FACTORS INFLUENCING ACCESS TO ANTENATAL CARE AND PREVENTION OF MOTHER-TO-CHILD TRANSMISSION OF HIV SERVICES AMONG NOMADIC WOMEN

(A CASE STUDY OF MAKARFI LGA, KADUNA STATE, NIGERIA.)

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Author

Presented To

Department of Medicine

ABSTRACT
Nomads are an under-served population with little or no access to health care mainly because of their geographical locations which are often hard to reach, their movement from place to place and cultural beliefs. Thousands of children in Nigeria are infected with HIV through their mothers annually. The success of PMTCT of HIV depends on the effectiveness of ANC and will require closing gaps in geographical coverage and accessing and utilization of the services. This study examines the factors that influence access to ANC and PMTCT services by determining the knowledge, attitude and practices of nomadic women of reproductive age and traditional birth attendants on HIV, ANC and PMTCT within nomadic settlements in Makarfi LGA. I assessed services provided by health facilities. A cross-sectional study was conducted using interviewer- administered, pretested semi-structured questionnaires for nomadic women and TBAs; and a checklist for health facilities. A minimum sample size of 366 was arrived at for the nomadic women and distributed proportionately to the selected wards. A total of 375 women between 13-45 years were interviewed, 83.6% between 15-34 years, 98% married, 94.5 % had no formal education, 80% unemployed and 36% had been pregnant at least 5 times. Sixty three percent were aware of HIV, 97% had poor knowledge of HIV and MTCT. Primary education had significant association with good knowledge of HIV (OR=42.4 ; 95% CI=9.6 – 200; p= <0.01). Seventy two percent had attended ANC at least once, 25% had adequate ANC attendance (≥4 visits with skilled attendant). Eighty six percent delivered babies at home alone,7% delivered with TBAs. Less than 1% tested for HIV. Primary education (OR=8 ; 95% CI= 1.1-161.6; p= 0.02) and low parity (OR= 2.1; 95% CI= 1.2-3.6; p= <0.01) hadpositive effect on ANC attendance. All TBAs had poor knowledge of HIV and PMTCT and engaged in unsafe practices (no gloves, unsterile materials). All health facilities were providing ANC and delivery services with 60% providing PMTCT services. ANC, delivery and PMTCT services are under-utilized due to lack of education, poor knowledge of HIV, cultural barriers and some health facility related factors since even those found to have adequate ANC attendance lacked basic knowledge of HIV and prevention. There is an urgent need to sensitize and educate this population on HIV and its prevention and the need to utilize available health services. This can be achieved through outreach services while involving community members. There is also need for health worker trainings to improve the quality of services. Key Words: Human Immunodeficiency Virus, Antenatal Care, Prevention of Mother-To-Child Transmission, Nomads, Makarfi-Nigeria.