Abstract
This study sought to assess the factors influence the utilization of PMTCT services among pregnant women in antenatal clinic in University of Calabar Teaching Healthcare (UCTH), Calabar. The specific Objectives of the Study were: to assess the level of knowledge about PMTCT services, determine the socio-economic factors influencing utilization of PMTCT services and to identify the cultural/religion factors influencing utilization of PMTCT services among pregnant women in UCTH. Three research questions were raised and a hypothesis formulated to guide the study as follows: There is no significant relationship between level of knowledge and utilization of PMTCT services among women. The study was a descriptive research where 85 pregnant women who attended antenatal clinic in UCTH were selected through the purposive sampling technique. Data were collected by administering questionnaire. Data were analyzed using frequency tables and percentages, the findings of the study revealed that: Majority of the respondents have good knowledge about PMTCT services. The socio-economic factors influencing utilization of PMTCT services among pregnant women were: 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. Cultural/religious beliefs do not hinder utilization of PMTCT services. The hypothesis was tested for significance at 0.05 level and 1 degree of freedom, using the Chi-Square (X2) analysis. The result showed that the calculated value 55.45 is higher than the critical value (3.84). Thus, the null hypothesis was rejected, indicating that there is significant relationship between level of knowledge and utilization of PMTCT services among women. Based on the findings, conclusion was drawn. It was recommended amongst others that: there is need for involvement of the stakeholders in the healthcare system in bridging the gap between knowledge and utilization of PMTCT services among women.
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).
