Knowledge, Attitude and Practice towards Prevention of Mother to Child Transmission of HIV among Pregnant Women Attending Antenatal Care in Southeast Ethiopia

Background

Acquired Immune Deficiency Syndrome (AIDS) is a syndrome first described in 1981. The consequence of progressive immune debilitation. AIDS pandemic has succumbed millions of people all over the world since it was first recognized in early 1980s, and no continent is free from the pandemic [1, 2]. Human immunodeficiency virus (HIV-1) and human immunodeficiency virus (HIV - 2) are retroviruses with RNA genomes; they are the etiologic agents of HIV infection and diseases AIDS. Forty million people infected with HIV worldwide, of which 50% are women. Communicable disease control center (CDC) estimates 40,000 new infections per year in US; about 70% among men, and 30% are women; 2,000 new infections/day in children <15 years [3, 4]. Due to effective retroviral therapy, number of individuals with chronic HIV was increasing in spite of decline in new infections in the 1990s; as a result fifteen percent of HIV infected pregnant women in the US obtain no prenatal care [5].

The main route of HIV transmission includes sexual contact, blood contact and mother to child transmission (MTCT). MTCT of HIV remains a major public health problem worldwide. It is the most common mode of transmission in children under the age of 15years, which is vertically transmitted from HIV positive pregnant women to her unborn baby [4, 6]. Male to female transmission more efficient than female to male and anal receptive sex more likely to transmit than vaginal sex, because of fragile nature of rectal mucosa and high viral load is present in rectal mucosa [4]. Exposure to infected blood through parenteral exposure via transfusions or sharing needles or occupational exposure, risk of transmission is 0.3% and 0.09% after mucous-membrane Lette A, et al. Knowledge, Attitude and Practice towards Prevention of Mother to Child Transmission of HIV among Pregnant Women Attending Antenatal Care in Southeast Ethiopia. Nurs Health Care Int J 2019, 3(5): 000201.

exposure, with needle stick injury, risk of transmission is 1/300 and the overall transmission risk of HIV/AIDS in breast fed child is as high as 30-40% [7]. Additional HIV/AIDS transmission mechanisms are in uterus or during labor/delivery 20% of transmission occurs <36 weeks, 50% in days before delivery, 30% intrapartum, risk of infant to be infected is ~20% increased rate of transmission if low CD4 counts or if high viral loads are recorded. And in patient who previously diagnose of HIV/AIDS, who have vaginal delivery, especially with ROM >4 hours, increases risk of infant infection up to around 40% [7, 8]. Untreated STDs, prematurity, and chorio-amnionitis increase the risk of mother-to-child transmission of HIV [9]. However, HIV is not believed to be transmitted by bites, sharing, utensils, bathrooms, bathtubs, exposure to urine, feces, vomitus (except if grossly contaminated with blood, and even then transmission is rare, if at all) [10].

More than 70% of over 42 million people living with HIV/AIDS worldwide live in sub-Saharan Africa. Of this 17 million are women and 2.5 million are children under the age of 15 years. AIDS has now become the leading cause of death in these countries and it has further worsened the morbidity and mortality of infants and children [4, 11]. Similarly, the virus continued to spread at a rapid pace, sparing no part of Ethiopia unaffected by the virus. In 2003 alone 90,000 adults and 25,000 children died of AIDS. This makes a cumulative total of 90,000 deaths leaving 539,000 orphans by the end of 2003 [2, 7, 11].

For the achievement of millennium development goals (MDGs), creating awareness and enhancing PMTCT practice has great importance particularly in the reduction of childhood and maternal morbidity and mortality which in turn has enormous impacts on socio- economic development of the country. This study determined knowledge, attitude and practice towards prevention of mother to child transmission among pregnant women attending antenatal care.

Study Area, Period and Design

An institutional based cross-sectional study was conducted from March, 2019 to May, 2019. The study was conducted in Goba referral hospital which is found in Goba town, Bale Zone, Southeast Ethiopia. Goba town is located 445 km from Addis Ababa. According to population and housing census of Ethiopia, the total population of the town is estimated to be over 32,000 Copyright© Lette A, et al.

[12]. Goba referral hospital has four Emergency OPD such as; gynecology, internal medicine, surgery, and pediatrics, ten ROPD including minor unit like dermatology, ophthalmology, dentistry, psychiatry, and also one operation room, four ward admission room, MCH, NICU, laboratory and drug store staff. There is respective specialist: four internist, three surgeon, two pediatrician, two gynecologist and obstetrician, 60 general practitioner, 128 nurses, 6 midwives and 40 medical interns working there, and there is also liaison officer, clinical director and respective department head to supervise them. The last year’s quarter report of patient flow at the ANC from registration book of MCH unit which was found to be 25 per day, 415 monthly and around 4,000 annually. During the study period the number of pregnant women attending ANC is increasing; estimated to be 31 per day and 600 monthly.

Sample Size Determination

The required sample size was calculated using a single population proportion formula assuming P=84.6%, Z= standard normal distribution taken as 1.96 at 95% confidence level, d= margin of error taken as 5%, 10% non-response rate and the final sample size calculated to be 220.

Data Collection and Sampling Procedure

The questionnaires were adapted from different literatures. Data was collected by face to face interview using structured and pretested questionnaire filled for respondent. This was first prepared in English and translated to Amharic then back to English again to check for its consistency. Four 12 graduates and one BSc nurse were recruited for data collectors and supervisor respectively. The interview was conducted after ANC service and each client was being interviewed privately. The study participants were selected by systematic random sampling; and we used medical registration number from their cards as lottery enrolment with sampling frame.

Data Quality Control

The supervisor and data collectors were trained for two days before data collection. Before actual data collection, the questionnaire was pre-tested for validity and reliability on 11 mothers; thereby possible adjustment or modification was made accordingly. The pre-test was done in Adaba health center among pregnant women attending ANC and was not included in our data analysis. The supervisor checked the data daily for its completeness.

Data Processing and Analysis

Data was cleaned, coded, explored for outliers and missed values. The data was entered into the computer and analysed and processed using SPSS software version 20 for window package. Descriptive analysis was carried out to examine the distribution of each of study variables.

Operational Definitions

Knowledge: Is that knowing what is diseases, the mode of transmission, the natural history of the disease means that whether it is cured or not, and the impact of diseases in day to day activity, future hope and how make to be not suffered the diseases. Knowledge was assessed by 11 questions.

• Knowledgeable: The study participants who score half or more than half (≥5 out of 11) of the knowledge questions are considered as knowledgeable.
• Not knowledgeable: The study participants who score less than or equal to half (≤5 out of 11) of the knowledge questions are considered as not knowledgeable.

Attitude: Measured by the understanding about the diseases, and attitude toward the suffered individuals. Attitude was assessed by asking 8 questions.

• Positive attitude: The study participants who score half or more than half (≥4 out of 8) of the attitude questions are considered as positive attitude.
• Negative attitude: The study participants who score less than or equal to half (≤4 out of 8) of the attitude questions are considered as negative attitude.

Practice: It sees and changes it in to meaning, full thing and uses it to prevent themselves and community from diseases, teach the other friends and relatives about it. Practice was assessed by asking 11 questions.

• Good practice: the study participants who score half or more than (>5 out of 11) of the practice questions are considered as good practice.
• Poor practice: study participants who score less than or equal to half (≤5 out of 11) of the practice questions are considered as poor attitude.

MTCT: Mother to child transmission of HIV/AIDS either prenatal (Trans placental), Intrapartum (during Labor), and post natal (breast feeding, needle sharing, body secretion) periods. Any way means if it is transmitted to her child [6]. Antenatal care: A general and/or medical care given to pregnant women before delivery [13].

• Per-natal transmission: A transmission that occurs during pregnancy, delivery or breast feeding [14].
• Un-protected sex: A sex that is practiced without proper and consistent use of condom [4].

Socio-demographic Characteristics

A total of 220 pregnant mothers were interviewed yield the response rate of 100%. The median age of the respondents was 28 years with majority 84(38.18%) of the respondents are between the age groups of 20-24 years. Regarding their residence, most of the respondents came from the rural area 119(54.09%). The majority 115(52.3%) were orthodox followers. One thirds 66(30 %) attended no formal education. More than half, 117(53.2%) were housewives (Table 1).

Lette A, et al. Knowledge, Attitude and Practice towards Prevention of Mother to Child Transmission of HIV among Pregnant Women Attending Antenatal Care in Southeast Ethiopia. Nurs Health Care Int J 2019, 3(5): 000201.

Copyright© Lette A, et al.

Lette A, et al. Knowledge, Attitude and Practice towards Prevention of Mother to Child Transmission of HIV among Pregnant Women Attending Antenatal Care in Southeast Ethiopia. Nurs Health Care Int J 2019, 3(5): 000201.

Copyright© Lette A, et al.

Attitude towards MTCT and PMTCT among ANC Clients

The majority 151(68.6%) believed that HIV positive women should have a baby. About sixty percent of participants thought that HIV positive women should breast feed her baby. The majority 118(55.2%) believed that if HIV positive women decided to breast feed her baby their husbands will support. Around eighty four percent of the participants thought that the community will reject them if HIV positive women decided to breast feed her baby. The majority 75(55.6%) believed that breast feeding for HIV positive women is natural obligation (Table 3).

than half, 127 (57.73%) haven’t ever been tested for HIV. The majority 189(85.9%) were willing to have HIV test for the current pregnancy (Table 4).

Lette A, et al. Knowledge, Attitude and Practice towards Prevention of Mother to Child Transmission of HIV among Pregnant Women Attending Antenatal Care in Southeast Ethiopia. Nurs Health Care Int J 2019, 3(5): 000201.

Copyright© Lette A, et al.

Prevalence of Knowledge, Attitude, and Practice

Generally, 206(93.6%) of mothers were knowledgeable, among this figure 129(62.6%) have good

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