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.
Table
of Contents
Title
page - - - - - - - - - - i
Certification- - - - - - - - - - ii
Dedication- - - - - - - - - - - iii
Acknowledgement- - - - - - - - - iv
Abstract - - - - - - - - - - v
Table
of contents- - - - - - - - - - vi
List
of tables- - - - - - - - - - ix
CHAPTER ONE
INTRODUCTION
1.1
Background of the study- - - - - - - - -1
1.2 Statement
of problems - - - - - - - -2
1.3 Purpose
of the study- - - - - - - - -3
1.4 Objectives
of the study- - - - - - - - -3
1.5 Research
questions- - - - - - - - -4
1.6 Hypothesis- - - - - - - - - - -4
1.7 Scope
of the study - - - - - - - - -4
1.8
Significance of the study- - - - - - - -4
1.9 Limitations- - - - - - - - - - -5
1.10 Operational
definition of terms- - - - - - - -5
CHAPTER TWO
LITERATURE REVIEW
2.1 Theoretically- - - - - - - - - -6
2.1.2 Knowledge
about prevention of mother to child transmission (PMTCT) among pregnant women- - - - - - - - -10
2.1.3
Factors influencing utilization of PMTCT- - - - -
12 2.2 Conceptual framework- - - - - - - - -19
CHAPTER THREE
METHODOLOGY
3.1 Research design- - - - - - - - - -22
3.2
Research setting- - - - - - - - - -22
3.3
Research population- - - - - - - - -23
3.3.1 Target population- - - - - - - - - -23
3.3.2
Accessible population- - - - - - - - -23
3.4.1
Sample Size- - - - - - - - - -23
3.4.2
Sampling technique- - - - - - - - -23
3.5
Instruments for data collection- - - - - - - -24
3.6.1 Validity of the instrument- - - - - - - -24
3.6.2 Reliability of the instrument- - - - - - - -24
3.7
Method of Data Collection- - - - - - - -25
3.8 Method of data analysis- - - - - - - - -25
3.9 Ethical considerations- - - - - - - - -25
CHAPTER FOUR
DATA
ANALYSIS AND RESULTS
4.1 Socio-Demographic
Variables- - - - - - - -26
4.2 Results for Research Questions- - - - - - - -28
4.3 Result of Research Hypothesis- - - - - - - -34
CHAPTER FIVE
DISCUSSION OF FINDING
5.1 Discussion of Findings- - - - - - - - -36
5.1.1 The knowledge of pregnant women in
UCTH about prevention and control of HIV/AIDS.- - - - - - - - - - -36
5.1.2 Socio-economic
factors influencing utilization of PMTCT services among pregnant women.- - -- - - - - - - -37
5.1.3 Cultural/religion factors influencing utilization
of PMTCT services among
pregnant women
in UCTH.- - - - - - -
-38
5.1.4 Relationship between level of knowledge and
utilization of PMTCT services among women- - - - - - - - -39
5.2
Summary- - - - - - - - - - -39
5.3 Conclusion- - - - - - - - - - -41
5.4 Recommendations- - - - - - - - - -41
REFERENCES
APPENDIX i (QUESTIONNAIRE)
APPENDIX ii (LETTER OF INTRODUCTION)
LIST
OF TABLES
Table
1: Socio-Demographic Data
Table
2: Level of knowledge about PMTCT services among pregnant women in UCTH
Table
3: Socio-economic factors influencing utilization of PMTCT service in UCTH
Table
4: Cultural/ religious factors influencing utilization of PMTCT service in UCTH
Table
5: chi-square (X2 ) Analysis of the relationship between level of knowledge and utilization of PMTCT service
CHAPTER
ONE
INTRODUCTION
1.2
Background
of the study
The greatest challenge
to human kind in the 21st century is the epidemic of Acquired immune
Deficiency Syndrome (AIDS).Human Immune Deficiency Virus (HIV) is the causative
organism of AIDS which was first discovered in the year 1981. Despite years of
campaigns, advocacy, control programmes and awareness exercises taken to curb
HIV/AIDS spread, there is still a worrisome rate of increase of the infection.
According to UNAIDS (2006), about 33.3 million people are estimated to live
with Human immune Deficiency virus globally; 22.5 million of this population
are from the sub-Saharan Africa.
Over 55% of these
people living with HIV are women of reproductive age who become pregnant. HIV
infection in women of reproductive age increase the epidemic of peri-natal HIV
(UNAIDS, 2006). About 2.5million children live with HIV globally and 1.8million
are from sub-Saharan Africa. Worldwide,
over 1700 children become infected with HIV daily (UNAIDS 2006).
In
Nigeria, about 69,400 children became infected with HIV through mother-to-child
transmission in 2011. This has led to a rise in the total number of children
living with HIV in the country to an unprecedented 440,000 (UNAIDS, 2012).
Majumali,
(2011), opined that, Virtually all HIV infection in children occurs following
mother to child transmission during the antenatal period (pregnancy),
intranatal period (labour/delivery) and the post-natal period. Mother-to-child
transmission of HIV is about 5-10% during pregnancy, 10-20% during labour and
10-15% during breastfeeding.
There is an estimation
of about 20-45% chances of a baby born to an HIV positive mother to become
infected without effective interventions to prevention of mother-to-child
transmission. With effective interventions, such as use of antiretroviral drugs
both for mother formula feeding etc., the risk of mother to child transmission
has been shown to reduce by 5%. Primary preventive measures (prevention of new
infections in parents, avoiding new pregnancies in HIV infected women) and
secondary preventive measures (preventing transmission of HIV from an infected
mother to her infant) are the three approaches in reducing mother to child
transmission (MTCT) promoted by the World Health Organisation (WHO), (McIntyres $ Gray 2004).New
approaches in preventing MTCT to <2% includes use of combined
anti-retroviral prophylaxis, elective caesarean section and by avoiding
prolonged breastfeeding or mixed
feeding.
In Nigeria, despite
these preventives measures of mother to child transmission, research has shown
poor utilization of these services. Thus, the need for this study.
1.2 Statement of problems
Mother
to child transmission of HIV has a lot of impact on the health of the mother
and infant including the economy of the country. MTCT increases the prevalence
of HIV in infants thereby resulting in increased infant and maternal morbidity
and mortality.
Despite
the introduction of improved preventive services of MTCT of HIV over the years,
HIV infections via MTCT (vertically/ perinatal transmission) is still on the
increase in Nigeria. In 2011, about 440,000 infants were infected with HIV
(UNAIDS, 2012).
During the researcher’s clinical experience in
the antenatal clinic UCTH, it was observed that despite availability of this
prevention of MTCT services, very few women utilized the services. For this
reason, this pertinent question formed the birth rock of this study: What then
are the factors that influence the utilization of prevention of mother to child
transmission services?
1.3 Purpose of the study
The
purpose of the study is to ascertain the factors influencing the utilization of
PMTCT services among pregnant women in antenatal clinic in UCTH.
1.4 Objectives of the study
The specific objectives of the study
are:
1.
To assess the level of knowledge about
PMTCT services among pregnant women in UCTH.
2.
To determine the socio-economic factors
influencing utilization of PMTCT services among pregnant women in UCTH.
3.
To ascertain the cultural/religion
factors influencing utilization of PMTCT services among pregnant women in UCTH.
1.5 Research questions
1.
What is the level of knowledge about
PMTCT services among pregnant women in UCTH?
2.
To what extent do socio-economic factors
influencing utilization of PMTCT services among pregnant women in UCTH?
3.
What are the cultural/religion factors
influencing utilization of PMTCT services among pregnant women in UCTH?
1.6 Hypothesis
There
is no significant relationship between level of knowledge and utilization of
PMTCT services among women.
1.7 Scope of the study
The
study is delimited to pregnant women that attended antenatal clinic in
University of Calabar Teaching Hospital.
1.8 Significance of the study
It
is very important that factors influencing the utilization of PMTCT services in
a resource poor setting should be studied. It is important in the context of
cross river state where health resources are unevenly distributed between rural
and urban areas including distribution of health care providers.
Practically:
The
findings of this study will be handy for cancelling purposes in ensuring
increased utilization of PMTCT services.
Research:
The
result of this study will increase the existing knowledge on utilization of
PMTCT services and will also serve as research as a resource material for
further research work.
Nurse/midwife:
The
findings of this study will help to improve the attitude of Nurses in delivery
of PMTCT services to ensure its utilization by pregnant women thereby
decreasing the rate of MTCT.
Government:
The
findings of this study will help improve policies on findings and distribution
of PMTCT services in both rural and urban areas to ensure its utilization.
1.9 Limitations
Major
limitation was encountered during this study because the Teaching Hospital was
on strike and many patients were not (accessed) reached. Also some respondents
refused to divulge their information for confidential purposes.
1.10 Operational definition of terms
Factors:
are variables that influence utilization
of PMTCT services
Utilization:
refers to the process of using PMTCT services
PMTCT
services: are services
that aims at offering preventive measures towards mother to child transmission.
Ante
natal: refers a period from conception to the onset of
labour