Knowledge, Attitude and Practice Towards Prevention of Mother to Child Transmission of Human Immune Deficiency Virus Among Male Partner of Pregnant Women Attending in Shegaw Motta Primary Hospital. Institutional Based Crosectional Study


 Background: The transmission of HIV AIDS from mother to child is high still now. One of the factors may be due to the low level of the knowledge; attitude and practice of male partners for the HIV infected pregnant mothers. Therefore, the study was aimed to assess the level of knowledge, attitude and practice of male partners of pregnant women, so that, level of knowledge, attitude and practice of male partners of pregnant women would be known. However, little research is done to assess knowledge, attitude and practice toward MTCT/PMTCT program where these studies are limited in their scope, which focus only on pregnant mothers and there is a gap in examining knowledge and attitude of male partners. Assessing the knowledge, attitudes and practice of male partner of pregnant women at ANC and PMTCT program is vital for interventions on men. Objective: To assess knowledge, attitude and practice towards prevention of mother to child transmission of HIV among male partner of pregnant women attending in Shegaw Motta Primary Hospital East Gojjam zone, Amahra Ethiopia in 2018.Results: From the total population 46.2% of the respondents had good knowledge. But, only 16.3 the respondents had poor knowledge. 55.6% of the respondents had positive attitude and 44.4% had negative attitude towards MTCT and PMTCT. 81.5% of the respondents had low level of involvement and 18. 5% of the respondents had high level of involvement towards MTCT and PMTCT Conclusion: Majority of the respondents had good knowledge and positive attitude towards MTCT and PMTCT. But majority of the respondents had low level involvement towards MTCT and PMTCT.


Introduction
Ethiopia, is one of sub Saharan African counties, has been facing highest number of mother to child transmission (MTCT) of Human Immune De ciency Virus (HIV). Prevention of mother to child transmission (PMTCT) of HIV program plays a big role in reducing the Mother-to-Child Transmission of HIV. Nevertheless, its effectiveness depends on involvement of male partners considering the fact that men are decision makers in Ethiopia families. They make important decisions that have major impact on women's health. Male partner involvement has been seen to increase uptake of Prevention of Mother to years. There were 2.3 million new HIV infections, including 260, 000 among children less than 15 years (2). More than 90% of the children who acquired HIV infection live in Sub-Saharan Africa. In the same year, in African countries, about 25.0 million people were estimated living with HIV including 2.9 million children. There were 1.6 million new infections and 230,000 million among children less than 15 years and 1.2 million Acquired Immunode ciency Syndrome (AIDS) related death (3).
Ethiopia is one of sub Saharan African counties facing high AIDS burden, at the end of 2012; approximately 760,000 people were estimated living with HIV, with 20,000 new HIV infections and estimated AIDS related death were 47,000. There were 9,500 new infections among children (4). Besides the dominant heterosexual transmission, vertical HIV transmission from mother to child accounts for more than 90% of pediatric AIDS and without any intervention about half of them will die before their second year birth day. The prevention of mother to child transmission (PMTCT) plays a major role in limiting the number of children being infected by HIV. Without any intervention, 20 -50% of infant would be infected but by implementing effective PMTCT program, the overall risk can be reduced to less than 5% with breast feeding population (5).
As a result, Ethiopia adopted the World Health Organization (WHO) four pronged PMTCT strategies as a key entry point to reduce risk of HIV transmission from mother to child and care for women, men and families. These include primary prevention of HIV infection, prevention of unintended pregnancies among HIV-infected women, prevention of HIV transmission from HIV-infected women to their child, provision of care and support to women infected with HIV, their infants and families (6).
PMTCT of HIV, provided integrally with maternal, neonatal and child health MNCH services by the Government of Ethiopia to mitigate the impacts of the HIV epidemic in general population and particular in children. The achievement of the National PMTCT program to date is not in parallel to other Maternal and Child Health Programs. Very serious gaps remain in terms of utilization of available service by the pregnant mother. The federal Ministry of Health identi ed some of the challenges; one of the challenges is low male partner involvement.
Studies from Eastern and Southern Africa showed that testing rates ranging from 8% to 15% of male partners at antenatal clinic (7 8, 9).
In this regard, the knowledge and awareness of male partner on the PMTCT matters for the active participation play crucial role for the effective implementation of the program because Sexual and Reproductive Health (SRH) programs and services have been focused primarily on women. Men have often lacked information to make informed decisions about healthy behaviors and the roles they might play in promoting overall family health, including accessing HIV prevention, care and treatment services.
Much is not known about the extent to which male partners having adequate information about sexual reproductive health in general and PMTCT program in particular. Hence, this study attempts to asses' knowledge, attitude and practice of male partner involvement in PMTCT program.
The Government of Ethiopia undertaking different efforts to mitigate the impacts of HIV epidemic among the whole population in general and among children in particular. One of the strategies is providing PMTCT services integrated with maternal, neonatal and child health (MNCH) services as one strategy.
Male involvement has been recognized as a priority for PMTCT programs (10).
Different scholars documented the impact of men involvement on the various components of PMTCT programs. Men play an important role in terms of women risk of acquiring HIV, prevention in terms of condom use in the couple's relationship and male partners also in uence women's utilization of service including testing for HIV and on decision of infant feeding options (11, 12, 13, 14, and 15).

Justi cation
The prevalence of MTCT is high still now. Even if MTCT was decreased from time to time, the deference was not enough to eradicate MTCT. Generally, the prevalence of MTCT in Ethiopia was 9.93. The prevalence of MTCT in Dredwa was 15.7% and in SNNPR was 4.16%. This prevalence indicates that MTCT is high even if PMTCT was given. This indicates that PMTCT program was not effective that was given before. This indicates that PMTCT program was not effective as a result of different in uencing factors. One of the factors may be due to the low level of the knowledge; attitude and practice of male partners for the HIV infected pregnant mothers. Therefore, the study was aimed to assess the level of knowledge, attitude and practice of male partners of pregnant women, so that, level of knowledge, attitude and practice of male partners of pregnant women would be known.
However, little research is done to assess knowledge, attitude and practice toward MTCT/PMTCT program where these studies are limited in their scope, which focus only on pregnant mothers and there is a gap in examining knowledge and attitude of male partners. Assessing the knowledge, attitudes and practice of male partner of pregnant women at ANC and PMTCT program is vital for interventions on men.

Study population
Male partners who, either sexual partners or husbands of pregnant women attending ANC/ PMTCT service in Shegaw Motta primary Hospital and available during data collection.

Inclusion and Exclusion criteria Inclusion criteria
Male partners who were either sexual partners or husbands of pregnant women who were volunteer, counseled and tested for PMTCT in this study

Exclusion criteria
Men who were not volunteers mentally ill who can′t and those who cannot communicate because of hearing problem were excluded.

Sample size determination
The sample size was calculated by using single population proportion formula with estimated proportion of 60.3% of male partners practice from a study conducted at two health centers of Addis ketema sub city (in Addis Ababa),(33),Marginal error 5%, non response rate of 10% or possible absenteeism and refusal to participate in the study and con dence interval 95%. Therefore, the sample size was determined using the simple proportional formula and by using Z -Con dence interval 95% CI/Con dence interval/ is 1.96 p -Estimate population proportion that is for a variable of 60.3% of male partners practice on /PMTCT

Data analysis
After collecting all the necessary data the data was coded on prearranged coding sheet by the principal investigator. Data were entered in to a SPSS and analysis was made using SPSS version 23 statistical package, errors related to inconsistency of data were checked and corrected during data cleaning.

Data quality Control
The structured interview was administrated by two data collectors who had experience to conduct an interview. They were trained for one day (including half day of pre -test) on the objective, relevance of the study, con dentiality of information, respondents right, informed consent and techniques of interview. The six Investigators were supervising the data collection process.

Ethical clearance
Ethical clearance was attained by letter of permission, which was obtained from Debre Markos University, collage of health science o ce and Shegaw Motta primary hospital medical director o ce. Written consent was obtained from each subject and secured after detail explanation of the nature and main purpose of the study. Con dentiality of the information forwarded by subjects was assured by omitting names of the study subjects from the questioner and large effort was made to maintain the privacy of the respondents during interview. the right of the respondents was respected

Dissemination of result
The study will be disseminated to the department of midwifery, collage of health science research o ce, Hospitals and nongovernmental organizations to get rid of gap in knowledge, attitude and involvement of male in PMTCT. At the end of the study, the result will be presented to Debre Markos University College of health science.

Results
A total 405 male partners of pregnant mothers attending ANC in Shegaw Motta primary hospital were interviewed with 100% response rate.
Approximately half of the respondents, 214 (52.8%) were found in the age range of 25-35. Majority of the interviewed respondents 132 (32.6%) were diploma and higher in quali cation. Majority of them, 344 (84.9%) were married. Among the study population, 247 (61%) of the respondents had their own businesses, 118 (29.1%) were employed (table 1). The mean of respondents' knowledge, attitude and practice was 13.8, 19 and 1.31 respectively. Knowledge of the respondents about MTCT and PMTCT The three categories were grouped in to two categories to make the analysis is easy. Don't know and no responses were grouped as one category. As shown in table 3, majority of the respondents were knowing that HIV can be transmitted from mother to child during pregnancy, 303 (74.8%). Majority of the respondents were known HIV can be transmitted from mother to child during breast feeding, 324 (80%). But majority of the respondents didn't know HIV cannot be transmitted from mother to child by sleep together, 217 (53.6%). As indicated in table 5. The ve categories grouped in to two categories to make the analysis is easy. Agree and strongly agree was grouped as one category and undetermined, Disagree and strongly Dis agree was grouped as one category.     (19). But, these ndings were higher than a study conducted at Debre Markos that majority of the respondents had moderate knowledge (20).

Availability of data and materials
Minimal data can be accessed upon request from author (HAA).
Ethics approval and consent to participate Not applicable.