KNOWLEDGE, ATTITUDE AND PRACTICE TOWARDS PREVANTION OF MOTHER TO CHILD TRANSMISSION OF HIV/AIDS AMONG PREGNANT MOTHERS

ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICE TOWARDS PREVANTION OF MOTHER TO CHILD TRANSMISSION OF HIV/AIDS AMONG PREGNANT MOTHERS ATTENDING ANC OF DILLA UNIVERSITY GENERAL HOSPITAL , GEDEO ZONE, SNNPRS ,ETHIOPIA, 2023

1. DILLA UNIVERSITY SCHOOL OF MEDICINE AND HEALTH SCIENCE DEPARTMENT OF PUBLIC HEALTH ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICE TOWARDS PREVANTION OF MOTHER TO CHILD TRANSMISSION OF HIV/AIDS AMONG PREGNANT MOTHERS ATTENDING ANC OF DILLA UNIVERSITY GENERAL HOSPITAL , GEDEO ZONE, SNNPRS ,ETHIOPIA, 2023 BY:-DIGAFE GEDECHO 1

2. OUTLINE OF PERSENTATION Introduction Conceptual frame work Objectives Methods and materials Result Discussion Conclusion and recommendation Acknowledgement References 2

3. 1.INTRODUCTION 1.1 Background The HIV infection which causes the AIDS continues to be a serious global problem. An estimated 34 million people worldwide are infected with HIV, 52% of who are women. Of these, 3.4 million are children under 15 years of age, 90% of whom live in SSA. MTCT of the virus during pregnancy, labor and breastfeeding, is responsible for an estimated 20% of all HIV infections and more than 95% of pediatrics HIV transmissions (WHO,UNAIDS and UNICEF(2009)). 3

4. In sub-Saharan Africa, where about two-thirds of the global disease burden resides, 57% of adults living with HIV are women. As more women contract the virus, the number of children infected from their mothers has been growing Ethiopia has one of the largest populations infected with HIV with approximately 1.5 million people are living with the virus. According to UNAIDS, general HIV knowledge is remains low in Ethiopia with just over 25 percent of men and under 25 percent of women having accurate knowledge on HIV prevention (UNAIDS,1999-2000). 4

5. 1.2 Statement of the Problem Worldwide HIV/AIDS had created an enormous challenge on the survival of human kind. Since its recognition, the virus has infected 65 million individuals and over 33 million already died due to AIDS . Currently , over 42 million people are living with the virus, and of these more than 70% are in SSA. Without any preventive interventions, nearly 50% of HIV positive mothers will transmit HIV to their children during pregnancy, labor and breastfeeding (UNAIDS(2011)). Not surprisingly, inadequate continuum of care, magnitude of PMTCT and associated services including HIV testing and counseling and ARV prophylaxis are still very low in developing countries (WHO,UNAIDS and UNCEF(2009)) 5

6. …Cont Various factors contribute to the high burden of pediatric HIV infection in Ethiopia and other sub-Saharan African countries.( Gurmu tesfaye and etalAIDS,2014). The research done in Hawassa referral Hospital showed that only about half (48.3%) of the respondents knew that antiretroviral drugs given for sero -positive pregnant mothers could reduce the risk of transmission ( Amanuel A,Abajobir and Agegnehu,2013). The research done in Ambo Hospital showed that only 44.4% of respondents knew that ART reduce maternal to child transmission ( Gurmu tesfaye and etalAIDS,2014). Therefore this study was designed to assess knowledge,attitude and practice of PMTCT. 6

7. Cont… Since 2011,the global community has committed itself to accelerating progress for the PMTCT initiative to eliminate new pediatric HIV infections and improve maternal,newborn and child survival with in context of HIV(WHO/UNCEF and UNAIDS,2011). 1.3 Significance Of The Study This research project is significant to health planner and health care provider to initiate to solve any health risks that cannot have idea and knowledge about PMTCT. Moreover , the results of this study help healthcare institutions to recognize mothers knowledge, attitude and utilization of PMTCT service. Finally it used as a reference and indication of gaps for further study related to the problem in the study area . 7

8. 2. CONCEPTUAL FRAME WORK Figure:- conceptual frame work showing factors influencing utillization and knowledge about PMTCT service Socio-demographic factors - Age
-Marital status
-Educational status -Occupation
-Income of family Cultural and Individual factors -Stigma and descrimination -partner/husband
permission Obstetric factor - Number of ANC visit
-Gestational age
-place of last delivery Institutional factors -Cost of transportation
-Distance of hospital
-Absence of counsilar MTCT of HIV/AIDS 8

9. 3.OBJECTIVES 3.1 General Objective To assess the knowledge, attitude, and practice towards prevention of Mother -to -child transmission of HIV/AIDS among pregnant mothers attending Antenatal Care (ANC) at DUGH,2023. 3.2 Specific Objectives To determine knowledge on prevention of mother-to-child transmission of HIV/AIDS among pregnant mothers attending antenatal care at DUGH,2023. To determine attitude towards prevention of mother-to-child transmission of HIV/AIDS among pregnant mothers attending antenatal care at DUGH,2023. To determine practice on prevention of mother-to-child transmission of HIV/AIDS among pregnant mothers attending antenatal care at DUGH,2023. 9

10. 4. METHODS AND MATERIALS 4.1 Study Area and period The study was conducted in ANC of dilla university general Hospital which is located at Dilla town, Gedeo zone, south, nation, nationality people and regional state, 360Km away from Addis Ababa which is a capital city of Ethiopia. Study period : This research was conducted from August 17 to September 17,2023. 4.2 Study Design An institutional based descriptive cross-sectional study was conducted. 10

11. 4.3. Source and study population 4.3.1 . Source Population All pregnant mothers attending ANC at dilla university general hospital 4.3.2 . Study population All selected pregnant mothers attending ANC follow up during study period 4.3.3 . Sampling Unit Pregnant women 4.4. Eligibility criteria
4.4.1. Inclusion criteria All pregnant mothers who were attending regular ANC follow up during data collection period was included 4.4.2. Exclusion Criteria Pregnant mothers who were critically ill among these who attending ANC follow up was excluded. 11

12. 4.5 Sample size determination and sampling technique The following sample size determination formula was used. n= ( Zα /2) 2 p (1-p) d 2 Where; n =sample size Z= 95% confidence interval =1.95 P= prevalence rate. d= margin of error (5%) By using the data from the previously done research by gurmu tesfaye 2014 at ambo hospital the assessment of knowledge, attitude and practice is 44.4%, 93.5% and 36.38% respectively(Gurmu tesfaye,2014) and then knowledge was selected because it gives maximum sample size 12

13. Variable Prevalence Marginal error CI n(sample size) Knowledge 0.44 5% 95% 375 Attitude 0.93 5% 95% 99 Practice o.36 5% 95% 350 Using the above formula; n= 1.96 2 0.44(1-0.44) 0.05 2 n=375; the sample size required for this study was 375. 13

14. 4.5.2 Sampling procedure The sample was taken from DUGH ANC follow up. Mothers were selected by systematic random sampling technique, From reproductive age (18-49) groups those who are pregnant mothers attending ANC follow up at the time of data collection. 4.6. Study variables Knowledge of mothers to PMTCT. Practice of mothers to PMTCT Attitude of mothers to PMTCT 14

15. 4.7. Data Collection Procedure 4.7.1. Data Collection Instrument The data was collected using questionnaire adapted from prior different literature developed for similar purpose by different authors . 4.7.2. Data Collection Method The data was collected through face to face interview in each pregnant mother after got informed consent. The questionnaire was prepared in english and translate into the amharic and other local language and then checked for consistency by translating it back to english . 15

16. 4.8. Operational Definition Knowledge:-- Those respondents who got three and more right answer from 5 knowledge question were considered to have good knowledge otherwise poor( Gurmu tesfaye and etalAIDS,2014 ) Attitude:- Those respondents who answer three and more from five attitude question were considered to have good attitude otherwise poor ( Gurmu tesfaye and etalAIDS,2014 ) Pr actice :- Those respondents practice three and more practice questions were considered to have good practice otherwise poor( Gurmu tesfaye and etalAIDS,2014 ) 16

17. 4.9 Data Quality Controls Pre test was conducted from 5% of the study population and the necessary modification was taken,the pretest was done another health facility. The data collection process was closely supervised and the collected data was cross cheeked on every day activity for consistency and completeness of data. 4.10 Data Processing And Analysis The collected data was entered and analyzed by using SPSS version 21 which wassummarized in to a frequency tables, charts and graphs. 17

18. 4.11 Ethical Considerations College of medicine and health sciences, department of public health was approved the study protocol. The officials at different level were communicated by letter from college of health science and the administrator was requested to give consent for data collection in the hospital. So that the responsible body were informed in the study. The participation was voluntary based, they were informed that they had the right to withdraw from the interview immediately during data collection. Data collector respected the community culture, custom and other value and benefits during the data collection periods 18

19. 4.12 Dissemination Plan At the end of the study, the result was presented to Dilla university school of public health science and disseminated to the concerned stakeholders. The result of the study was disseminated to DUGH and to the concerned stakeholders. 19

20. 5 . Result 5.1 . Socio demographic and economic characteristics A total of 375 women responded to the questionnaire, Majority 192 (51%) of the women were within the age group of 20-24 years . From the respondents, 67(17.9%) of them cannot read and write, 52 (13.9%) can read and write, 88(23.5%) had primary education, while 89 (23.7%) and 79(21.1%) had secondary and above secondary educational status respectively . 20

21. Table01: socio demographic characteristics of pregnant mothers attending ANC at dilla general hospital sept, 2023 Category Frequency Percent 15-19 4 1 20-24 192 51 25-30 102 27 30-34 33 9 35-40 41 10 >=40 3 0.8 Married 337 89.9 Divorced 18 4.8 Widowed 14 3.7 Unmarried 6 1.6 Total 375 100.0 Variable Age Martal status 21

22. Orthodox 95 25.3 Muslim 17 4.5 Protestant 263 70.1 Total 375 100.0 can read and write 52 13.9 Not read and write 67 17.9 Primary school 88 23.5 Secondary school 89 23.7 Diploma and above 79 21.1 Total 375 100.0 Farmer 67 16.8 House wife 193 51.5 Merchant 51 13.6 Govt employer 68 18.1 Total 375 100.0 Religion Educational status Occupation 22

23. 5.2. Reproductive health history Most of the 226 (90%) of the women had ANC follow up during last pregnancy. From the respondents, 150 (40%) had two times ANC Visit for the current pregnancy followed by three times 112 (29.9%), one 76 (20.3%) and four times 37(9.9%) visit during their pregnancy respectively. According to respondents, 158(63%)of the women delivered their last child at HC, 26(10.3%) were delivered in at home. 23

24. Table 02: Reproductive history of pregnant mothers attending ANC in Dilla general hospital Sept,2023. Category Frequency Percent Para one 124 33 Multipara 231 62 Grand multipara 20 5 Yes 226 90 No 25 10 One 76 20.3 Two 150 40.0 Three 112 29.9 Four and above 37 9.9 One 94 37.4 Two 103 41 Three 34 13.5 Four 7 2.8 Five and above 13 5.1 Variable Parity ANC during last pregnancy Current ANC visit Number of alive child 24

25. Home 26 10.3 Health center 158 63 Hospital 55 22 Private clinic 10 4 Others 2 7 Delivery place of last pregnancy 25

26. 5.3. Knowledge of women on mother-to-child transmission of HIV/AIDS and its prevention This study attempted to assess the knowledge of pregnant mothers attending ANC on MTCT of HIV. Accordingly, all of the respondents heard about HIV/AIDS and,360 (96%) about possibility of MTCT of HIV. The study assessed the knowledge on PMTCT of HIV/AIDS of the pregnant attending the hospital. Among the respondents, 348 (96.7%) knew PMTCT of HIV and the remaining 12(3.3%) didn't know possibility of PMTCT. Generally most of the respondents, 348 (92.8%) had good knowledge towards PMTCT of HIV, while only 27(7.2%) had poor knowledge . 26

27. Table 3: knowledge of women on mother to child transmission of HIV/AIDS and prevention among pregnant mother attending ANC at dilla general hospital Sept,2023. Category Frequency Percent Yes 375 100.0 No Yes 360 96 No 15 4.0 Total 375 100.0 During pregnancy 63 17.5 During labor 24 6.7 Breast feeding 29 8.0 In all 232 64.5 Do not know 12 3.3 Yes 348 96.7 No 12 3.3 Total 360 100.0 Variable Have you ever heard about HIV Possibility of MTCT of HIV Time of mother to child transmission of HIV/AIDS Possibility of PMTCT 27

28. ART use 28 8 Use condom 72 21 Delivery health institution 170 48.5 Use contraceptive 19 5.5 Inhibit breastfeeding 26 7.5 Do not know 33 9.5 Total 348 100.0 Infant formula 74 62 Cow milk 127 15 Beast feeding for 6 months only 54 19 Others 6 4 Health institution 229 64 Mass media 71 20 Friends 52 14 Others 8 2 Total 360 100.0 Methods of HIV prevention PMTCT Feasible infant feeding option Source of information 28

29. 5.4 . Attitude of respondents towards PMTCT The study have showed that most of the respondents, 320(85%), had good attitude towards PMTCT of HIV, while only 55(15%) had poor attitude. Majority of the respondents, 252(67.2%) have shown their willingness to support their spouses that tested positive for HIV. Most of the respondents, 365 (95%), would agree to testing and counseling, and only 6 (1.3%) would not agree and the remaining 14(3.7%) were neutral. Among the respondents, 358(96%) were agree to every HIV positive pregnant mother must delivered at health center . 29

30. Table 4: Attitude of PMTCT of HIV/AIDS among pregnant women attending ANC at dilla general hospital Sept, 2023. Category Frequency Percent Support 252 67.2 Separate 53 14.1 Divorce 70 18.7 Total 375 100.0 Strongly agree 168 45 Agree 187 50 Hesitate 6 1.3 No option 14 3.7 Total 375 100 Strongly agree 227 61 Agree 131 35 Hesitate 14 3.5 No option 2 0.5 Total 375 100 Variable What you will do if your spouse is sero positive Pregnant women should be test and counseled HIV infected pregnant mother must delivered at health institution 30

31. Strongly agree 178 47.5 Agree 152 40.5 Hesitate 2 5 No option 43 11.5 Total 375 100.0 Strongly agree 150 40.0 Agree 170 45.3 Hesitate 22 5.9 No option 33 8.8 Total 375 100.0 HIV positive mother should take ART drug during pregnancy HIV positive women should not breast feed her child if there is risk of infection 31

32. 5.5 Practices of prevention of mother to child transmission of HIV/AIDS As the study indicated that most of the respondents, 290(77.5%) had good practice towards PMTCT. Most of the respondents, 350(93%) have been tested for HIV. From the respondents, 300(80%) had taken post-counseling services. Among respondents 138 (36.8%) reported that breast feeding by HIV positive mothers is not encouraged . 32

33. Table 5: practice of PMTCT of HIV/AIDS among pregnant women attending ANC at dilla general hospital Sept, 2023. Category Frequency Percent Yes 350 93 No 25 7 Total 375 100 Yes 300 80 No 50 20 Total 350 100 Three month ago 40 11 Six month ago 43 12 One year ago 132 38 Upon recent pregnancy 135 39 total 350 100.0 Yes 294 84 No 56 16 Total 350 100.0 Variable Tested for HIV Have you taken post counseling service Time of last HIV test Sharing test resulting with husband 33

34. Encouraged 237 63.2 Not encouraged 138 36.8 Total 375 100.0 Encouraged if advisable 295 78.7 Not encouraged 80 21.3 Total 375 100.0 Breast feeding by HIV positive lactating mothers The use of condom with spouse 34

35. 6.Discussion In this study, all of the respondents heard about HIV/AIDS. This finding was the same with other studies done in Ethiopia (i.e. in Ambo hospitals and Hawassa referral Hospital)[ Amanuel A. Abajobir and A gegnehu B. Zeleke AIDS,2013 and Gurmu TesfayeBachu Tufa and etalAIDS ]. This may be because of the global or universal nature of the problem. The study which conducted in Hawassa hospital from respondents 90.1%, 82.3% were knowledgeable in both MTCT and PMTCT of HIV respectively but our study were a little bit greater in which the respondents were knowledgeable to MTCT and PMTCT 96%,96.7% respectively. 35

36. But this study result was less than research done in ambo hospital in which all of respondents were knowledgeable with MTCT and possibility of PMTCT. In this study most of respondents 348(92.8%) had good knowledge, while only 27(7.2%) had poor knowledge. This study have showed that most of the respondents, 320 (85%), had good attitude towards PMTCT of HIV, and 55(15%) had poor attitude. By this the result of this study is less when compared with Ambo Hospital and Hawassa University referral Hospital which have showed that most of the respondents, 93.6%, 97.4% had good attitude towards PMTCT of HIV, while only 6.4%, 2.6% had poor attitude respectively ( Amanuel A. Abajobir and A gegnehu B. Zeleke AIDS,2013 ). 36

37. This study have showed that from the respondents, (95%), would agree to testing and counseling of pregnant women’s, 6(1.3%) would not agree and 14(3.7%) were neutral. This is may be due to health education is provided prior to the study, as this study indicated 290(77.5%) had good practice 7.Conclusion Generally most of the respondents above 2/3 had good knowledge towards PMTCT of HIV while only a small number of respondents had poor knowledge. Most of the respondents had good attitude towards PMTCT of HIV, less than 1/3 had adequate attitude while a little had poor attitude. 37

38. Most of the respondents had good practice towards PMTCT while small number had poor practice. Majority of the respondents have shown their willingness to support their spouses that tested positive for HIV. 8. Recommendation I recommend health office of dilla town should collaborate with health extension, hospital and health center workers to Work on and promoting home-based care And provision of care and support with special emphasis on sero -positive pregnant mothers creating a strong formal linkage or networking between health facilities, to maximize the service coverage 38

39. Lastly I recommend dilla university to collaborate with concerned body and arrange health education program aimed at alleviating the spread of HIV/AIDS and halting the child and maternal mortality due to HIV/AIDS and related opportunistic infections. 39

40. ACKNOWLEDGEMENT First of all I would like to thank the almighty God. Then I would like to express my heartfelt and deepest gratitude to my advisor SEGLEWONGEL G.(BSC,MPH) for her encouragement, constructive advice, helpful suggestion, guidance while writing this paper. Next, I would like to thank dilla university college of medicine and Health science and department of Public health, for their high cooperation in the writing process of research papar , assigning the required advisors and giving the chance to develop this research paper that was helpful for my study. 40

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42. 7. UNAIDS, 1999-2000.The impact of VCT. A global review of the benefits and challenges of testing Geneva: UNAIDS. 8. World Health Organization and USAIDS: Guidance on Provider-Initiated HIV Testing and Counseling in Health Facilities. Geneva, Switzerland: WHO; 2006 9. WHO/UNAIDS/UNICEF (2007) Towards universal Access scaling up priority HIV/AIDS Intervention in the health sector. Progress report, Ethiopia. 10. UNAIDS/WHO 2004,Mirtuzie,Hindereker and Morkve ,2010. 11.(2014), centhre for disease control and prevention WHO, PEPFAR (President's energay plan for AIDS relief) 12.UNAIDS (2013) report on the global AIDS endemic Geneva . 42

43. 13. WHO, UNAIDS, and UNICEF (2009) towards universal access ;scaling up priority HIVLAIDS intervention in the health sector, progress report . 14.Prof. EyasuMekonen ( pharmacoloest ) KassahunKiros (gynecologist) and etal Food, Medicine and Healthcare Administration and Control Authority of EthiopiaStandard (2014) ,3rd edition. 15.TsinuelGrima(MD) HabitamuFikadu (MD) and etalof pediatrics and child health lecture note Jimma university. 16. Amanuel A. Abajobir and A gegnehu B. Zeleke AIDS and clinical research article on KAP and factors towards PMTCT of HIV/AIDS among pregnant mother attending ANC in Hawassa referral hospital south Ethiopia ,2013. 43

44. 17. Gurmu TesfayeBachu Tufa and etalAIDS and clinical research article on KAP towards PMTCT of HIV/AIDS among pregnant mother attending ANC clinic at Ambo hospital ,2014. 18. Review of lecture of PMTCT in Ethiopia knowledge , attitude and practices ( DRAFT). 19. EDHS 2016 44

45. Thank You 11/30/2023 DU 45