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Making it happen: prevention of mother to child transmission of HIV in rural Malawi
Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The devastating consequences of HIV/AIDS have caused untold harm and human suffering globally. Over 33 million people worldwide are estimated to be living with HIV and AIDS and a majority of these are in sub-Saharan Africa. Women and children are more infected particularly in sub-Saharan countries. Globally, an estimated number of 370 000 children were newly infected in 2007, mainly through mother to child transmission (MTCT). Implementation of prevention of mother to child transmission (PMTCT) programmes has been introduced in many sub-Saharan countries during the last years.

Operational research was conducted to study the demand and adherence of key components within a PMTCT Programme among women in rural Malawi. This study was carried out at Malamulo SDA Hospital in rural Malawi and employed a mixture of both quantitative and qualitative approaches. Data sources included antenatal care (ANC), PMTCT and delivery registers, structured questionnaires, in-depth interviews with HIV positive women in the programme and focus group discussions with community members, health care workers and traditional birth attendants.

Over the three year period of the study (January 2005 to December 2007), three interventions were introduced in the antenatal care (ANC) at the hospital at different times. These were HIV testing integrated in the ANC clinic in March 2005, opt-out testing in January 2006 and free maternal services in October 2006. A steady increase of the service uptake as interventions were being introduced was observed over time. HIV testing was generally accepted by the community and women within the programme. However, positive HIV tests among pregnant women were also experienced to cause conflicts and fear within the family. Although hospital deliveries were recognised to be safe and clean, home deliveries were common. Lack of transport, spouse support and negative attitudes among staff were some of the underlying factors.

Further study on the quality of care offered in the presence of increased service uptake is required. Community sensitisation on free maternal care and male involvement should be strengthened to enable full utilisation of services. Additionally, service providers at facility and community levels, policy makers at all levels and the communities should see themselves as co-workers in development to reduce preventable maternal and infant mortality including MTCT of HIV.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2009. , 64 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1251
Keyword [en]
HIV, PMTCT, maternal services, Malamulo SDA Hospital, Malawi
National Category
Medical and Health Sciences
Research subject
Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-26223ISBN: 978-01-7264-835-7 OAI: oai:DiVA.org:umu-26223DiVA: diva2:240963
Distributor:
Epidemiologi och folkhälsovetenskap, 901 87, Umeå
Public defence
2009-10-23, Room 260, Radiology dept 2nd floor, building 3A, Norrlands University Hospital, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2009-10-05 Created: 2009-09-30 Last updated: 2010-01-18Bibliographically approved
List of papers
1. The implications of policy changes on the uptake of a PMTCT programme in rural Malawi: first three years of experience
Open this publication in new window or tab >>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 1654-9716, E-ISSN 1654-9880, Vol. 2Article in journal (Refereed) Published
Abstract [en]

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
Keyword
Malawi, PMTCT, antenatal care, health policy, health service demand
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-21841 (URN)10.3402/gha.v2i0.1883 (DOI)000208160000005 ()20027274 (PubMedID)
Funder
FAS, Swedish Council for Working Life and Social Research, 2006-1512
Note

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).

Available from: 2009-04-20 Created: 2009-04-20 Last updated: 2017-12-13Bibliographically approved
2. Home deliveries: implications for adherence to nevirapine in a PMTCT programme in rural Malawi
Open this publication in new window or tab >>Home deliveries: implications for adherence to nevirapine in a PMTCT programme in rural Malawi
2007 (English)In: AIDS Care, ISSN 0954-0121, E-ISSN 1360-0451, Vol. 19, no 5, 646-652 p.Article in journal (Refereed) Published
Keyword
Adolescent, Adult, Anti-HIV Agents/*administration & dosage/supply & distribution, Child, Delivery; Obstetric, Disease Transmission; Vertical/*prevention & control/statistics & numerical data, Female, HIV Infections/*drug therapy, Home Childbirth, Humans, Infant, Malawi, Nevirapine/*administration & dosage/supply & distribution, Patient Compliance, Postnatal Care/methods, Pregnancy, Pregnancy Complications; Infectious/*drug therapy, Rural Health
Identifiers
urn:nbn:se:umu:diva-18091 (URN)17505925 (PubMedID)
Available from: 2007-12-18 Created: 2007-12-18 Last updated: 2017-12-14Bibliographically approved
3. HIV-positive women's experiences of a PMTCT programme in rural Malawi
Open this publication in new window or tab >>HIV-positive women's experiences of a PMTCT programme in rural Malawi
2010 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 26, no 1, 27-37 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: to explore women's experiences of a prevention of mother-to-child transmission (PMTCT) programme in rural Malawi. DESIGN, SETTING AND PARTICIPANTS: an exploratory, qualitative study using in-depth interviews with 24 purposively selected women infected with human immunodeficiency virus (HIV). The women were in three groups of eight: (1) those who delivered at the hospital and took nevirapine (NVP) before birth and whose babies received NVP within 72 hours of birth; (2) those who birthed at home and took NVP before birth but their babies never received NVP; and (3) those who birthed at home and did not take NVP and whose babies did not receive NVP. Data were analysed using content analysis. FINDINGS: four themes emerged: (1) 'a wish to confirm and protect' refers to women's decisions to take the HIV test, (2) 'a revelation for action' is an illustration of how the testing may be part of an empowering process, (3) 'a dilemma between silence and openness' points to the dilemma that women are facing in their decision to share or not to share their HIV status with spouse, family, friends and community, and (4) 'a desire challenged by circumstances, chance and tradition' refers to the circumstances and actions which prevent these women from actually delivering at the hospital to protect their babies from HIV infection. CONCLUSIONS: the PMTCT programme influences women's lives profoundly, and the importance of quality counselling and strengthening male involvement is stressed as the programme is implemented by an increasing number of service providers.

Place, publisher, year, edition, pages
Elsevier, 2010
Keyword
HIV, PMTCT, Home and hospital deliveries, Malawi
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-21783 (URN)10.1016/j.midw.2008.04.007 (DOI)000274918000005 ()18571297 (PubMedID)
Available from: 2009-04-20 Created: 2009-04-20 Last updated: 2017-12-13Bibliographically approved
4. Community perceptions of a PMTCT programme in Malawi
Open this publication in new window or tab >>Community perceptions of a PMTCT programme in Malawi
2009 (English)In: African journal of midwifery and women's health, Vol. 2, no 1, 28-42 p.Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-25573 (URN)
Available from: 2009-08-20 Created: 2009-08-20 Last updated: 2015-04-29Bibliographically approved

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