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The implications of policy changes on the uptake of a PMTCT programme in rural Malawi: first three years of experience
Malamulo SDA Hospital, Makwasa, Malawi.
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.ORCID-id: 0000-0001-5474-4361
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.ORCID-id: 0000-0001-7087-1467
2009 (Engelska)Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 2Artikel i tidskrift (Refereegranskat) 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.

Ort, förlag, år, upplaga, sidor
Häggeby: CoAction Publishing, 2009. Vol. 2
Nyckelord [en]
Malawi, PMTCT, antenatal care, health policy, health service demand
Nationell ämneskategori
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Identifikatorer
URN: urn:nbn:se:umu:diva-21841DOI: 10.3402/gha.v2i0.1883ISI: 000208160000005PubMedID: 20027274Scopus ID: 2-s2.0-84857780656OAI: oai:DiVA.org:umu-21841DiVA, id: diva2:211954
Forskningsfinansiär
FAS, Forskningsrådet för arbetsliv och socialvetenskap, 2006-1512
Anmärkning

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).

Tillgänglig från: 2009-04-20 Skapad: 2009-04-20 Senast uppdaterad: 2023-03-24Bibliografiskt granskad
Ingår i avhandling
1. Making it happen: prevention of mother to child transmission of HIV in rural Malawi
Öppna denna publikation i ny flik eller fönster >>Making it happen: prevention of mother to child transmission of HIV in rural Malawi
2009 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
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.

Ort, förlag, år, upplaga, sidor
Umeå: Umeå universitet, 2009. s. 64
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 1251
Nyckelord
HIV, PMTCT, maternal services, Malamulo SDA Hospital, Malawi
Nationell ämneskategori
Medicin och hälsovetenskap
Forskningsämne
epidemiologi
Identifikatorer
urn:nbn:se:umu:diva-26223 (URN)978-01-7264-835-7 (ISBN)
Distributör:
Epidemiologi och folkhälsovetenskap, 901 87, Umeå
Disputation
2009-10-23, Room 260, Radiology dept 2nd floor, building 3A, Norrlands University Hospital, Umeå, 09:00 (Engelska)
Opponent
Handledare
Tillgänglig från: 2009-10-05 Skapad: 2009-09-30 Senast uppdaterad: 2010-01-18Bibliografiskt granskad

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