Effectiveness of interventions to prevent mother-to-child transmission of HIV in Southern Ethiopia

Abstract

BackgroundIn Ethiopia, Progress in Reducing Mother-to-Child-Transmission (PMTCT) of human immunodeficiency virus (HIV) is being curtailed by behavioral and cultural factors that continue to put unborn children at risk, and mother-to-child transmission is responsible for more than 90% of HIV infection in children. The objective of this study was to assess PMTCT services by examining knowledge about reducing vertical transmission among pregnant women.MethodsA multistaged sampling institution-based survey was conducted in 113 pregnant women in Arba Minch. Qualitative and quantitative data were obtained.ResultsOf the 113 respondents, 89.4% were from Arba Minch, 43.4% were at least 25 years of age, 73.4% had formal education at primary level or above, 100% reported acceptance of voluntary counseling and testing, 92.0% were knowledgeable about mother-to-child transmission, and 90.3% were aware of the availability of the PMTCT service in the health facility. Of 74 HIV-positive women in PMTCT, only three (4.1%) had had skilled birth attendants at delivery. There was an unacceptable degree of loss of women from PMTCT. Maternal educational level had a statistical association with income (P < 0.001) and voluntary counseling and testing for pregnant women (P < 0.05). Factors that determined use of PMTCT included culture, socioeconomic status, and fear of stigma and discrimination.ConclusionIn the area studied, intervention to reduce mother-to-child transmission of HIV is failing to reach its goal. This is an alarming discovery requiring quick reconsideration and strengthening of preventive strategies at all levels.

Loss to Followup: A Major Challenge to Successful Implementation of Prevention of Mother-to-Child Transmission of HIV-1 Programs in Sub-Saharan Africa

“…A study conducted in Ivory Coast revealed that mothers were afraid of being scolded at by health staff and that health workers were not attending to them when they had come for follow-up visits [39]. In Ethiopia, a study revealed that poor monitoring of PMTCT services by health workers was one of the reasons to poor followups in PMTCT program because health facilities did not have registered information on HIV-1-positive mothers who enrolled in PMTCT but failed to return for follow-up care [13]. …”

“…Studies conducted in Malawi and Zimbabwe showed that many existing programs suffered from high attrition rates and incomplete PMTCT followup due to the fact that many women, especially in rural areas, delivered at home rather than at a health facility [11, 20]. A study conducted in Ethiopia revealed that only 16% of births were attended by skilled personnel while in Uganda a study revealed that 71 (95.9%) of HIV-1-positive women did not return for an institutional delivery [13, 35]. Cultural influences, poor socioeconomic status, and fear of the stigma associated with an HIV-1-positive status are factors that influence choice of delivery location [13].…”

“…Followup of PMTCT is a key factor in realizing this goal since it ensures retention of PMTCT clients and adherence to PMTCT interventions. The quality and effectiveness of PMTCT services should be assessed on the basis of the number of mother-child pairs who are receiving consistent followup and antiretroviral treatment, and the number of confirmed HIV-1-negative children born to HIV-1-positive women [13]. …”

HIV status, knowledge of mother-to-child transmission of HIV and antenatal care use among Ethiopian women

“…These findings that ANC use was greater among women with higher knowledge of MTCT are consistent with this prior cross-sectional survey that reported higher knowledge of MTCT among women in a healthcare setting compared with national EDHS estimates. Conversely, a study conducted in 2009 among pregnant women attending prevention of MTCT services in Southern Ethiopia found only 15.0% of women knew that delivery in a health facility, HIV treatment and avoiding breastfeeding were methods to prevent MTCT to the infant [12]. …”

“…The following variables were considered to be potential confounders in the adjusted model based on previous findings of their association with HIV status, knowledge of MTCT and ANC use: age, place of residence, total number of live births in the last 5 years, education, and marital status [9-12]. All relevant variables were included as indicators in the unadjusted and adjusted models.…”