Socio-demographic associations of HIV among women attending antenatal care in selected rural primary care facilities in South Africa's Eastern Cape province.

Abstract Background: To effectively reduce vertical HIV transmission requires a reduction of HIV prevalence and incidence among pregnant women and a full understanding of its epidemiology. The study aimed to determine the prevalence of HIV among women attending antenatal care and further determine spousal support during antenatal care attendance in rural areas in Eastern Cape province, South Africa. Methods: A Cross-sectional study of women attending antenatal care in four Primary Care facilities was conducted using an interviewer-administered questionnaire which collected information on socio-demographic characteristics and medical history. Binomial logistic regression analyses were used to determine factors associated with HIV and to estimate the prevalence ratio (PR). The 95% confidence interval (95%CI) is used for precision of estimates; p≤0.05 for statistical significance. Results: A total of 343 participants were included in the final analysis. The antenatal HIV prevalence was 38.2% (95%CI: 33.2 – 43.9). For 75% of the women, the HIV diagnosis was made 141 days before the date of the interview (median=77 days, interquartile range=42-141 days). Participants between the age of 30 to 39 years were 50% more likely to be HIV positive compared to those who were between the age of 20 to 29 years, these differences were statistically significant (PR=1.5; p-value=0.001). Furthermore, self-employed women were 30% less likely to be HIV positive when compared to unemployed participants, this was also statistically significant (PR=0.7; p-value<0.0001). Conclusion: Despite a 100% antenatal HIV testing rate, the antenatal HIV prevalence remains high in this population, coupled with no spousal attendance in antenatal care. It is important to move beyond awareness about the HIV status to actionable strategies of reducing the HIV incident cases. It is therefore important to remain vigilant and monitor mother-to-child transmission that could be associated with this increased prevalence.

Download Full-text

Socio-demographic associations of HIV among women attending antenatal care in selected rural primary care facilities in South Africa's Eastern Cape province.

10.21203/rs.3.rs-36743/v3 ◽

2021 ◽

Author(s):

Sikhumbuzo A Mabunda ◽

Khuthala Sigovana ◽

Wezile Chitha ◽

Teke Apalata ◽

Sibusiso Nomatshila

Keyword(s):

Primary Care ◽

Antenatal Care ◽

Statistical Significance ◽

Hiv Prevalence ◽

Hiv Positive ◽

P Value ◽

Eastern Cape Province ◽

Eastern Cape ◽

Care Facilities ◽

Incident Cases

Abstract Background: To effectively reduce vertical HIV transmission requires a reduction of HIV prevalence and incidence among pregnant women and a full understanding of its epidemiology. The study aimed to determine the prevalence of HIV among women attending antenatal care and further determine spousal support during antenatal care attendance in rural areas in Eastern Cape province, South Africa.Methods: A Cross-sectional study of women attending antenatal care in four Primary Care facilities was conducted using an interviewer-administered questionnaire which collected information on socio-demographic characteristics and medical history. Binomial logistic regression analyses were used to determine factors associated with HIV and to estimate the prevalence ratio (PR). The 95% confidence interval (95%CI) is used for precision of estimates; p≤0.05 for statistical significance.Results: A total of 343 participants were included in the final analysis. The antenatal HIV prevalence was 38.2% (95%CI: 33.2 – 43.9). For 75% of the women, the HIV diagnosis was made 141 days before the date of the interview (median=77 days, interquartile range=42-141 days). Participants between the age of 30 to 39 years were 50% more likely to be HIV positive compared to those who were between the age of 20 to 29, these differences were statistically significant (PR=1.5; p-value=0.001). Furthermore, self-employed women were 30% less likely to be HIV positive when compared to unemployed participants, this was also statistically significant (PR=0.7; p-value<0.0001).Conclusion: Despite a 100% antenatal HIV testing rate, the antenatal HIV prevalence remains high in this population, coupled with no spousal attendance in antenatal care. It is important to move beyond awareness about the HIV status to actionable strategies of reducing the HIV incident cases. It is therefore important to remain vigilant and monitor mother-to-child transmission that could be associated with this increased prevalence.

Download Full-text

Socio-demographic associations of HIV among women attending antenatal care in selected rural primary care facilities in South Africa’s Eastern Cape province

BMC Infectious Diseases ◽

10.1186/s12879-020-05744-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sikhumbuzo A. Mabunda ◽

Khuthala Sigovana ◽

Wezile Chitha ◽

Teke Apalata ◽

Sibusiso Nomatshila

Keyword(s):

Primary Care ◽

Antenatal Care ◽

Rural Areas ◽

Statistical Significance ◽

Hiv Prevalence ◽

Hiv Positive ◽

Eastern Cape Province ◽

Eastern Cape ◽

Care Facilities ◽

Incident Cases

Abstract Background To effectively reduce vertical HIV transmission requires a reduction of HIV prevalence and incidence among pregnant women and a full understanding of its epidemiology. The study aimed to determine the prevalence of HIV among women attending antenatal care and further determine spousal support during antenatal care attendance in rural areas in Eastern Cape province, South Africa. Methods A Cross-sectional study of women attending antenatal care in four Primary Care facilities was conducted using an interviewer-administered questionnaire which collected information on socio-demographic characteristics and medical history. Binomial logistic regression analyses were used to determine factors associated with HIV and to estimate the prevalence ratio (PR). The 95% confidence interval (95%CI) is used for precision of estimates; p≤0.05 for statistical significance. Results A total of 343 participants were included in the final analysis. The antenatal HIV prevalence was 38.2% (95%CI: 33.2–43.9). For 75% of the women, the HIV diagnosis was made 141 days before the date of the interview (median=77 days, interquartile range=42–141 days). Participants between the age of 30 to 39 years were 50% more likely to be HIV positive compared to those who were between the age of 20 to 29, these differences were statistically significant (PR=1.5; p-value=0.001). Furthermore, self-employed women were 30% less likely to be HIV positive when compared to unemployed participants, this was also statistically significant (PR=0.7; p-value< 0.0001). Conclusion Despite a 100% antenatal HIV testing rate, the antenatal HIV prevalence remains high in this population, coupled with no spousal attendance in antenatal care. It is important to move beyond awareness about the HIV status to actionable strategies of reducing the HIV incident cases. It is therefore important to remain vigilant and monitor mother-to-child transmission that could be associated with this increased prevalence.

Download Full-text

Socio-demographic associations of HIV among antenatal care attendees in selected rural primary care facilities in South Africa's Eastern Cape province

10.21203/rs.3.rs-36743/v1 ◽

2020 ◽

Author(s):

Sikhumbuzo A Mabunda ◽

Khuthala Sigovana ◽

Wezile Chitha ◽

Teke Apalata ◽

Sibusiso Nomatshila

Keyword(s):

Primary Care ◽

Antenatal Care ◽

Rural Areas ◽

Statistical Significance ◽

Prevalence Ratio ◽

Cross Sectional Study ◽

Hiv Prevalence ◽

P Value ◽

Cross Sectional ◽

Care Facilities

Abstract Background To effectively reduce vertical HIV transmission requires a reduction of HIV prevalence and incidence among pregnant women and a full understanding of its epidemiology. There is, however, literature paucity of HIV studies focusing on women attending antenatal care in rural areas in South Africa. Methods A Cross-sectional study of women attending antenatal care in four Primary Care facilities was conducted using an interviewer-administered questionnaire which collected information on socio-demographic characteristics and medical history. Binomial logistic regression analyses were used to determine factors associated with HIV and to estimate the prevalence ratio (PR). The 95% confidence interval (95%CI) is used for precision of estimates; p ≤ 0.05 for statistical significance. Results A total of 343 participants were recruited. The antenatal HIV prevalence was 38.2% (95%CI: 33.2–43.9). Participants older than 40 years were 4.6 times significantly more likely to be HIV positive compared to teenagers (p-value = 0.019). Furthermore, multiparous, unemployed and employed participants, were significantly associated with 40%, 60% and 70% higher antenatal HIV prevalences respectively when compared to primigravidas or tertiary students (p-value < 0.0001). Conclusion Despite a 100% antenatal HIV testing rate, the antenatal HIV prevalence remains high and is increasing in this population, coupled with no spousal attendance in antenatal care and poor condom compliance. It is therefore important to remain vigilant and monitor mother-to-child transmission that could be associated with this increased prevalence.

Download Full-text

Barriers to the Implementation of the HIV Universal Test and Treat Strategy in Selected Primary Care Facilities in South Africa’s Eastern Cape Province

Journal of Primary Care & Community Health ◽

10.1177/21501327211028706 ◽

2021 ◽

Vol 12 ◽

pp. 215013272110287

Author(s):

Onke R. Mnyaka ◽

Sikhumbuzo A. Mabunda ◽

Wezile W. Chitha ◽

Sibusiso C. Nomatshila ◽

Xolelwa Ntlongweni

Keyword(s):

Primary Care ◽

Statistical Significance ◽

P Value ◽

Successful Implementation ◽

Eastern Cape Province ◽

Eastern Cape ◽

Test And Treat ◽

Universal Test ◽

Universal Test And Treat ◽

Care Facilities

Background: The South African government implemented the Universal Test and Treat (UTT) approach to treating HIV in the second half of 2016. As part of a contribution to the successful implementation of UTT, this study looked at barriers to implementation of UTT emanating from weaknesses of the health system in 2 Community Health Centers in South Africa’s Eastern Cape Province. Methods: This was a quantitative cross-sectional design which had both descriptive and analytical components. Convenience sampling was used to select and recruit 2 primary care facilities and 30 nurses. Self-administered questionnaires were used to solicit data from facility managers and nurses. In addition, a record review was used to access 6 months’ data for the period 1 October 2017 to 31 March 2018. Data were analyzed using Stata 14.1. Categorical data were presented using frequency and contingency tables. The 95% confidence interval (95% CI) is used for the precision of estimates and the P-value of statistical significance is P < .05. Results: Facilities were found to have poor leadership and governance; human resource challenges that include shortages, lack of skills and lack of developmental support; poorly resourced service delivery platforms and poor information management. Of the three 90-90-90 targets, health facilities only satisfactorily achieved the second 90 of initiating all who test positive for HIV within a week (93.1% or n = 288/307). Conclusions: This study has been able to identify potential barriers to the implementation of the UTT strategy at the selected facilities including the lack of structured programs in place to monitor performance of healthcare staff, knowledge gaps, and a lack of good clinical governance practices as evidenced by the lack of customized protocols and Standard Operating Procedures.

Download Full-text

Competency of health workers in detecting and managing gestational hypertension, pre-eclampsia, severe pre-eclampsia and eclampsia during antenatal check-ups in primary care health facilities in Bangladesh: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2020-046638 ◽

2021 ◽

Vol 11 (7) ◽

pp. e046638

Author(s):

Sk Masum Billah ◽

Abdullah Nurus Salam Khan ◽

S M Rokonuzzaman ◽

Nafisa Lira Huq ◽

Marufa Aziz Khan ◽

...

Keyword(s):

Primary Care ◽

Health Workers ◽

Gestational Hypertension ◽

Cross Sectional Study ◽

P Value ◽

Sectional Study ◽

Hypertensive Disorders Of Pregnancy ◽

Cross Sectional ◽

Hypertensive Disorders ◽

Care Facilities

Study objectiveTo evaluate the competency of trained health workers in detecting and managing hypertensive disorders of pregnancy during routine antenatal check-ups (ANCs) at primary care facilities in Bangladesh.Study design and settingsCross-sectional study; conducted in 26 primary care facilities.Outcome measuresAccurate diagnosis of the hypertensive disorders of pregnancy.MethodIn total 1560 ANC consultations provided by primary health workers, known as Family Welfare Visitors (FWVs), were observed using a structured checklist between October 2017 and February 2018. All consultations were reassessed by study physicians for validation.ResultOf the ‘true’ cases of gestational hypertension (n=32), pre-eclampsia (n=29) and severe pre-eclampsia (n=16), only 3%, 7% and 25%, respectively, were correctly diagnosed by FWVs. Per cent agreement for the diagnosed cases of any hypertensive disorders of pregnancy was 9% and kappa statistics was 0.50 (p value 0.0125). For identification of any hypertensive disorders by FWVs, sensitivity and positive predictive values were 14% and 50%, respectively. There was a moderate positive correlation between the blood pressure measurements taken by FWVs and study physicians. Only 27% of those who had ‘some protein’ in urine were correctly identified by FWVs. Women diagnosed with any of the hypertensive disorders of pregnancy by FWVs were more likely to be counselled on at least one danger sign of pre-eclampsia (severe headache, blurring of vision and upper abdominal pain) than those without any such diagnosis (41% vs 19%, p value 0.008). All four cases of severe pre-eclampsia diagnosed by FWVs were given a loading dose of intramuscular magnesium sulphate and three among them were referred to a higher facility.ConclusionThe FWVs should be appropriately trained on risk assessment of pregnant women with particular emphasis on accurately assessing the diagnostic criteria of hypertensive disorders of pregnancy and its management.

Download Full-text

Perinatally acquired HIV-positive status disclosure and associated factors in Dire Dawa and Harar, Eastern Ethiopia: a health facility-based cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2017-019554 ◽

2018 ◽

Vol 8 (8) ◽

pp. e019554 ◽

Cited By ~ 3

Author(s):

Melkamu Merid Mengesha ◽

Yadeta Dessie ◽

Aklilu Abrham Roba

Keyword(s):

Health Status ◽

Statistical Significance ◽

Cross Sectional Study ◽

Hiv Treatment ◽

Hiv Positive ◽

P Value ◽

Sectional Study ◽

Cross Sectional ◽

Eastern Ethiopia ◽

Dire Dawa

ObjectivesThe aim of this study was to assess the level and factors associated with caregivers’ disclosure of perinatally HIV-infected (PHIV+) children’s seropositive status.DesignWe conducted a cross-sectional study in five public health facilities providing HIV treatment and care in Dire Dawa and Harar, Eastern Ethiopia. The data were collected from 310 caregivers through face-to-face interviews and record reviews. Data analyses were done using STATA V.14.2 and statistical significance was declared at p value <0.05.ResultsThe study revealed that the level of PHIV+ diagnosis disclosure was 49.4% (95% CI 43.8 to 54.9). Mean age at disclosure was 11.2 years. Disclosure level was higher among children who frequently asked about their health status (aOR (adjusted OR) 2.04, 95% CI 1.04 to 4.03) and when caregivers knew other people who had a disclosure experience (aOR 2.49, 95% CI 1.17 to 5.32). Disclosure level was less among children of 12 years or below (aOR 0.04, 95% CI 0.02 to 0.09) and among caregivers practising deception about the children’s HIV positive status (aOR 0.38, 95% CI 0.19 to 0.74).ConclusionOnly half of the caregivers disclosed their child’s PHIV+ diagnosis. To facilitate disclosure, caregivers should be counselled about the appropriate age of disclosure and related misconceptions that hinder it. It is also apparent that caregivers need to be guided as to how to address children’s frequent questions about their health status. These interventions can be made in a one-on-one approach or through patient group counselling when they come to get healthcare services.

Download Full-text

Accessing antiretroviral therapy for children: Caregivers' voices

Health SA Gesondheid ◽

10.4102/hsag.v21i0.987 ◽

2016 ◽

Vol 21 ◽

pp. 331-338

Author(s):

Margaret Williams ◽

Dalena R.M. Van Rooyen ◽

Esmeralda J. Ricks

Keyword(s):

Antiretroviral Therapy ◽

Tertiary Care ◽

Scale Up ◽

Target Population ◽

Sub Saharan Africa ◽

Hiv Care ◽

Hiv Positive ◽

Eastern Cape ◽

Care Facilities ◽

Sub Saharan

Despite efforts to scale up access to antiretroviral therapy (ART), particularly at primary health care (PHC) facilities, antiretroviral therapy (ART) continues to be out of reach formany human immunodeficiency virus (HIV)-positive children in sub-Saharan Africa. In resource limited settings decentralisation of ART is required to scale up access to essential medication. Traditionally, paediatric HIV care has been provided in tertiary care facilities which have better human and material resources, but limited accessibility in terms of distance for caregivers of HIV-positive children. The focus of this article is on the experiences of caregivers whilst accessing ART for HIV-positive children at PHC (decentralised care) facilities in Nelson Mandela Bay (NMB) in the Eastern Cape, South Africa. A qualitative, explorative, descriptive and contextual research design was used. The target population comprised caregivers of HIV-positive children. Data were collected by means of indepth individual interviews, which were thematically analysed. Guba's model was usedto ensure trustworthiness. Barriers to accessing ART at PHC clinics for HIV-positive children included personal issues, negative experiences, lack of support and finance, stigma and discrimination. The researchers recommend standardised programmes be developed and implemented in PHC clinics to assist in providing treatment, care and support for HIV positive children.

Download Full-text

Factors Related to the Quality of Antenatal Care Based on The Complete Scope of the Examination of Pregnant Women in the Health Center at Palopo City

Journal of Health Science and Prevention ◽

10.29080/jhsp.v3i3s.294 ◽

2019 ◽

Vol 3 (3S) ◽

pp. 84-89

Author(s):

Dian Furqani ◽

Nuraerni Semagga

Keyword(s):

Antenatal Care ◽

Pregnant Women ◽

Gestational Age ◽

Statistical Significance ◽

P Value ◽

Service Access ◽

Maternal Knowledge ◽

Cross Sectional ◽

Maternal Characteristics

This study aims to see the factors that influence the quality of Antenatal Care in the City of Palopo; the type of design used is analytical descriptive with the Cross-Sectional Study approach. Samples from this study were all pregnant women based on 1, 2 and 3th-trimester pregnancy age, and 3 who were lived at the research location as many as 154 people who conducted inspection visits from January to March 2018. The results showed that the average age of the mother was 20 years. In the research statisticallly interconnected variables are maternal knowledge showed p-value (0.000). There are several variables have statistical significance, but there are differences in the percentage between the classification of each variabels as for the quality of Antenatal care associated with parity, maternal characteristics (age, education and occupation), antenatal care in each of the 1.2 trimester, and 3. Service access and economic welfare status, where each variable has a p-value> 0.005. The study expects that a health program should not look the quantity of maternal pregnancy visits, but pay attention to the examination checks received at each gestational age. We hope to encourage mothers to be more active in paying attention to the examinations that will be accepted based on their gestational age so that good health services and of recipients of services occur.

Download Full-text

Women’s perception and satisfaction with the quality of antenatal care services in mission hospitals in Benin City, Nigeria

Pyramid Journal of Medicine ◽

10.4081/pjm.2020.82 ◽

2020 ◽

Vol 3 (1) ◽

Author(s):

Collins Ejakhianghe Maximilian Okoror ◽

Ehigha Jude Enabudoso ◽

Maryjane Ifeyinwa Okoroh

Keyword(s):

Antenatal Care ◽

Statistical Significance ◽

Vital Role ◽

P Value ◽

Cross Sectional ◽

Nigerian Women ◽

Benin City ◽

Delivery Services ◽

High Level

Despite the vital role and availability of antenatal care, only a small proportion of Nigerian women utilise it. Women’s perception and satisfaction with antenatal care is believed to improve health outcomes, continuity of care, adherence to treatment, and the relationship with the provider. The aim is to ascertain the women’s perception and satisfaction with the quality of ANC services in mission hospitals in Benin City, Nigeria. This cross-sectional descriptive study was carried out among 405 pregnant women in their third trimester. Data collection was with a pretested interviewer-administered questionnaire and analysis with IBM SPSS Statistics version 21.0. Statistical significance was taken as P value <0.05. The women’s perception of doctors and nurses was good for all domains assessed. Their satisfaction was highest for cleanliness of the facility 336 (83.0%) and lowest for amount paid for delivery services 168 (41.5%). The overall satisfaction for services received was high 337 (83.2%). The religion of the respondents, gestational age at ANC booking, payment for booking, the delivery fee and availability of requisite resources to cater for the women showed statistically significance with the overall satisfaction. However, only religion (AOR = 17.450, 95% CI = 3.364-90.508) and availability of requisite resources (AOR = 4.629, 95% CI = 2.426-8.832) independently influenced their satisfaction. This study showed a high level of satisfaction with the services rendered. However, making services more affordable as well as improving their quality through investment in both human and material resources to deliver essential care to all clients will drive better satisfaction among them.

Download Full-text

Known HIV status among adolescent women attending antenatal care services in Eswatini, Ethiopia and Mozambique

Reproductive Health ◽

10.1186/s12978-021-01090-2 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Joel Njah ◽

Mary Ann Chiasson ◽

William Reidy

Keyword(s):

Antenatal Care ◽

Older Women ◽

Sexual And Reproductive Health ◽

Age Groups ◽

Hiv Prevalence ◽

Hiv Positive ◽

Hiv Status ◽

Pregnant Adolescents ◽

Women Living With Hiv ◽

Living With Hiv

Abstract Background Antenatal care (ANC) clinics remain important entry points to HIV care for pregnant women living with HIV—including adolescents. Prior knowledge of their HIV status at ANC enrollment is crucial to providing services for prevention of mother-to-child transmission (PMTCT) of HIV. We examined known HIV status of pregnant adolescents and women in other age groups at ANC enrollment. Methods A descriptive study of routinely reported PMTCT data from 419 facilities in Eswatini, Ethiopia, and Mozambique, from January through December 2018 was conducted. We assessed knowledge of HIV status by country for three age groups: adolescents aged 15–19 years, young women aged 20–24 years, and older women aged 25–49 years. We report HIV prevalence and proportions of known and newly diagnosed HIV infections in women, by age group and country. The data were summarized by frequencies and proportions, including their 95% confidence intervals. Results Among the facilities examined, 52 (12.4%) were in Eswatini, 63 (15.0%) in Ethiopia, and 304 (72.6%) in Mozambique. Across three countries, 488,121 women attended a first ANC visit and 23,917 (4.9%) were HIV-positive. Adolescents constituted 22% of all ANC attendees, whereas young and older women represented 33% and 45%, respectively. HIV prevalence was lowest among adolescents than in other age groups in Eswatini (adolescents 11.9%, young 24.2% and older 47.3%), but comparable to young women in Ethiopia (adolescents 1.6%, young 1.6% and older 2.2%) and Mozambique (adolescents 2.5%, young 2.5% and older 5.8%), However, in each of the three countries, lower proportions of adolescents knew their HIV-positive status before ANC enrollment compared to other age groups: in Eswatini (adolescents 51.3%, young 59.9% and older 79.2%), in Ethiopia (adolescents 42.9%, young 63.7% and older 75.2%), and in Mozambique (adolescents 16.4%, young 33.2% and older 45.6%). Conclusion Overall, adolescents made up nearly one-quarter of the women examined and had the least knowledge of their HIV status at ANC enrollment. Their HIV prevalence and known HIV-positive status varied widely across the countries examined. Adolescent-friendly sexual and reproductive health, and PMTCT services, before pregnancy, are needed to improve knowledge of HIV status and support pregnant adolescents and their infants. Plain English summary Antenatal care (ANC) clinics are important for HIV testing of pregnant adolescents, who may not know their HIV-positive status at the first ANC visit. We describe data on pregnant adolescents and women in other age groups in ANC services to examine their prior HIV status at ANC enrollment across three African countries. We examined data from 419 PMTCT sites in Eswatini, Ethiopia, and Mozambique from January-December 2018, to evaluate HIV testing results for adolescents, young and older women aged 15–19, 20–24 and 25–49 years, respectively. We report the number of women living with HIV and the proportions of known and newly identified women living with HIV, by age-group and country. Across three countries, 488,121 women attended ANC and 23,917 (4.9%) were living with HIV. Adolescents constituted 22% of all ANC attendees, whereas young and older women represented 33% and 45%, respectively. HIV prevalence in each country compared to other age groups was lowest and varied among adolescents from 11.9% in Eswatini, to 1.6% in Ethiopia and to 2.5% in Mozambique. Also, fewer adolescents knew their HIV-positive status before ANC enrollment compared to young and older women from 51.3% in Eswatini, 42.9% in Ethiopia to only 16.4% in Mozambique. Pregnant adolescents made up nearly one-quarter of all ANC attendees; a majority of them had no previously known HIV-positive status. Adolescent-friendly, sexual and reproductive health services, before pregnancy and in PMTCT services, are needed to support pregnant adolescents and their infants.

Download Full-text