FACTORS INFLUENCING UTILIZATION OF PREVENTION OF MOTHER TO CHILD TRANSMISSION (PMTCT) SERVICES AMONG PREGNANT WOMEN

1.1 Introduction

The Prevention of mother-to-child transmission (PMTCT) programmes offer a range of services for women of reproductive age living with or at risk of HIV to maintain their health and stop their infants from acquiring HIV. PMTCT services should be offered before conception, and throughout pregnancy, labour and breastfeeding (Westerncape, 2021). The prevention of mother-to-child transmission (PMTCT) of HIV is one of the great public health successes of the past 20 years. Much concerted research efforts and dedicated work have led to the achievement of very low rates of PMTCT of HIV in settings that can implement optimal prophylaxis. Though several implementation challenges remain, global elimination of pediatric HIV infection seems now more than ever to be an attainable goal. Often overlooked, the role of prophylaxis of the newborn is nevertheless a very important component of PMTCT.

As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Research hypothesis and questions, Limitation of the study and Definition of terms.

1.2 Background of Study

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). 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).

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.

African societies have a peculiar attitude towards the sick or mentally ill persons and this is evident in the rejection, scornful disposition and a negative perception of the sick individual (Sharma 1998; Mohammed et al. 2004; Mohammed and Mohammed 2008). Mental illness is a disorder of one or more of the functions of the mind such as emotion, perception, memory or thoughts, which causes suffering to the person and embarrassment to the family and society. There are a varied number of mental illnesses but the most common and broader classification is psychoses, neuroses and mental retardation. Mental illness could be spurred by environmental or cultural factors and also, by physiological malfunctioning and heredity, these are referred to as functional and organic psychoses respectively.

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.

Although mental health problems are extremely common in our society, there has historically been a negative attitude towards people with mental disorders. A study found that public attitudes towards people with mental illness in England and Scotland became less positive between 1994 and 2003 (Mehta N,et al, 2009). Stigma is thought to stop those with mental health problems seeking appropriate medical help (Jorm AF, 2000). Stigmatizing attitudes towards mental disorders may be influenced by lack of knowledge of psychiatric illness, (Schomerus G, Angelmeyer MC, 2008) and contact with people with mental disorders may lead to more positive attitudes and enlightened views. (Addison SJ, Thorpe SJ, 2004).

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.

Therefore, in Nigeria where the research was carried out, the activities that was conducted is to know the Factors Influencing Utilization of Prevention of Mother to Child Transmission (PMTCT) Services among Pregnant Women.

1.3 Statement of Problems

Investigation revealed that 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. Mother to child transmission 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 Mother to child transmission of Human Immune Deficiency Virus over the years, Human Immune Deficiency Virus infections via mother to child 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, it was observed that despite availability of this prevention of MTCT services, very few women utilized the services.

1.4 Aim and Objectives of Study

The aim of the study is to ascertain the Factors Influencing Utilization of Prevention of Mother to Child Transmission (PMTCT) Services among Pregnant Women. In achieving this aim, the following specific objectives were laid out as follows:

1. To ascertain the cultural/religion factors influencing utilization of PMTCT services among pregnant women in the study area;
2. To assess the level of knowledge about PMTCT services among pregnant women in the area under review; and
3. To determine the socio-economic factors influencing utilization of PMTCT services among pregnant women in the area under study.

1.5 Research Questions

The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:

• What is the level of knowledge about PMTCT services among pregnant women in the area under review?
• To what extent do socio-economic factors influencing utilization of PMTCT services among pregnant women in the area under study?
• What are the cultural/religion factors influencing utilization of PMTCT services among pregnant women in the study area?

1.6 Research Hypothesis

In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.

Hypothesis One

• H0: There is no significant relationship between level of knowledge and utilization of PMTCT services among women.
• H1: There is a significant relationship between level of knowledge and utilization of PMTCT services among women.

1.7 Significance of Study

The study 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.

1. Practically: The findings of this study will be handy for cancelling purposes in ensuring increased utilization of PMTCT services.
2. 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.
3. 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.
4. 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.

1.8 Scope of Study

The scope of this research is focused on the Factors Influencing Utilization of Prevention of Mother to Child Transmission (PMTCT) Services among Pregnant Women in Okpe Local Government Area, Delta State.

1.9 Limitations of the Study

During the course of this study, there were some problems encountered which stood as limitations to the research work. Some of the limitations include:

1. Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
2. Establishment Policies: Establishment policies posed a serious limitation as most staffs are not ready to release information needed for this research work. There were lots of information needed from the staffs of this establishment to enhance the study which took them time to release or they did not release at all for security purposes, hence the scope was reduced.
3. Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
4. Initial Cooperation Delay from Respondents: A particular limitation of this work came as a result of the respondent refusal to offer their cooperation at the initial time they were contacted. This contributed in making the success of this research study difficult.

1.10 Operational Definition of Terms

PMTCT:

It is an acronym for Prevention of Mother-To-Child Transmission

Factors:

These are variables that influence utilization of PMTCT services

Utilization:

It refers to the process of using PMTCT services

Ante natal:

It refers a period from conception to the onset of labour

PMTCT Services:

These are services that aim at offering preventive measures towards mother to child transmission.