Full Project – SOCIO-DEMOGRAPHIC PREDICTORS OF PREVENTION OF MOTHER -TO- CHILD TRANSMISSION OF HIV AND AIDS SERVICES UTILIZATION AMONG HIV POSITIVE PREGNANT WOMEN IN TARABA STATE, NIGERIA

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TABLE OF CONTENTS

Title page

Approval Page

Certification

Dedication

Acknowledgements

Table of Contents

List of Tables

List of Figures

Abstract

CHAPTER ONE: Introduction

Background to the Study

Statement of the Problem

Purpose of the Study

Research Questions

Hypotheses

Significance of the Study

Scope of the Study

CHAPTER TWO: Review of Related Literature

Conceptual Framework

HIV and AIDS, MTCT AND PMTCT

PMTCT services, Components of PMTCT services

PMTCT services Utilization

Socio- demographic Predictors

Schematic Presentation of Conceptual Framework

Theoretical Framework

Health Belief Model

Theory of Planned Behaviour

Andersen’s Model of Health Services Utilization

Socio-Ecological Model

Schematic Presentation of Theoretical Framework

Empirical Studies

Summary of Literature Review

CHAPTER THREE:            Methods

Research Design

Area of Study

Population for the Study

Sample and Sampling Technique

Instruments for Data Collection

Validity of the Instruments

Reliability of the Instruments

Method of Data Collection

Ethical Consideration and Procedure

Method of Data Analysis

CHAPTER FOUR: Results and Discussion

Results

Summary of Major Findings

Discussion

Implication of the Study

CHAPTER FIVE: Summary, Conclusions and Recommendations

Summary

Conclusions

Recommendations

Suggestions for Further Studies

References

Abstract

HIV transmission in children has become a critical public health problem which has threatened to reverse the gains of the child survival strategy if nothing is done to halt it. This is partly due to lack or poor utilization of the Prevention of Mother –To-Child Transmission of HIV services by HIV positive pregnant women in Taraba State. The study was to investigate the Socio-demographic Predictors of Prevention of Mother-to-child transmission of HIV services Utilization among HIV positive pregnant women in Taraba State, Nigeria. The design was cross- sectional, the population for the study consisted of HIV positive pregnant women (15-49years) attending antenatal clinic in all the facilities offering PMTCT services in Taraba State and health care providers attending to them. A sample size of 650 was drawn from the population using single population proportion formula. Convenience and purposive sampling procedure was used to select the respondents and a two stage cluster sampling procedure was used to select the facilities for the study. Three instruments were used for data collection; they include; researcher designed questionnaire (SODPOPSUQ), focus group discussion guide and key informant interview protocol. They were validated by five experts, three from Department of Health and Physical Education and two from Nursing Sciences Department all of University of Nigeria Nsukka. The Cronbach Alpha co efficiency was used to test the reliability of the SODPOPSUQ and an index of .96 was obtained. Data was collected by the help of two midwives from each facility who were briefed by the researcher. Research questions were answered using descriptive statistic of tables, frequencies and percentages and Pearson’s Chi-Square. The null hypotheses were tested using logistic regression analysis at .05 level of significance. The findings revealed that more than a half (50.3%) of the HIV positive pregnant women who utilized PMTCT services were 15-29 years, more than a half (52.1%) were Christians, majority (67.7%) were married. The results further indicated that majority of the HIV positive pregnant women utilized PMTCT services at least once during the most recent pregnancy (72.2%). (86%) utilized health education services, (91.4%) HCT, (69%) ARV, (80%) safe delivery services and (68.4%) Infant feeding options services, except screening and family planning services (45%). However, only 35% utilized it up to four times which is grossly inadequate. However, only age is a significant predictor of PMTCT service utilization (p-<018; 95% CI= .089-2.531). The findings revealed that utilization declines as a woman advanced in age. Based on the findings, it was recommended that public awareness should be heightened among the elderly women to encourage them to utilize the services more. Also, health care providers should endeavour to place more emphasis on proper counselling.

CHAPTER ONE

Introduction

Background to the Study

The HIV pandemic is an important global public health issue and increasingly, the burden of the disease falls on women and children. Of the estimated 200million women around the world who become pregnant each year, ninety-nine percent of them are HIV-negative and need counseling, information, and services to remain so, while the remaining 1per cent are HIV positive and need effective maternal and child care (Nguyen, 2009). HIV prevalence among women attending antenatal clinic has risen in the past decade, leading to an increase in the number of HIV positive children born to HIV- infected mothers. One of the goals of the June 2001 declaration of the committee of the United Nations General Assembly (UNGASS) special session on HIV and AIDS was to reduce the proportion of infants infected by HIV by 20per cent by 2005 and 50per cent by 2010. The Nigerian National goal for PMTCT as contained in the 2003 AIDS policy is to reduce the transmission of HIV through MTCT by 50 per cent by the year 2010 and to increase access to quality HIV counselling and testing services by 50 per cent by the same year (Federal Ministry of Health, 2010). It has been estimated that 90 per cent of paediatric HIV is through mother-to-child transmission (Nyasalu & Nyasalu, 2011).

Mother-to-child transmission (MTCT) or vertical transmission or peri-natal transmission (these terms will be used interchangeably) refer to a situation where an HIV-positive mother passes the virus to her child during pregnancy, labour, delivery or breastfeeding (Avert, 2014).This does not have to be so if people of child bearing age access and adequately utilize PMTCT services. It has been estimated that 47 per cent of infant HIV could be averted through the prevention of mother to child transmission of HIV (PMTCT) programme. This programme is a comprehensive health service intervention that is aimed at limiting HIV transmission from mother to child. Preventing HIV infection in these women protects the women themselves for their own sake, and protects their children and partners, as a woman who is not infected cannot pass the virus to either her husband or her child (UNAIDS 2014). It is less expensive and can result in massive reductions in HIV transmission if effectively implemented (Avert, 2014). The PMTCT programme has prevented 35,000 children from acquiring this virus from their mothers worldwide (WHO, 2014). As such, it is arguably the most critical HIV intervention for children. Despite the proven effectiveness of the prevention of mother- to- child transmission (PMTCT) of human immunodeficiency virus (HIV) programme, Nigeria currently has one of the highest burden of vertical transmission

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