Knowledge of reproductive age women on prevention of mother to child transmission of human immunodeficiency virus and associated factors at Mecha district, Northwest Ethiopia: A community based cross sectional study

Abstract

Introduction

Vertical transmission of Human Immunodeficiency Virus (HIV) during pregnancy, delivery and breast feeding period continues to be a major public health problem and constitutes the most important cause of HIV infection in children less than 15 years old in the world (1). Over 90% of new infections of human immunodeficiency virus in infants and young children occur through mother-to-child transmission (2). In Ethiopia it is estimated that 109,133 children less than 15 years were living with HIV in 2016 and there were an estimated of 2,420 new  infections each year due to mother-to-child transmission (3).         

Knowledge of reproductive age women on prevention of mother-to-child transmission (MTCT) of HIV plays a major role in limiting the number of children being infected by HIV. With timely interventions like testing for HIV during pregnancy, safe delivery  practices, preventive anti-retroviral (ARV) drugs, and modified infant feeding practices    the risk of a baby getting HIV infection from an infected mother can be reduced  from 20%-45% to 2–5% (4-6).

Even though there were some institution based studies conducted, there was no study done at the community level in Ethiopia.Therefore this study was conducted to identify knowledge of reproductive age women on PMTCT of HIV and associated factors at the community level

Method

Study design and Setting

Community based cross sectional study was conducted from July 1- 30/2016 in Mecha district, Ethiopia.The district has an estimated  population size of 383,861 among whom 82,506 were reproductive age group in 2016.

Participants

The source population were all reproductive age women in Mecha districtand and the study   population was  reproductive age women living in selected kebeles in Mecha district during study period.

Sample size determination and sampling procedure

Sample size was determined by using single population proportion formula with the assumptions

of 95% level of confidence, 50% proportion, 5% of margin of error and design effect of two.

Finally, considering a nonresponse rate of 10%, the total sample size was 853. Multi-stage sampling technique was used to select the study participants.

Data collection tools and techniques

Data were collected by using pretested interviewer administered questionnaire. The collected data was reviewed and checked for completeness before data entry.

Variables

The dependent variable was knowledge on PMTCT of HIV and the independent variables were; socio-demographic characteristics, reproductive characteristics, comprehensive knowledge of HIV/AIDS and knowledge on MTCT of  HIV/AIDS

Operational definition

The women who scored above or equal to the mean of the responses of knowledge assessment questions were considered as knowledgeable on PMTCT and  the women who identified correctly the three different periods of MTCT of HIV  considered as knowledgeable on MTCT.

Data analysis

The data were analyzed by using SPSS version 20.Bivariate analysis was done for all explanatory variables and those variables with P < 0.2 were entered into multivariable logistic regression. Adjusted odds ratio with 95 % confidence interval was  computed and P-value less than 0.05 considered as a significant value.

Ethical clearance

Ethical clearance was obtained from ethical review committee of university of Gondar and permission was obtained from Mecha woreda health office. Written informed consent and assent (for participants aged less than 18 rear old) was obtained prior to data collection.  

Result

From the total of 853 reproductive age women included in the study, 830 of them responded the question correctly making the response rate of  97.3%.

Socio demographic characteristics

The mean (+ SD) age of the respondents were 28.5+ 8.02 and 210 (25.3%) of the women were within the age group of 20-24 years. Majority 640 (77.1%) of the study population were from rural area (Table 1).

Table 1: Sociodemographic characteristics of respondents at Mecha district, Ethiopia,  2016 

Reproductive health characteristics

Concerning the reproductive status of the women, 389 (46.9%) were multipara. About 84.9%, 82.5% and 61.3% of the respondents had history of using family planning, ANC follow up and institutional delivery respectively.

Comprehensive knowledge of the women about HIV/AIDS

Four hundred six (48.9%) of the respondents had comprehensive knowledge about HIV/AIDS. Nearly one fifth, 19.2% and  6.5 % of the respondents described that HIV can be transmitted by mosquitos and  by super natural powers respectively. Most 757(91.2%) of them knew that healthy-looking person may have AIDS virus. About 73.3% of the respondents knew that someone can prevent from HIV by consistent condom use and limiting sex partners.  

Knowledge of the women on MTCT

Six hundred sixty one (79.6%) knew that HIV could be transmitted from an infected mother to her baby. Concerning the time of transmission of the virus from the infected mother to her child, 77.9%, 50.2% and 49.9% responded that MTCT could be through breast feeding, during delivery and during pregnancy respectively. Over all 221(26.6%) of the respondents were knowledgeable on MTCT of HIV.

Knowledge of the Women on PMTCT

More than three fourths, 636 (76.6%) of the respondents had heard about PMTCT of HIV of whom 186 (22.4%) of the respondents were knowledgeable on PMTCT of HIV. (Table 2).

Table 2: Kowledge of women about PMTCT, at Mecha district, Ethiopia, 2016 

Factors associated with knowledge of women on PMTCT of HIV

Compared to women who live in the rural areas, those women living in the urban areas were 2.5 times (AOR =2.486, 95%CI = 1.160-5.328) more likely to be knowledgeable on PMTCT of HIV. Women with education level of secondary and above were 5.4 times (AOR =5.445, 95%CI= 2.698-10.986) more likely to be knowledgeable on PMTCT of HIV than those with no formal education. 

Women who had history of ANC follow up were 4.4times (AOR =4.430, 95%CI = 1.471- 13.340) more knowledgeable on PMTCT of HIV/AIDS than who hadn’t ANC follow up. Women who had history of institutional delivery were more knowledgeable about PMTCT (AOR =4.766, 95%CI = 2.004-11.334) than those who didn’t  have. 

Women who were knowledgeable on comprehensive knowledge on HIV/AIDS were 1.7 times (AOR =1.697, 95%CI = 1.011-2.846) more likely to be knowledgeable on PMTCT of HIV than non- knowledgeable counter parts.Women who were knowledgeable on MTCT of HIV were 2.2 times (AOR =2.203, 95% CI=1.369-3.544) more knowledgeable on PMTCT of HIV than those who did not have. 

Women who had discussions with their husband about HIV/AIDS, MTCT and its prevention were 2.7 times (AOR= 2.700, 95%CI =1.658, 4.396) more likely to be knowledgeable than those who had not (Table 3).

Table 3: Association between knowledge of PMTCT and explanatory variables among

reproductive age women on Mecha district , Ethiopia, 2016 

Discussion

In this community based cross sectional study about 22.4% of the respondents were knowledgeable on PMTCT of HIV.This finding is less than the study conducted at Gondar (83.5%) (7), Hawasa referral hospital (82.3%) (8) and Southern Nigeria (91.4 %,) (9). This discrepancy might be due to the study setting and source population difference.

Those women residing in urban areas were 2.5 times (AOR =2.5, 95%CI =1.16-5.33) more likely to be knowledgeable when compared to the rural residents. This finding is in line with studies conducted at Hawassa referral hospital, Gondar and Tanzania (7,8,10). It might be due to the urban location geographical accessibility and availability of nearby health services and greater media exposure compared with rural areas.

In this study education level of secondary and above were 5.4 times (AOR =5.4, 95%CI = 2.69-10.98) more likely to be knowledgeable on PMTCT of HIV than those with no formal education.This explanation is in line with the study done in, Addis Ababa ,Hawassa and Tanzania (8,11,12). This could be because when the women become educated their health seeking behavior and access to information might be increased. 

Women who had history of ANC follow up were about 4.4times (AOR =4.4, 95%CI = 1.47-

13.34) more likely to be knowledgeable on PMTCT of HIV/AIDS than those who hadn’t ANC followup. It could be due to women who had history of ANC follow up might get the chance to learn from health professionals and this information may enhance women’s knowledge about PMTCT. This finding is consistent with the study conducted at Hawassa referral hospital (8) despite the confidence interval in our study was found to be wide. 

Women who had history of institutional delivery were more knowledgeable about PMTCT (AOR=4.77, 95%CI = 2.00-11.33) than those  who had not. This finding is also consistent with the study conducted at Hawassa referral hospital (8). This might be women who had history of  institutional delivery might get the chance of PMTCT service at the health institution from health professionals. 

Women who had  comprehensive knowledge on HIV/AIDS were 1.7 times (AOR =1.7, 95%CI = 1.01 -2.85) more likely to be knowledgeable on PMTCT of HIV than non-knowledgeable counter parts. This finding was consistent with a study conducted in Gondar and Assosa, Ethiopia(7,13). The possible interpretation for this positive association is that those women with comprehensive knowledge on HIV may appreciate the prevention strategies of mother to child transmission of HIV

Women who were knowledgeable on MTCT of HIV were 2.2 times (AOR =2.20, 95% CI=1.37-3.54) more knowledgeable on PMTCT of HIV than those who did not have.

This finding is in agreement with previous study done at Assosa town, Ethiopia(13).This might be due to women with knowledgeable on MTCT of HIV might have greater understanding on prevention possibilities.

Women who had discussions with their husband about HIV/AIDS, MTCT and its prevention were 2.7 times (AOR= 2.700, 95%CI =1.7, 4.4) more likely to be knowledgeable than those who had not. This finding is inline with the study done on Mekele and  Southern Ethiopia (13,14). This might be explained due to women having  discussion with their husband regarding HIV/AIDS will help to share the information and increase her level of understanding which enhances her PMTCT knowledge.

Conclusion and Recommendation

Knowledge on PMTCT among women was found to be low. Residence, education level ANC follow up, history of institutional delivery, comprehensive knowledge on HIV/AIDS, knowledge on MTCT of HIV and women who held discussions with their husband about HIV/AIDS were significantly associated with women’s knowledge on PMTCT. Emphasis shall be given on continuous education regarding PMTCT, strengthening ANC and institutional delivery coverage with integrated PMTCT service. Further study is needed to identify the most appropriate ways to strengthen male involvement. 

Limitation 

Being cross-sectional study might make difficult to draw conclusion about cause effect relationship. 

List of Abbreviations

AIDS: Acquired Immunodeficiency Syndrome, ART: Anti-Retroviral Therapy, MTCT: Mother To Child Transmission, PMTCT: Prevention of Mother To Child Transmission

Declarations

Ethics Approval and consent to participate 

This study was approved by ethical review committee of university of Gondar and permission was obtained from Mecha woreda health office. Then informed written consent and assent were taken from the study participants. 

Availability of data and material 

The datasets generated during the current study are available from the corresponding author on reasonable request.

Funding

The authors have no support or funding to report

Acknowledgement

We would like to acknowledge University of Gondar for giving a chance to undertake this study.We are also thankful to all data collectors and supervisors for their commitment and research participants for their time. We also extend our gratitude to the study participants for sharing the information.

Consent for publication

Not applicable

Competing interests

We, the authors declare that we didn’t have competing interests.

Authors' contributions

TL was investigator, involved in proposal writing, designing, and recruitment and training of supervisors and data collectors, analysis and write-up of the manuscript. EC, ML, TY and HT contributed in the designing of the methodology, supervision and involved in the analysis stage of the manuscript. All authors read and approved the final manuscript.

Authors’ Information

Tewachew Muche Liyeh (TL) ,Lecturer ,Department of Midwifery, college of health sciences, Debre Tabor University, Debre Tabor, Ethiopia

Email:[email protected]

Endeshaw Admasu Cherkose (EC):Assistant Professor of reproductive health ,Department of  Midwifery, college of medicine and health sciences, University of Gondar, Gondar, Ethiopia

Email: [email protected]

Miteku Andualem Limenih(ML): lecturer, Department of Midwifery, college of medicine and healthsciences, University of Gondar, Gondar, Ethiopia

Email: [email protected]

Tigist Seid Yimer (TY) :Lecturer, Department of Midwifery, college of health sciences, Debre TaborUniversity, Debre Tabor, Ethiopia

Email: [email protected]

Hailemariam Demewozu Tebeje (HT) :Lecturer, Department of  Midwifery, college of medicine and health sciences, University of Gondar, Gondar, Ethiopia

Email:[email protected]

References