Table of Contents
Page
Title page – – – – – – – – – i
Approval Page        –          –          –          –          –          –          –          –          ii
Dedication – – – – – – – – – iii
Certification   –       –          –          –          –          –          –          –          iv
Acknowledgement     –          –              –          –          –          –          –          v
Table of Contents      –          –               –          –          –          –          –          vi
List of Tables         –          –          –          –          –          –          viii
Abstract – – – – – – – – – ix
CHAPTER ONE: Introduction
Background to the Study – – – – – – – 1
Statement of the Problem-Â Â Â Â Â Â Â Â Â Â –Â Â Â Â Â Â Â Â Â Â –Â Â Â Â Â Â Â Â Â Â –Â Â Â Â Â Â Â Â Â Â –Â Â Â Â Â Â Â Â Â Â –Â Â Â Â Â Â Â Â Â Â 9
Purpose of the Study            –          –          –          –          –          10
Research Questions            –          –          –          –          –          10
Hypotheses     –          –          –          –          –          –          –          11
Significance of the Study         –          –          –          –          –          11
Scope of the Study    –          –          –          –          –          –          –          –          13
CHAPTER TWO: Review of Related Literature
Conceptual Framework              –          –          –          –          –          15
International initiatives to PMTCT of HIV – – – – 21
Factors affecting PMTCT of HIV and AIDS services – – 22
Theory and Evaluation Models          –            –          –          –          –          23
           Theory of reasoned action (TRA)       –          –          –          24
           Health belief model (HBM)       –          –          –          –          25
           Evaluation model               –          –          –          –          26
Empirical Studies on PMTCT of HIV and AIDSÂ Â Â Â Â Â Â Â Â Â Â –Â Â Â Â Â Â Â Â Â Â –Â Â Â Â Â Â Â Â Â Â 28
Summary of Literature          –          –          –          –          –          32
CHAPTER THREE: Methods
Research Design     –          –          –          –          –          –          35
Population of the Study          –          –          –          –          –          35
Sample and Sampling Techniques     –          –          –          –          –          35
Instruments for Data Collection       –          –          –          –          –          36
           Validity of instruments             –          –          –          –          36
           Reliability of instruments         –          –          –          –          37
Method of Data Collection       –          –          –          –          –          37
Method of Data Analysis          –          –          –          –          –          37
CHAPTER FOUR: Results and Discussions
Results           –          –          –          –          –          –          –          –          39
Summary of Major Findings             –          –          –          –          48
Discussions             –          –          –          –          –          –          50
CHAPTER FIVE: Summary, Conclusions and Recommendations
Summary    –          –          –          –          –          –          –          56
Conclusions             –          –          –          –          –          –          58
Recommendations       –          –          –          –          –          –          59
Suggestions for Further study       –          –          –          –          –          60
Limitations to the Study             –          –          –          –          –          60
References     –      –          –          –          –          –          –          –          62
Appendices
A Questionnaire for HIV Positive pregnant Women         –          69
B   Questionnaire for PMTCT Service Providers     –          –          71
CÂ Â Focus Group Discussion Guide (FGDG)Â Â Â Â Â Â Â Â Â –Â Â Â Â Â Â Â Â Â Â –Â Â Â Â Â Â Â Â Â Â 75
D  Reliability Analysis of the Questionnaires       –          –          –          76
E  SPSS Analysis of the Questionnaires           –          –          –          77 Â
F  Letter of Introduction from the Department            –          –          85
G Letter of Research Approval from FMC Umuahia   –          –          86
H Letter of Invitation for Focus Group Discussion  –      87                               Â
List of Tables
Tables                                                                                              Page
PMTCT Services Available       –          –          –          –          –          39
Extent to which Qualified PMTCT Service Providers are Available – – 40
Extent of Availability of PMTCT Materials        –          –          –          41
Adequacy of PMTCT Service Providers            –          –          –          42
Adequacy of PMTCT Materials         –          –          –          –          43
Level of Utilization of VC, HIV Testing, ART, CS and Safer Infant Feeding Counseling – – – – – – 44
Factors Influencing the Utilization of PMTCT Services  –          45
Result of One-Way ANOVA Verifying the Utilization Level of PMTCT Services Based on Level of Educational of HIV Positive Pregnant Women – – – – – – – 46
Result of t-Test for level of utilization of PMTCT Services Based
On Location of HIV Positive Pregnant Women              –          –          47
Result of One-Way ANOVA Verifying the Utilization Level of PMTCTServices Based on Age of HIV Positive Pregnant Women – – – 48
Abstract
The study was to evaluate the PMTCT of HIV and AIDS programme in Umuahia hospitals. The study evaluated the availability of PMTCT service, availability and adequacy of qualified service providers and materials, the level of utilization of PMTCT services and factors that influenced the utilization of PMTCT service. The factors evaluated in relation to the utilization of the services were educational level, location and age of HIV positive pregnant women. To achieve the purpose of the study, eleven research questions were posed and four null hypotheses were postulated. The study adopted a cross sectional survey research design. It covered the only PMTCT site (FMC Umuahia) and 5 private hospitals providing VC. All the HIV positive pregnant women that attended ANC at the period of study (4 weeks) were used. All the 14 PMTCT service providers in FMC Umuahia and the 8 PMTCT trained staff in 5 private hospitals were also used as respondents. Data collected were 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 seven, while mean and standard deviation were used to answer research questions two to six. T-test and ANOVA were used to verify the three null hypotheses formulated for the study at 05 level of significance. Data generated from the FGD with PMTCT service providers were used to substantiate the findings. The study revealed that voluntary counseling, HIV testing, antiretroviral therapy, caesarean section and safer infant feeding counseling services were available in the government hospital. Majority of the PMTCT service providers and materials were moderately available and adequate. Four out of the five PMTCT services available were highly utilized by the clients. The study also revealed that majority of the respondents indicated that majority of the factors influenced the utilization of these services. The study further revealed that the utilization of these PMTCT services did not differ by level of education, location and age of clients except the use safer infant feeding counseling which differed based on the location of the clients. Based on the major findings and conclusions, it was recommended among others that 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. To educate and encourage rural women who are HIV positive to strictly practice safer infant feeding after delivery.
CHAPTER ONE
Introduction
Background to the Study
Everyday, approximately 5,000 women are newly infected with HIV (Human Immunodeficiency Virus), and more than 3,000 die from AIDS (Acquired Immune Deficiency Syndrome) – related illnesses (UNAIDS, 2000a). In most parts of the world, HIV infection is increasing faster among women than men. Nowhere is the trend more apparent than in sub – Saharan Africa where women comprise 58 per cent of existing HIV infection (UNAIDS, 2000b). These differences in infection rates are due to a combination of factors. Women and girls are commonly discriminated against in terms of access to education, employment and land inheritance. With increasing poverty levels, African women have found themselves in casual relationship with men as this can serve as a conduit for financial and social security. Women, therefore, find it difficult to demand for safe sex, as they become subordinates or dependents of mainly older men. Women are also biologically prone to infection and HIV is easily transmitted from men to women than the reverse.
This has led to the increase in women living with HIV. Results of initial early studies analyzing progression and survival in HIV syndrome suggested a difference based on gender. Most of these studies indicated that the prognosis for women was worse than for men. This reflected late access to limited care (Bastian, Bennet, Adams, Waskin, Divine & Edlin, 1993; Melnick, Sherer, Louise, Hillman, Rodriguez, Lackman, Capps, Brown, Caryln & Korvick 1994). Lack of access to care, minimal self – motivation, and attention to the health care of their children over that of themselves all contributed to decreased rates of early detection and intervention. HIV and AIDS for women, therefore, is an issue of access to health care (UNAIDS, 2003). Furthermore, at the end of 2004, UNAIDS reported that women made up almost half of the 37.2 million adults (aged 15 to 49) living with HIV and AIDS worldwide. The hardest-hit regions are areas where heterosexual contact is the primary mode of transmission. This is most evident in sub-Saharan Africa, where close to 60 per cent of adults living with HIV and AIDS are women. Women and girls make up a growing proportion of those infected by HIV and AIDS (UNAIDS/WHO, 2005a).
AIDS is a disease of the immune system that makes the individual highly vulnerable to life-threatening infections such as tuberculosis (TB) and certain types of cancer. AIDS is caused by a retrovirus known as Human Immunodeficiency Virus (HIV) which attacks and impairs the body’s natural defence system against diseases and infections (Piwoz & Preble, 2000). They further stated that HIV is a slow-acting virus that may take years to produce illness in a person. HIV is transmitted via three primary routes: having unprotected sex with a person already carrying the HIV virus; transfusions of contaminated blood and its by-products or use off non-sterilized instruments, such as shared needles, razor, and other surgical tools; and from an infected mother to her child (MTCT) during pregnancy, labour, childbirth or breastfeeding.
According to UNAIDS/WHO (2000), the principal mode of transmission of HIV in Africa is heterosexual. The second is mother – to – child transmission, which is the main mode of acquisition of HIV infection in children under 15 years. The number of children living with HIV infection is estimated at 2.5 million since the epidemic began. Each year, around half a million children aged under 15 become infected with HIV. Almost all of these infections occur in developing countries, and more than 90 per cent are the results of mother – to – child transmission during pregnancy, labour and delivery or breast – feeding. Without interventions, there is a 20 – 45 per cent chance that a baby born to an HIV – infected mother will become infected (De Cock, Fowler, Mercier, de Vincenzi, Saba & Hoff, 2000).
Mother to child transmission (MTCT) also known as vertical transmission occurs when HIV positive woman passes the virus to her baby. This can occur during pregnancy, labour and delivery or breastfeeding, (Msellati, Leroy & Lepage, 1992). The most effective means of reducing mother – to – child transmission is to provide fully suppressive Antiretroviral therapy (ART) to the mother in long term, thereby not only reducing the risk of vertical transmission, but also sustaining the life and health of the mother while the child is growing up. In high income countries, MTCT has been virtually eliminated thanks to effective prevention programmes (Preble & Piwoz, 2002).
