Factors affecting utilization of natal services by HIV pregnant women in Jnja District, Uganda.

Abstract

BACKGROUND: The Uganda MoH policy on PMTCT requires all HIV positive pregnant women to deliver in higher facilities to access nevirapine and modified obstetrical care in order to reduce MTCT. However, only 34% of the HIV positive pregnant women in Jinja District delivered in health facilities between August 2004 and December 2006. OBJECTIVE: The objective of this study is to identify the factors that affect utilization of the natal services by HIV positive pregnant women in Jinja District with the hope of increasing health facility deliveries to reduce mother to child transmission of HIV infection. METHODOLOGY: Case control study was conducted in Jinja District in which the HIV positive mothers who delivered their most recent born outside health facilities (cases) were compared with mothers who delivered their most recent born in health facilities (controls). Total of 429 respondents (143 cases and 286 controls) were interviewed. Variables with significant values in bi-variate analysis and the variables that were highly suspected were transferred to logistic regression modal to predict the actual factors affecting the utilisation of natal services by HIV positive pregnant women in Jinja District. RESULTS: Factors that predict delivery outside health facility include, long distance to health facility, adj,OR 1.8 (1.0-3.2), not knowing that nevirapine is to be taken at on set of labour, adj OR (15.2(6.1-37.9), Believe that HIV positive mothers are not being given same care like HIV negative mothers adj. OR 4.9 (2.7-9.0), and belief that the blood is tested for HIV without the consent of the mothers adj. OR 2.2 (1.1-4.5). But belief of mal-practices adj. OR 0.4(0.2-0.7) and belief of nurses bad conduct adj. OR 0.2(0.1-0.5) negatively predict delivery outside health facilities. CONCLUSION: HIV positive pregnant women find it very difficult to deliver in higher health facilities because of the long distances to these health facilities from their homesteads. Not knowing that delivery in health facilities is to access nevirapine and modified obstetrical care to reduce MTCT and not knowing when to take nevirapine affect utilisation of the natal services. The practices of testing mothers blood for HIV without their consent and not giving HIV positive mothers same care like HIV negative mothers has made the mothers to develop unfavourable attitude towards delivery in health facilities. RECOMMENDATIONS: • The MoH policy on PMTCT has to be revised to allow health facilities to conduct deliveries of HIV positive pregnant women so as to reduce the distance between mother’s homesteads and the nearest delivering centres. • The DDHS has to organise comprehensive training of the health providers on counselling and communication skills to improve on the knowledge on use of nevirapine and modified obstetrical care in mothers who attend ANC. • Regular updates of midwives on care for HIV positive pregnant women and testing of the mother’s blood for HIV with consent have to be organised by in-charges of health facilities. DISSEMINATION OF THE FINDINGS: The findings will be disseminated to school of graduate studies Makerere University, school of public health Makerere University, study areas and publications in journals.