The implications of policy changes on the uptake of a PMTCT programme in rural Malawi: first three years of experience
2009 (English)In: Global health action, ISSN 1654-9880, Vol. 2Article in journal (Refereed) Published
Objective: To study how the demand for antenatal care (ANC), HIV testing and hospital delivery was influenced by policy changes among pregnant women in rural Malawi.
Design: Retrospective analysis of monthly reports.
Setting: Malamulo SDA hospital in Thyolo district, Makwasa, Malawi.
Methods: Three hospital-based registers were analysed from 2005 to 2007. These were general ANC, delivery and Prevention of Mother to Child Transmission (PMTCT) registers. Observations were documented regarding the introduction of specific policies and when changes were effected. Descriptive analytical methods were used.
Results: The ANC programme reached 4,528 pregnant mothers during the study period. HIV testing among the ANC attendees increased from 52.6 to 98.8% after the introduction of routine (opt-out) HIV testing and 15.6% of them tested positive. After the introduction of free maternity services, ANC attendance increased by 42% and the ratio of hospital deliveries to ANC attendees increased from 0.50:1 to 0.66:1. Of the HIV-tested ANC attendees, 52.6% who tested positive delivered in the hospital and got nevirapine at the time of delivery.
Conclusions: Increasing maternity service availability and uptake can increase the coverage of PMTCT programmes. Barriers such as economic constraints that prevent women in poor communities from accessing services can be removed by making maternity services free. However, it is likely, particularly in resource-poor settings, that significant increases in PMTCT coverage among those at risk can only be achieved by substantially increasing uptake of general ANC and delivery services.
Place, publisher, year, edition, pages
Häggeby: CoAction Publishing, 2009. Vol. 2
Malawi, PMTCT, antenatal care, health policy, health service demand
Public Health, Global Health, Social Medicine and Epidemiology
IdentifiersURN: urn:nbn:se:umu:diva-21841DOI: 10.3402/gha.v2i0.1883ISI: 000208160000005PubMedID: 20027274OAI: oai:DiVA.org:umu-21841DiVA: diva2:211954
FunderFAS, Swedish Council for Working Life and Social Research, 2006-1512
We thank the Swedish Institute, Sweden for the financial support without which the study would have been a non-starter. We are also grateful for the support given by the unit of Epidemiology and Public Health Sciences, Umea University. Furthermore, we thank the management and staff of Malamulo SDA Hospital, P/Bag 2, Makwasa, Malawi for their support throughout the entire period of carrying out the study. This work was undertaken within the Centre for Global Health at Umea University with support from FAS, the Swedish Council for Working Life and Social Research (grant no. 2006-1512).2009-04-202009-04-202015-04-29Bibliographically approved