child transmission of the virus.
- 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.
- The government should provide PMTCTcentres 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.
- 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.
- Infant feeding counseling needs to be improved and access to portable water for formular feeding should be made available.
REFERENCES
- Adeneye, A.K, (2007). Willingness to seek HIV testigs counselling among pregnant women attending ANC in Ogun state, Nigeria, MEDLINE Journals 26 (4), pp. 337-353.
- Bajunirwe, F. and Muzoora, M. (2005). Barriers to the implementation of programs for prevention of mother to child transmission of HIV: a cross sectional survey in rural & urban Uganda, AIDs Research and Therapy, 2, p. 1-10.
- Busza J, Walker D, Hairston A, Sim Y. R and Mpofu D (2012). community-based approaches for prevetion of mother to child transmission in resource poor settings a social ecological review: journal of International AIDS society 15 (2) 1737
- Christian Aid (2008). Stigma and support for people living with HIV in Khartoum: A christain Aid report. Khartoum: Christain Aid.
- Connor E.M (2004). Reduction of maternal infant transmission of human immune deficiency virus type 1with Zidovudine treatment. New England Journal of medicine, 331: 1173-1180.
- Danforth, B., Eardley, c., Grisewold T, and Litma, Y (2009). Household decision making about delivery I health facilities: Evidence from Tanzania. Journal of health population Nutri. 27 (5). 696-703 Tanzania: J H publishers]
- De cook, (2009). Prevention of mother to child transmission of HIV transmission in resource poor countries.-translating research into policy and practice JAMA, 283: 1175 – 1182
- Falnes, E. F. (2010) Mothers’ knowledge and utilization of the prevention of the mother to child transmission services in North Tanzania, Journal of International AIDs Society, doi:10.1186/1758- 2652 , pp. 13-36.
- Federal Ministry of Health Nigeria (2010). National guidelines for prevention of mother to child transmission of HIV (PMTCT), 4th ed. Abuja.
- Gray, G (2004). The PETRA study: early and late efficacy of the three short ZDV (3TC) combination regimens to prevent MTCT of HIV 1. XIII International AIDS conference, Durban S.A 9-14 July.
- Kadowa, I and Nuawaha, F. (2009). Factors influencing disclosure HIV positive status in Mityana district of Uganda, African Health science, 9. (1), pp. 26-33.
