review of prevention of mother to child transmission of hiv in addis ababa, ethiopia

286 Pages·2014·7.32 MB·English

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REVIEW OF PREVENTION OF MOTHER TO CHILD
TRANSMISSION OF HIV IN ADDIS ABABA, ETHIOPIA
by

TEFERA GIRMA NEGASH

Submitted in accordance with the requirements for the degree of

DOCTOR OF LITERATURE AND PHILOSOPHY IN HEALTH STUDIES

at the

UNIVERSITY OF SOUTH AFRICA

SUPERVISOR: PROF VJ EHLERS

JUNE 2014
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Acknowledgements
I want to thank the following persons and institutions for their respective contributions to
this dissertation.
• A special thank you to my supervisor Prof VJ Ehlers for her guidance, support
and encouragement.
• UNISA’s Professors, UNISA-Ethiopia regional learning center staff and guest
lecturers who assisted me during the proposal development and data analysis
phases of this study.
• Addis Ababa City Administration Health Bureau Ethical Committee for reviewing
my application timeously and for allowing me to conduct this study in the health
facilities under their jurisdiction.
• My employer for granting me leave during different phases of the research that
required my absence from the office.
• Fellow UNISA doctoral students who provided valuable feedback during the
proposal development programme.
• Mr Tsegaye Hailu for his assistance with data analysis and the interpretation of
the statistics.
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REVIEW OF PREVENTION OF MOTHER TO CHILD TRANSMISSION OF HIV IN
ADDIS ABABA, ETHIOPIA.
STUDENT NUMBER: 4201-473-5
STUDENT: TEFERA GIRMA NEGASH
DEGREE: DOCTOR OF LITERATURE AND PHILOSOPHY IN HEALTH STUDIES
DEPARTMENT: HEALTH STUDIES, UNIVERSITY OF SOUTH AFRICA
SUPERVISOR: PROF VALERIE JANET EHLERS

ABSTRACT
This study aimed to identify factors affecting women’s utilisation of the prevention of
mother-to-child transmission (PMTCT) of HIV, evaluate the quality of PMTCT services,
describe health outcomes of mothers and infants and to identify factors that influence
mother-to-child transmission (MTCT) of HIV. Structured interviews were conducted with
384 women who had utilised PMTCT services. Information was also obtained from the
health records of these women and of their infants.
Better educated women, who had male partners and were self-employed were more
likely to use PMTCT services. Being unmarried, poor and feeling stigmatised made it
difficult for women to use these services.
Respondents were satisfied with PMTCT services except that clinics sometimes had no
medications. The health care workers followed the Ethiopian guidelines during HIV
testing and counseling but not when prescribing treatment.
Although the respondents’ CD4 cell counts improved, their clinical conditions did not
improve.
The MTCT rate was significantly higher if infants did not receive ARVs, had APGAR
scores below seven, weighed less than 2.5kg at birth, were born prematurely, and if
their mothers had nipple fissures.
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PMTCT services could be improved if more women used these services, health care
workers followed the national guidelines when prescribing ARVs, clinics had adequate
supplies of medicines, all infants received ARVs, and mothers’ nipple fissures could be
prevented. Antenatal care should help to avoid premature births of infants weighing less
than 2.5kg and having APGAR scores below 7.
Future research should compare formula feeding versus breastfeeding of infants with
HIV-positive mothers.
KEY CONCEPTS: APGAR score, antenatal care (ANC) , antiretroviral therapy (ART),
antiretrorivals (ARVs), Donabedian’s Model of Health Care Quality, Ethiopian health
care services, Health Belief Model (HBM), HIV/AIDS, HIV counseling and testing, infant
feeding options, mother-to-child transmission of HIV (MTCT), nipple fissures, partner
testing; prevention of mother to child transmission of HIV (PMTC)
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TABLE OF CONTENTS
CHAPTER 1
ORIENTATION TO THE STUDY
1.1 INTRODUCTION…………………………………………………………………………1

1.2 BACKGROUND INFORMATION ABOUT THE RESEARCH PROBLEM………....5

1.2.1 The source of the research problem……………………………………….….…….5
1.2.2 Global HIV/AIDS burden…………………………………………………….….…….6
1.2.3 HIV/AIDS prevalence in Ethiopia………………………………………….….……...7
1.2.4 Historical and geographical background information about Ethiopia……...……..7
1.2.5 Population and health system of Ethiopia……………………………………..……8

1.3 PMTCT AND VIRUAL ELIMINATION HIV……………………………………….….…9
.
1.4 PMTCT IN ETHIOPIA………………………………………………………….………..13

1.5 STATEMENT OF THE RESEARCH PROBLEM………………………….….……...15

1.6 AIM OF THE STUDY………………………………………………………….………...16

1.6.1 Research purpose…………………………………………………………….……...16
1.6.2 Research objectives……………………..………………………………….…….….16

1.7 SIGNIFICANCE OF THE STUDY……………………………………………………..17

1.8 DEFINITIONS OF KEY CONCEPTS………………………………………………....18
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1.9 OPERATIONAL DEFINITIONS……………………………………………………….20

1.10 THEORETICAL FOUNDATIONS OF THE STUDY………………….…………..21

1.10.1 Health Believe Model (HBM)……………………….……………….………………21
1.10.2 Donabedian’s model of health care quality……………….……….………………22
1.10.3 Relevance of the theoretical frameworks used for this study….………………..22

1.11 RESEARCH DESIGN AND METHOD……………………….……………………26

1.12 SCOPE OF THE STUDY……………………………………………………………27

1.13 STRUCTURE OF THE THESIS……………………………………………………28

1.14 SUMMARY……………………………………………………………………..……..28

CHAPTER 2
LITERATURE REVIEW

2.1 INTRODUCTION……………………………………………………………………29

2.2 DESCRIPTION OF THE THEORETICAL FRAMEWORKS…………………….31

2.2.1 Health Belief Model (HBM)………………………………………………………31
2.2.2 Donabedian’s model………………………………………………………….…..32
2.2.3 Justification for using the chosen theoretical frameworks………………….…34
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2.3 FACTORS AFFECTING THE UTILISATION OF PREVENTION OF MOTHER
TO CHILD TRANSMISSION OF HIV SERVICES……………………………………35

2.3.1 Perceived susceptibility…………………………………………………...………35
2.3.2 Perceived severity…………………………………………………………..……..36
2.3.3 Perceived benefits………………..…………………………………………..……36
2.3.4 Perceived barriers…………………………………………………………….……37
2.3.5 Perceived self-efficacy……………………………………………………….……38
2.3.6 Cues to action……………………………………………………………………...38

2.4 PREVENTION OF MOTHER TO CHILD TRANSMISSION OF HIV…………...39

2.4.1 Primary prevention of mother to child transmission of HIV……………………41
2.4.2 Family planning, HIV counseling and testing for prevention of mother to child
transmission of HIV………………………………………………………………………42
2.4.3 Antiretroviral intervention, adherence and breast feeding for the prevention of
mother to child transmission of HIV…………………………………………………….45

2.5 FACTORS AFFECTING MOTHER TO CHILD TRANSMISSION OF HIV…….50

2.6 OUTCOMES OF PREVENTION OF MOTHER TO CHILD TRANSMISSION
INTERVENTIONS……………………………………………………………….……….52

2.6.1 HIV status and exposure of children…………………………………….………55
2.6.2 Health outcome of mothers receiving prevention of mother to child
transmission of HIV services……………………………………………………….……58
2.6.3 Patients’ satisfaction with prevention of mother to child transmission of HIV
services……………………………………………………………………………...…….60

2.7 SUMMARY…………………………………………………………..…………..……61
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CHAPTER 3
RESEARCH DESIGN AND METHOD
3.1 INTRODUCTION……………………………………………………………………63

3.2 RESEARCH DESIGN………………………………………………………………64

3.3 RESEARCH METHOD……………………………………………………………..66

3.3.1 Population and Sampling…………………………………………………………67

3.3.1.1 Population………………………………………………………..………………68
3.3.1.2 Sampling………………………………………………………………………….69
3.3.1.3 Sample size……………………………………………………………………....70

3.3.2 Data collection………………………………………………………………………72

3.3.2.1 Data collection approach and method………………………………………….74
3.3.2.2 Development and testing of the data collection instruments…………………74
3.3.2.3 Characteristics of the data collection instruments………………………….....74
3.3.2.4 Pre-testing of the data collection instrument………………………………..…76
3.3.2.5 Data collection process………………………………………………………..…76

3.3.3 Data analysis……………………………………………………………………..…77

3.4 RELIABILITY OF THE STUDY……………………………………………………...79

3.5 VALIDITY OF THE STUDY……..………………………………………………...…82

3.6 ETHICAL CONSIDERATIONS……………………………………………………....83