knowledge of hiv among pregnant women

Description

ABSTRACT
Background: According to a WHO report, HIV/AIDS continues to be a major global public health issue, having claimed 36.3 million in 2021 and 37.7 million people living with HIV at the end of 2020, more than two-thirds of whom were in the WHO African Region including Africa. Among sub-Saharan Africa, Nigeria is one of the countries that face an HIV/AIDS epidemic with an estimated 90,000 HIV-positive pregnant women, 14,000 HIV-positive births, 800,000 AIDS orphans, and 28,000 AIDS deaths annually. Thus, this study assessed the knowledge of pregnant women towards the prevention of mother-to- child transmission of HIV.
Methods: A hospital-based cross-sectional study was conducted in Umaru Shehu General Hospital among 242 pregnant women. The simple random sampling method was used to collect the data and respondents were interviewed face to face by using a standard and structured questionnaire. The quality of the data was assured by questionnaire pretesting, translation, and retranslation. After the collection of the data, each questionnaire was thoroughly reviewed for consistency, and completeness by the data collectors, super- visor, and investigators. Then, the data were inserted into Epi Info v3.5 and analyzed using SPSS v24. Descriptive statistics were employed to examine the findings, and the result was presented using tables, charts, and graphs.
Results: Two-third (66.7%) of the pregnant women had good knowledge and the remaining one-third (33.3%) had poor knowledge towards mother to child transmission of HIV/AIDS and its prevention. A good attitude has been observed among a majority of the respondents (71%) towards the prevention of mother-to-child transmission of HIV/AIDS. Unlike the above, only half of the pregnant women (50%) had good practice towards the prevention of mothers to child transmission of HIV/AIDS.
Conclusion: This study found that half of pregnant women (50%) had poor practice and around one-third of them (29%) had negative attitudes towards the prevention of mother-to-child transmission of HIV/AIDS. Therefore, creating a positive attitude and good practice among pregnant women are the most important components for the prevention of mother-to-child transmission of HIV/ AIDS.

COVER PAGE
II. CERTIFICATION
III. DEDICATION
IV. ACKNOWLEDGEMENT
V. ABSTRACT:
CHAPTER ONE
INTRODUCTION
1.1 BACKGROUND OF THE STUDY
1.2 STATEMENT OF THE PROBLEM
1.3 AIM AND OBJECTIVES OF STUDY
1.4 RESEARCH QUESTIONS
1.5 RESEARCH HYPOTHESES
1.6 SIGNIFICANCE OF THE STUDY
1.7 SCOPE AND LIMITATION OF THE STUDY
1.8 DEFINITIONS OF TERMS
1.9 ORGANIZATION OF THE STUDY
CHAPTER TWO
LITERATURE REVIEW
2.1 REVIEW OF THE STUDY
2.2 HIV AMONG PREGNANT WOMEN REVIEWED
2.3 EPIDEMIOLOGY OF HIV
2.4 SUSCEPTIBILITY OF WOMEN TO HIV INFECTION
2.5 EFFECT OF PREGNANCY ON THE NATURAL HISTORY OF HIV INFECTION
2.6 EFFECT OF HIV INFECTION ON PREGNANCY
2.7 MOTHER-TO-CHILD TRANSMISSION
2.8 FACTORS AFFECTING MOTHER-TO-CHILD TRANSMISSION OF HIV-1
CHAPTER THREE
METHOD
3.1 STUDY AREA
3.2 STUDY DESIGN AND PARTICIPANTS CHARACTERISTICS
3.3 SAMPLE SIZE DETERMINATION AND TECHNIQUE
3.4 MEASUREMENT AND DATA COLLECTION PROCEDURE
3.5 DATA QUALITY CONTROL
3.6 DATA PROCESSING AND ANALYSIS
CHAPTER FOUR
RESULTS/ANALYSIS
4.1 RESULTS AND DISCUSSION
CHAPTER FIVE
CONCLUSION AND RECOMMENDATION
REFERENCES

CHAPTER ONE
1.0 INTRODUCTION
1.1 BACKGROUND OF THE STUDY
Mother-To-Child Transmission (MTCT) is responsible for more than 700,000 estimated new HIV infections in children worldwide yearly. In a single day, more than 1800 babies contract HIV from their mothers worldwide; and many of these cases occur in Africa. The probability of infection from mothers who do not receive treatment is higher in Africa (25% – 52%) than the United States (US) or Europe (12%-30%).
Human Immunodeficiency Virus (HIV) is easily transmitted through unprotected (i.e. without condom use) anal intercourse (penis in anus) than other sexual activities. It is also more likely to be transmitted to the receptive partner than the insertive partner in both vaginal (8/10,000 exposures) and anal (138/10,000 exposures) intercourse. Thus, women are more vulnerable to HIV infection because they are more often the receptive partners, especially in sub-Saharan Africa. In the world today, Nigeria accounts for about 10% of all HIV/AIDS cases. Women constitute 57% of adults infected with HIV in Nigeria, a prevalence which is higher than that of the global figure of 48%. Sixty percent of new infections occur in the 15 – 25-year-old age group but the prevalence is highest among productive young people between the ages of 20 – 29 years. Heterosexual transmission accounts for 80% of all infections. The pandemic is having a ruinous effect on the reproductive health of women in Nigeria. The number of HIV-positive women has increased, with an attendant alarming increase in the number of HIV-positive children in recent years. In 2007, around 370,000 children under 15 became infected with HIV, mainly through mother-to-child transmission. About 90% of these MTCT infections occurred in Africa where AIDS is beginning to reverse decades of steady progress in child survival. In high income countries of the world, MTCT has been virtually eliminated thanks to effective voluntary testing and counseling, access to antiretroviral therapy, safe delivery practices, and the widespread availability and safe use of breast-milk substitutes. If these interventions were used worldwide, they could save lives of thousands of children each year. Hence, there is an urgent need to combat this menace. The “Prevention of Mother-to-Child Transmission of HIV” service was started in October 2003 at Aminu Kano Teaching Hospital, Kano. Following the designation of this center as a service center for the program of prevention of mother-to-child transmission, a committee was formed, which involved pediatricians, obstetricians, nurses, pharmacists, public health physicians and counselors to run the program. It is therefore pertinent to determine the knowledge and awareness about HIV/ AIDS and mother-to-child transmission among mothers attending the pediatric HIV clinic. The information obtained will influence the counseling and education of patients and the community about HIV/AIDS. This will further decrease mother- to- child transmission of HIV/AIDS.
Results of the Nigeria Demographic Health Survey of 2003 showed that among pregnant women attending antenatal care clinics only 24.3% (44.4% urban and 16.2% rural) had been counselled about HIV; 79.2% of women and 82.5% of men had never been tested for HIV; and, 46% of women as compared to 56.4% of men knew that mother-to- child transmission is possible. In addition, 60% of pregnant women (83% of urban and 51% of rural women surveyed) made use of antenatal care services, while 2.5% had visited traditional birth attendants (TBAs). But only 32.6% (54.2% urban and 23.8% rural) had their babies delivered in a health facility, while 66.4% had delivered at home (National Population Commission & ORC Marco, 2004).
Antenatal VCT is one of several interventions used to reduce MTCT. In a survey of health and laboratory facilities in all six zones of Nigeria, the data that were collated and analysed concerning an individual’s reason for HIV testing at the surveyed laboratory facilities showed that only 16.3% of those surveyed had used voluntary testing services (Idigbe, Ibrahim, Ubane, Onwujekwe, Esan, Otoh & Ade-doyin, 2000). However, accurate data on the acceptability of HIV testing among pregnant women in Nigeria are scarce, but given the trend of rising HIV infection among pregnant women (National AIDS/STDs Control Programme, 1999) and the promotion of exclusive breastfeeding in the country (Esan, 1997), one would expect a high incidence of mother-to-child HIV transmission. Even so, the success of antenatal VCT is dependent upon women’s and communities’ knowledge and perceptions of HIV. Despite increasing HIV prevalence among women using antenatal clinics in Nigeria (National AIDS/STDs Control Programme, 2002), very little is known about their know-ledge and perceptions of HIV. Such information is important for understanding and determining the likelihood that pregnant women will accept and seek VCT-which would contribute to preventing MTCT, through increased acceptability and demand for confidential antenatal HIV testing, and so prepare for the scaling-up of Nevirapine therapy in the country. Knowledge of this is important if any serious impact is to be made by 2010 to meet the internationally agreed global goal (declared by governments during the United Nations General Assembly Special Session [UNGASS] on HIV/AIDS in June 2001) to reduce by at least one-third the mortality of infants and children under age five during the decade 2001–2010, and by two-thirds by 2015. These goals are to be achieved by reducing the proportion of the infant population infected with HIV by 2% by 2005, and by 50% by 2010, by ensuring that 80% of pregnant women accessing antenatal care have information, counselling and other HIV-prevention services available to them; increasing the availability and access to treatment to reduce MTCT; effective interventions for HIV-positive women including VCT; access to treatment using antiretroviral therapy and, where appropriate, breastmilk substitutes; and the provision of a continuum of care (WHO, 2003a and 2003b). This is vital in view of the over-riding goal of Nigeria’s national policy on HIV/AIDS and sexually transmitted infections (STIs), which is to reduce HIV prevalence to less than 1% of the country’s population by 2010 (National AIDS/STDs Control Programme, 2002). Realizing this, it becomes imperative to investigate pregnant women’s knowledge and perceptions about HIV, particularly as it concerns transmission to infants during birth or breastfeeding (Berer, 1999). Because the prevention of mother-to-child transmission of HIV (MTCT) programme with Nevirapine therapy for HIV-positive pregnant women has commenced in selected health institutions across the country (National AIDS/STDs Control Program, 2002), data on the grassroots knowledge of pregnant women can inform planning, policy development, advocacy and counseling plans.
1.2 STATEMENT OF THE PROBLEM
Despite improvements in PMTCT services over the years, MTCT of HIV infections is high especially in Nigeria. Despite increasing HIV prevalence among women using antenatal clinics in Nigeria (National AIDS/STDs Control Programme, 2002), very little is known about their know-ledge and perceptions of HIV. Such information is important for understanding and determining the likelihood that pregnant women will accept and seek VCT-which would contribute to preventing MTCT, through increased acceptability and demand for confidential antenatal HIV testing, and so prepare for the scaling-up of Nevirapine therapy in the country. Knowledge of this is important if any serious impact is to be made by 2010 to meet the internationally agreed global goal (declared by governments during the United Nations General Assembly Special Session [UNGASS] on HIV/AIDS in June 2001) to reduce by at least one-third the mortality of infants and children under age five during the decade 2001–2010, and by two-thirds by 2015. The researcher intend to assess the knowledge of HIV among pregnant women in Borno State. Knowledge of the interventions of PMTCT is important, so that pregnant women can be aware and through motivation they can have a positive attitude towards PMTCT.

1.3 AIM AND OBJECTIVES OF THE STUDY
The main aim of this research is to examine the knowledge of hiv among pregnant women in Borno State. However, the specific objectives of this research are:
i) To examine pregnant women’s attitude towards antiretroviral drugs in prevention of Mother-to-Child Transmission of HIV
ii) To examine the role of the hospitals in the utilization of PMTCT services
iii) To investigate the pregnant women’s knowledge of Prevention of Mother- to-Child Transmission of HIV (PMTCT) services
iv) To understand the perceptions of pregnant women towards prevention method as a factor in preventing the spread of sexually transmitted diseases (HIV/ AIDS) to their unborn child.

1.4 RESEARCH QUESTIONS
1. To what extent has the society try to educate its pregnant women about HIV/AIDS?
2. Does economic status and educational background among women determine pregnant women’s knowledge of HV/AIDS?
3. Are the married men responsible for HIV/AIDS among pregnant women?

1.5 RESEARCH HYPOTHESES
H0: There is no relationship in the knowledge of HIV/ AIDS and the prevention of the disease among pregnant women in Borno state.
H1: There is a relationship in the knowledge of HIV/ AIDS and the prevention of the disease among pregnant women in Borno state.
H0: Economic status and educational background among women does not determine pregnant women’s knowledge of HV/AIDS.
H2: Economic status and educational background among women determine pregnant women’s knowledge of HV/AIDS.

1.5 SIGNIFICANCE OF THE STUDY
Human Immune deficiency Virus (HIV) and acquire immune deficiency syndrome (AIDS) has continue to be the major concern not only to Borno State Government but the Federal Government and the entire world. Specifically, the study will be beneficial to pregnant women, to follow recommended steps and advices that will help fight against mother to child transmission of HIV. To doctors and mid-wives on administering necessary care, counselling, to pregnant women during antenatal and prenatal check-ups. To the women generally in the area of public-enlightenment, on the need to follow doctor’s directives on adequate medication during pregnancy. This study will also serve as a pioneer effort towards the understanding of HIV/ AIDS among antenatal attendees in Maiduguri Teaching Hospital, Borno State. The result of this study may help policy maker’s particularly educational planners in Borno State to design more appropriate instructional programme on HIV/ AIDS. Finally, the findings of this study will serve as a reference point to scholars that chose to embark on a project of this nature.

1.6 SCOPE AND LIMITATION OF THE STUDY
This study centers on examining the knowledge of HIV among pregnant women in Borno State, specifically antenatal attendees in Maiduguri Teaching Hospital. In the course of the study, the researcher encounters some constraints which limited the scope of the study;
Time: the time at the disposal of the researcher which was allocated for the study was a major limitation as the researcher had to combine other academic activities with the study.
Finance: The finance at the disposal of the researcher in the course of the study could not permit wider coverage as resources are very limited as the researcher has other academic bills to cover.
Availability of research material: The research materials available to the researcher at the time of this study were insufficient, thereby limiting the study.

1.7 DEFINITIONS OF TERMS
Pregnancy: Pregnancy, also known as gestation, is the time during which one or more offspring develops inside a woman. A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy can occur through sexual intercourse or assisted reproductive technology. Childbirth typically occurs around 40 weeks from the last menstrual period (LMP).
HIV: HIV is a member of the genus Lentivirus, part of the family Retroviridae. Lentiviruses have many morphologies and biological properties in common. Many species are infected by lentiviruses, which are characteristically responsible for long-duration illnesses with a long incubation period. Lentiviruses are transmitted as single-stranded, positive-sense, enveloped RNA viruses.
Knowledge: Knowledge is a familiarity, awareness, or understanding of someone or something, such as facts, information, descriptions, or skills, which is acquired through experience or education by perceiving, discovering, or learning.
PMTCT: Prevention of mother-to-child transmission (PMTCT) programmes provide antiretroviral treatment (ART) to HIV-positive pregnant women to stop their infants from acquiring the virus.
MTCT: this is an acronym for Mother-to-child transmission.

1.8 ORGANIZATION OF THE STUDY
This research work is organized in five chapters, for easy understanding, as follows. Chapter one is concern with the introduction, which consist of the (background of the study), statement of the problem, objectives of the study, research questions, research hypotheses, significance of the study, scope of the study etc. Chapter two being the review of the related literature presents the theoretical framework, conceptual framework and other areas concerning the subject matter. Chapter three is a research methodology covers deals on the research design and methods adopted in the study. Chapter four concentrate on the data collection and analysis and presentation of finding. Chapter five gives summary, conclusion, and recommendations made of the study.

CHAPTER FIVE

5.1  CONCLUSIONS AND RECOMMENDATION

The study found that 66.7% of pregnant women had good knowledge but half of them (50%) had poor practice and around one-third of the pregnant women (29%) had negative attitudes towards the prevention of mother-to-child transmission of HIV/AIDS.

There was an encouraging level of knowledge of mothers were not satisfactory towards mother-to-child transmission of HIV/AIDS and its prevention. These imply that big and collaborative effort is needed to compact mother-to-child transmission of HIV/AIDS. Therefore, increasing knowledge among pregnant women are the most important components for the prevention of mother-to-child transmission of HIV/AIDS.

Strength and Limitation of the Study

There was no same study in the study area so that it can be used as a baseline for other studies. It also helps to conduct an interventional study in a particular area.

It was not possible to establish a temporal relationship between the exposure and outcome variable as this study design was a cross-sectional study. The result may not be representative of entire pregnant mothers in Ethiopia due to the small sample size. We recommend other researchers conduct a study to test the relationship between the variables that affect knowledge, attitude, and practice of pregnant women towards the prevention of mother-to-child transmission of HIV.

LIST OF ABBREVIATIONS

AIDS, acquired immune deficiency syndrome;

ANC, antenatal care; ART, antiretroviral therapy;

ARV, anti-retro viral;

FMOH, Federal Ministry of Health;

HIV, human immune deficiency virus;

IEC, information, education, and communication

MCH, maternal and child health; MOH, Ministry of Health;

MTCT, mother to child transmission;

PMTCT, prevention of mother to child transmission;

UNAIDS, Joint United Nations Program on HIV/ AIDS;

UNICEF, United Nation Children’s Fund;

VCT, voluntary counseling and testing;

WHO, World Health Organization.