Thesis Abstract

Abstract
The prevention of mother-to-child transmission (PMTCT) services are crucial in reducing the transmission of HIV from mother to child during pregnancy, childbirth, and breastfeeding. Despite the availability of these services, the utilization rates among pregnant women attending antenatal clinics remain suboptimal in many settings. This study aimed to investigate the factors influencing the utilization of PMTCT services among pregnant women attending the antenatal clinic at the University of Calabar Teaching Hospital (UCTH). A cross-sectional study design was employed, and data were collected using structured questionnaires from 385 pregnant women attending the antenatal clinic at UCTH. The data collected were analyzed using descriptive and inferential statistics. The results indicated that the utilization of PMTCT services among pregnant women at UCTH was influenced by various factors, including socio-demographic characteristics, knowledge about PMTCT, perceived benefits of PMTCT services, perceived barriers to accessing services, social support, and previous experiences with healthcare services. The study found that older pregnant women were more likely to utilize PMTCT services compared to younger women. Higher educational level, being married, and having a higher income were also associated with increased utilization of PMTCT services. Furthermore, pregnant women who had a good understanding of PMTCT services and perceived the benefits of these services were more likely to utilize them. On the other hand, perceived barriers such as stigma, discrimination, long waiting times, and transportation costs were identified as hindrances to the utilization of PMTCT services. Social support from partners, family members, and healthcare providers played a significant role in encouraging pregnant women to access PMTCT services. Additionally, pregnant women who had positive experiences with healthcare services in the past were more likely to utilize PMTCT services. The study highlights the importance of addressing the socio-economic, educational, and psychosocial factors that influence the utilization of PMTCT services among pregnant women. In conclusion, improving the utilization of PMTCT services among pregnant women requires a multi-faceted approach that addresses individual, social, and health system-related factors. Strategies to enhance knowledge about PMTCT, reduce barriers to access, provide social support, and improve the overall quality of healthcare services are essential in promoting the utilization of PMTCT services among pregnant women attending antenatal clinics.

Thesis Overview

INTRODUCTION1.1. Background of the studyThe 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. 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.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). 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). 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.There is an estimation of about 20-45% chances of a baby born to an HIV positive mother to become infected without effective interventions to prevention of mother-to-child transmission. With effective interventions, such as use of antiretroviral drugs both for mother formula feeding etc., the risk of mother to child transmission has been shown to reduce by 5%. Primary preventive measures (prevention of new infections in parents, avoiding new pregnancies in HIV infected women) and secondary preventive measures (preventing transmission of HIV from an infected mother to her infant) are the three approaches in reducing mother to child transmission (MTCT) promoted by the World Health Organisation (WHO), (McIntyres $ Gray 2004).New approaches in preventing MTCT to <2% includes use of combined anti-retroviral prophylaxis, elective caesarean section and by avoiding prolonged breastfeeding or mixed feeding.In Nigeria, despite these preventives measures of mother to child transmission, research has shown poor utilization of these services. Thus, the need for this study.1.2 Statement of problems 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. MTCT 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 MTCT of HIV over the years, HIV infections via MTCT (vertically/ perinatal 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 UCTH, it was observed that despite availability of this prevention of MTCT services, very few women utilized the services. For this reason, this pertinent question formed the birth rock of this study: What then are the factors that influence the utilization of prevention of mother to child transmission services?1.3 Purpose of the study The purpose of the study is to ascertain the factors influencing the utilization of PMTCT services among pregnant women in antenatal clinic in UCTH.1.4 Objectives of the studyThe specific objectives of the study are:To assess the level of knowledge about PMTCT services among pregnant women in UCTH.To determine the socio-economic factors influencing utilization of PMTCT services among pregnant women in UCTH.To ascertain the cultural/religion factors influencing utilization of PMTCT services among pregnant women in UCTH.1.5 Research questionsWhat is the level of knowledge about PMTCT services among pregnant women in UCTH?To what extent do socio-economic factors influencing utilization of PMTCT services among pregnant women in UCTH?What are the cultural/religion factors influencing utilization of PMTCT services among pregnant women in UCTH?1.6 Hypothesis There is no significant relationship between level of knowledge and utilization of PMTCT services among women.1.7 Scope of the study The study is delimited to pregnant women that attended antenatal clinic in University of Calabar Teaching Hospital.1.8 Significance of the study It 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.Practically: The findings of this study will be handy for cancelling purposes in ensuring increased utilization of PMTCT services.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.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.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.1.9 Limitations Major limitation was encountered during this study because the Teaching Hospital was on strike and many patients were not (accessed) reached. Also some respondents refused to divulge their information for confidential purposes.1.10 Operational definition of termsFactors: are variables that influence utilization of PMTCT servicesUtilization: refers to the process of using PMTCT servicesPMTCT services: are services that aims at offering preventive measures towards mother to child transmission.Ante natal: refers a period from conception to the onset of labour