Cultural Beliefs and Gender Dynamics of Pmtct Services Among Pregnant Woman

Cultural Beliefs and Gender Dynamics of Pmtct Services Among Pregnant Woman

CHAPTER ONE

OBJECTIVES

The objective of this study was to examine the cultural beliefs and gender dynamics of pmtct  services among pregnant woman in University of Calabar teaching hospital(UCTH). Specifically, the study sought to determine the:

• To evaluate the availability of PMTCT services in University of Calabar teaching hospital(UCTH).
• To evaluate the availability of qualified PMTCT service providers in UCTH
• To evaluate the availability of materials for PMTCT services in UCTH
• To evaluate the adequacy of qualified PMTCT service providers in UCTH
• evaluate the adequacy of PMTCT materials in Umuahia hospitals
• evaluate the level of utilization of these PMTCT services (VC, HIV testing, ART, CS and safer infant feeding counseling) in UCTH
• To evaluate the factors that influence the utilization of PMTCT services in UCTH.

CHAPTER TWO

REVIEW OF RELATED LITERATURE

It appears there is dearth of literature on evaluation of prevention of mother to child transmission of HIV and AIDS services in hospitals especially as it pertains Nigeria. Reviewed literature relevant to the present study is presented under the following sub-headings:

1.  conceptual framework;

international initiatives to PMTCT of HIV;

factors affecting PMTCT of HIV and AIDS services;

2. theory and evaluation models;
3. empirical studies on PMTCT of HIV and AID services and,
4. summary of literature review.

CONCEPTUAL FRAMEWORK

The term evaluation is a broad one, though there have been attempts by many authors to define it. Evaluation according to Lassel (1974) is the process of determining whether a product met its quality assurance (QAR). Beeby (1977) defined evaluation as the systematic collection and interpretation of evidence leading as part of the process to a judgment of value with a view to action. According to Beane, Toeffer and Alessi (1986), evaluation is that process in which we decide how well we are doing whatever it is we are trying to do. Sarre (1991) defined evaluation as the assessment of the effectiveness of programmes that were designed as tentative solution to existing problems. From the definitions advanced by the authors above, it could be observed that evaluation involves taking intelligent decision or passing judgment. Stufflebeam (2002) is of the view that evaluation is a process of delineating, obtaining and providing useful information for judging decisions alternatives.

Various types of evaluation according to Windsor and Thomas (1984) include: formative evaluation – an evaluation that produces information used during the developmental stages of a health education programme, to improve it. A common procedure in a formative evaluation is conducting a pilot study, using alternative methods of assessing the immediate or short-term cognitive, affective, or psychomotor (skill) effects of elements of the programme. Process evaluation- an evaluation that provides documentation on what is going on in a programme and confirms the existence and availability of physical and structural elements (such as facilities, staff, space, or services, are being provided or being established according to the given programme plan) of the programme. Process evaluation might be referred to as a quality assurance review or study. Summative evaluation- an evaluation that provides a summary statement of a health promotion programme’s effectiveness over a specified period of time. It enables decision makers to plan and allocate resources. programme impact evaluation –an evaluation that assesses the overall effectiveness of a programme in producing favourable cognitive, belief, and behavioural effects in the target population. It measures the relative effectiveness of different types of programmes in meeting selected objectives.

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CHAPTER THREE

RESEARCH   METHODOLOGY

This chapter presents description of the research design, population, sample and sampling techniques, instrument for data collection, method of data collection and method of data analysis which will be used for the present study.

RESEARCH DESIGN

In order to accomplish the objectives of this study, the cross sectional survey research design was adopted. Cross sectional survey research, according to Levin (2006), when simply put, provides a snap shot of a situation in a population, and the characteristics associated with it at a specific point in time. This is in line with the observation of Thomas and Nelson (1990) that the purpose of survey is to reveal current state of a condition and to show the need for change.

The cross sectional survey research design was considered appropriate for the present study, because it was successfully used by Bajunirwe and Muzoora (2005) to examine the barriers to the implementation of programmes for the PMTCT of HIV in rural and urban Uganda. The design was also successfully used by Karamagi et al (2006) to study antenatal HIV testing in rural eastern Uganda in 2003: incomplete rollout of the PMTCT of HIV programme. The researcher therefore, adopted it.

POPULATION FOR THE STUDY

The population for the study comprised all the PMTCT service providers in UCTH. HIV positive pregnant women who registered for PMTCT at FMC, UCTH also comprised the population of the study. The total population was estimated at 22 PMTCT Doctors  and 102 HIV positive pregnant women (Hospital Records, FMC Umuahia, 2008).

CHAPTER FOUR

RESULTS AND DISCUSSIONS

This chapter presents and discusses the results of the study in line with the seven research questions and three null hypotheses that guided the study. Incorporated into the discussions were the findings from the focus group discussion with PMTCT service providers.

Results

Research question 1.

What PMTCT services are available in University of Calabar teaching hospital? Data answering this question are contained in Table 1 below.

CHAPTER FIVE

SUMMARY, CONCLUSIONS AND RECOMMENDATIONS

Summary

The purpose of the present study was to evaluate the cultural beliefs and gender dynamics of pmtct  services among pregnant woman. The factors evaluated against the utilization of the services were educational level, location and age of HIV positive pregnant women. To achieve the purpose of the study, seven research questions were formulated and three null hypotheses were postulated.

The study adopted a cross sectional survey research design. It covered the only PMTCT site (FMC UCTH) and 5 private hospitals providing VC. All the HIV positive pregnant women that attended ANC at the period of study (for 4 weeks) were used. All the 14 PMTCT service providers in FMC UCTH and the 8 PMTCT trained staff in 5 private hospitals were also used as respondents. Data collected was both quantitative and qualitative. Fifty eight HIV positive pregnant women who attended ANC at the period of study responded to the questionnaire for HIV positive pregnant women (QHPPW) while 22 PMTCT service providers responded to the questionnaire for PMTCT service providers (QPSPs). Seven PMTCT service providers were also the participants of the focus group discussion.

For the purpose of reaching a valid conclusion, data from the 58 respondents who completed the QHPPH and 22 respondents who completed the QPSPs were analyzed quantitatively. Frequency distribution and percentages were used to answer research questions one and eleven, while mean and standard deviation were used to answer research questions two to ten. T-test and ANOVA statistics were used to verify the four null hypotheses formulated at 05 level of significance. Data generated from the FGD with PMTCT service providers were used to back up the discussion of findings. The major findings of the study were as follows:

1. Majority of the respondents indicated that the following PMTCT of HIV and AIDS services were available in the government hospital: voluntary counseling (100%); HIV testing (72.7%); antiretroviral therapy (63.6%); caesarean section (63.6%) and safer infant feeding counseling (72.7%). (See Table 1).
2. Majority of the qualified PMTCT service providers had calculated mean which were above the criterion mean of 2.50: Doctors ( x=3.55>2.50, SD=.735) and nurses ( x = 3.00>2.50, SD=1.309) were highly available. Midwives ( x =2.77>2.50, SD=1.412), counselors ( x = 2.55>2.50, SD=1.471), lab technicians ( x =2.88>2.50, SD=1.356), pharmacists ( x = 2.59>2.50,  SD=1.403)  and  programme  manager  ( x =2.59>2.50,  SD=1.501)  were moderately available. Social workers ( x =1.55<2.50, SD=.912) and health educators ( x = 1.59 < 2.50, SD=1.141) were not available as their means fell below the criterion mean of 2.50. (See Table 2).

3. HIV test kit ( x= 3. 09 > 2.50, SD=1.342) and reagents ( x = 3.05 >2.50, SD=1.327) were highly available. Other materials such as microscopes ( x = 2.91, SD=1.377), drugs ( x = 2.86, SD=1.457), CD4 count machine ( x = 2.73, SD=1.386), incubators ( x = 2.73, SD=1.386), power supply plant ( x = 2.73, SD=1.386) and centrifuges ( x = 2.59, SD=1.403) were moderately available except spectrophotometer ( x = 1.55, SD=1.057) and washers ( x = 1.55, SD=.963) that were not available as their means fell below the criterion mean of 2.50. (See Table 3).

4. Doctors were highly adequate ( x=3.09 > 2.50, SD=1.109); nurses and midwives ( x = 2.82 > 2.50, SD=1.332), counselors ( x = 2.64 > 2.50, SD=1.432), lab technicians ( x =2.77 > 2.50, SD=1.307), pharmacists ( x68 > 2.50, SD=1.460) and programme manager ( x = 2.64 > 2.50, SD=1.432) were moderately adequate while social workers ( x = 1.50 < 2.50, SD=.964) and health educators ( x =1.55 < 2.50, SD=1.057) were not adequate as their means fell below the criterion mean of 2.50. (See Table 4).

5. Power supply plant ( x=3.00 > 2.50, SD=1.309) was highly adequate; HIV test kit ( x = 2.95 >2.50, SD=1.327), reagents ( x = 2.91 >2.50, SD=1.377), drugs ( x = 2.77 >2.50, SD=1.412), microscopes ( x = 2.77 >2.50, SD=1.343), incubators ( x = 2.73 >2.50, SD=1.386), CD4 count machine ( x = 2.55 >2.50, SD=1.405) and centrifuges ( x = 2.55 >2.50, SD=1.405) were moderately adequate while spectrophotometre ( x = 1.41 <2.50, SD=.908) and washers ( x = 1.55 <2.50, SD=.963) were not adequate. (See Table 5).
6. Voluntary counseling ( x= 3.90 >2.50, SD=.484), HIV testing ( x = 3.98 >2.50, SD=.131), antiretroviral therapy ( x = 3.90 >2.50, SD=.447) and safer infant feeding counseling ( x =86 >2.50, SD=.576) were highly utilized by HIV positive pregnant women while caesarean section ( x = 1.88 <2.50, SD=1.272) was not utilized. (See Table 6).
7. Majority of the respondents indicated that all the factors influenced the utilization of PMTCT services whereby the responses range from 63.5 to 95.5% except the use of TBAs (36.4%), lack of transport at critical times (36.4%) and constant power supply (45.5%). (See Table 7).
8. There was no significant difference in the utilization level of PMTCT services by HIV positive pregnant women regarding voluntary counseling, HIV testing, antiretroviral therapy, caesarean section and safer infant feeding counseling according to level of education. (See Table 8).
9. There was no significant difference in the utilization level of PMTCT services by HIV positive pregnant women regarding voluntary counseling, HIV testing, antiretroviral therapy and caesarean section according to location except for safer infant feeding counseling. (See Table 9).
10. There was no significant difference in the utilization level of PMTCT services by HIV positive pregnant women regarding voluntary counseling, HIV testing, antiretroviral therapy, caesarean section and safer infant feeding counseling according to age. (See Table 10).

Conclusions

Based on the findings, the following conclusions were drawn.

1. PMTCT of HIV and AIDS services were available in UCTH (FMC). This answers research question 1.
2. Doctors and nurses were highly available; midwives, counselors, lab technicians, pharmacists and programme managers were moderately available while social workers and health educators were not available. This answers research question 2.
3. HIV test kit and reagents were highly available; CD4 count machine, drugs, centrifuges, inculcators, microscopes and power supply plants were moderately available while spectrophotometer and washers were not available. This answers research question 3.
4. Out of all the service providers, only doctors were highly adequate; nurses, midwives, counselors, lab technicians, pharmacists and progamme managers were moderately adequate, while social workers and health educators were not adequate. This answers research question 4.
5. Power supply plant was highly adequate; HIV test kit, CD4 count machine, reagents, drugs, centrifuges, incubators and microscopes were moderately adequate while spectrophotometer and washers were not adequate. This answers research question 5.
6. Voluntary counseling, HIV testing, antiretroviral therapy, and safer infant feeding counseling were highly utilized while caesarean section was not utilized. This answers research question 6.
7. Stigmatization, availability of PMTCT services, addition of PMTCT to general ANC clinic, confidentiality of HIV status, free medical care, availability of trained PMTCT, staff, availability of PMTCT materials, support from husband, caring attitude of services providers, high cost of care, low awareness about PMTCT and lack of knowledge of PMTCT were factors that influence the use of PMTCT services. This answers research question 7.
8. There was no significant difference in the level of utilization of PMTCT services based on level of education of HIV positive pregnant women. This verifies hypothesis 1.
9. There was no significant difference in the level of utilization of VC, HIV testing, ART and CS base on location of HIV positive pregnant women except for the level of utilization of safer infant feeding counseling which differ base on location of the clients. This verifies hypothesis 2.
10. There was no significant difference in the level of utilization PMTCT services base on the age of HIV positive pregnant women. This verifies hypothesis 3.

Recommendations

Based on the findings, discussions and conclusions in this study, the following recommendations were made:

1. Social workers and Health Educators should be employed and trained for PMTCT programme to sensitize, educate and encourage HIV positive pregnant women to avail themselves of PMTCT programme and to educate and encourage rural women who are HIV positive to strictly practice the safer infant feeding after delivery.
2. The government, donor agencies and support groups should adequately provide antiretroviral drugs HIV test kits and CD4 count machines for Calabar hospital.
3. More PMTCT nurses and midwives should be trained to make them highly available and adequate for the work.
4. More PMTCT sites should be established in the state. This is because; we have only one PMTCT site in the state. If we have more PMTCT sites, many more HIV positive pregnant women will have access to PMTCT programme.
5. The government and policy makers should develop a policy against HIV and AIDS stigmatization and discrimination (National Policy on HIV and AIDS Stigmatization). The HIV and AIDS patients should be taken as other human beings that are sick.

Suggestion for Further Study

Following from the findings of this present study, the following were recommended for further study:

1. A study  on  safer  infant feeding practices among HIV positive pregnant women in Cross river should be undertaken.
2. A similar study should be carried out in other states of the federation so that the information so collected can constitute a body of knowledge regarding PMTCT programme implementation in Nigeria.
3. A study on effectiveness and out come of PMTCT of HIV and AIDS programme should be conducted in the state.
4. A study on occupational risk of HIV and AIDS among PMTCT service providers should be carried out in UCTH.
5. A study to follow up HIV positive pregnant women after delivery and their adherence to ART should be undertaken.

Limitations to the Study

The researcher was able to complete the study despite some limitations. The researcher encountered the following limitations during the study.

The confidentiality of HIV status made it impossible for the researcher to have a FGD with the clients. This was because there was no group ANC for the clients. Their ANC was based on individual appointment with the doctors. More so, some of them were living in far places, it was not possible to have an agreed date for FGD with them.

Among the limitations encountered was the problem of limited sites for PMTCT programme

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