Socio demographic characteristics, antenatal clinic attendance and PMTCT knowledge of postnatal HIV+ women at an urban public health facility in Nairobi, Kenya
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Background: Women who have inadequate or poor knowledge about Prevention of Mother to Child Transmission (PMTCT) of Human Immunodeficiency Virus (HIV) are more likely to default on antiretroviral treatment and less likely to implement MTCT preventive measures thus a sub-optimal viral suppression and an increase in MTCT rates. Early and frequent Antenatal Clinic (ANC) attendance integrated with PMTCT services increases MTCT knowledge and uptake of the services thus optimising intervention outcomes. Objectives: To determine the sociodemographic characteristic levels that influence Antenatal Clinic (ANC) attendance, PMTCT knowledge and Antiretroviral (ARV) drugs uptake among postnatal HIV+ women. Setting: Pumwani Maternity Hospital in Nairobi, Kenya. Methodology: This was a cross-sectional descriptive study that was conducted at Pumwani Maternity Hospital which is in a low social income set up in Nairobi County. The hospital has active ANC and Postnatal Clinic (PNC) facilities that provide PMTCT and specialist referral obstetric services to more than 30,000 maternity clients annually. HIV+ positive postnatal women who were seeking health services at the hospital were identified using their health records and recruited into the study either while still in the postnatal ward after delivery or during post natal clinic visits within the period of the study. Standardized structured questionnaire was administered to collect the appropriate study data from the mothers. Results: A total of 326 HIV+ women, aged 15 - 42 years (mean 28.3 years) participated in the study. Most of the women were either married (72.9%), single East and Central Africa Medical Journal 2015; 2(1): 10-17 10 (15.7%), widowed (6.8%) or separated (4.6%) and of low levels of education. Majority were either housewives (38.3%) or engaged in small businesses such as selling vegetables and merchandising food items and second hand clothes. Their overall estimated monthly mean domestic expenditure was about US$ 102. Most of the women (92.4%) attended antenatal clinic in peripheral health facilities and only came to PMH for delivery services. Majority (94.5%) of the women received Counselling and Testing (CT) while a few (3.3%) reported being counselled but not tested at the antenatal clinic. Among the women who were counselled but not tested for HIV antenatally majority (81.8%) declined to be tested due to fear of being told that they were HIV+. They learnt about their status later after delivery when they were convinced to undertake the test. Regarding knowledge about MTCT 94.7% ofthe women agreed that they were aware that HIV can be transmitted from the mother to her child by various methods. Some of the women (14.1%) were not aware that abstaining from breastfeeding can prevent MTCT and almost half of them (45.7%) did not know that exclusive breast feeding was also another preventive measure. Almost 15% of the mothers were not aware that they could prevent MTCT by using ARV's. Some of the women (15%) had not informed their husbands regarding their HIV status. However we did not establish any significant relationship between the husband's knowledge of the wife's HIV status and the women's acceptance to use ARV's. There was also no significant relationship between the husband's consent and women's decision to use ARV's whereas most of the women (99.3%) confirmed that they would take the ARV's regardless of whether their husband agreed to the usage or not. The ARV adherence was not influenced by the number of ANC visits, parity, education status and husband's lack of awareness about the wives' HIV status. Data on ANC attendance indicated that majority (91.1 %) ofthe women attended ANC at it~1',~one or more times either in the peripheral facilities or at Pumwani Hospital but most (66%) made the first visit in the 5th to 7th month (average 6th month) of gestation. HighANC attendance rate was significantly associated with the uptake of prophylactic ARV's (1)=0.001). The frequency of ANC attendance was also significantly associated with the health facility where the mother attended the clinic (P=0.0045). Almost half (46.6%) of the women made only 1 to 3 ANC visits. Reasons for not attending ANC included not wishing to attend (66.6%), not knowing the importance of ANC (16.7%) and far distance to the clinics (16.7%). Conclusion: The main gaps that were observed in this study are the late initiation and low frequency of ANC attendance, low PMTCT knowledge and delayed first visit and uptake of ARV's among HIV+ women in this low socioeconomic set up. This calls for improvement of health services and community oriented PMTCT education in the peripheral health facilities where the bulk of ANC activities took place.