Abstract

HIV/AIDS is a major global public health concern worldwide over 40 million people are estimated to be infected with 28 million people from Sub-Saharan Africa at the end of 2001. Prevention of mother to child transmission of HIV/AIDS refers to an attempt to reduce or decrease the rate of MTCT. The aimed of the study was to assess challenges faced by nurses/midwives in delivery PMTCT of HIV/AIDS at the Muyuka district hospital. A descriptive survey was use, where 30 midwives including nurses working at ANC, IWC, labour room, maternity and family planning units were selected by the convenience sampling method. A questionnaire was use, designed with both closed and opened ended questions. Data was analyzed using an SPSS, version 21.0. The result shows that midwives and nurses have adequate knowledge on mother to child transmission (MTCT) and prevention of mother to child transmission (PMTCT) of HIV/AIDS with percentages 100% and 86.7% respectively. The results equally show that they face a lot of challenges which include; lack of materials use in the program with 16.7%, lack of confidentiality with 16.7%, poorly trained staffs (33.3%), poor patients’ collaboration (23.3%) and staff rotation within hospital units (10.0%). It can then be concluded that nurses and midwives have adequate knowledge on MTCT and PMTCT of HIV/AIDS but with a lot of challenges. We can thereby recommend that seminars can be used to handle some of the challenges presented by the nurses and midwives.

CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Globally, HIV/AIDS is now the leading cause of mortality among women of reproductive age and contributes a great deal to the death of infants and children. Even in countries that were showing substantial progress in providing prevention of mother to child transmission interventions, the major challenges that still remain include making sure the interventions are going on smoothly and that they are bringing about the desired outcomes. The effect of the interventions should be demonstrated by a decrease in pediatric infections, HIV-free survival for infants, and improved maternal and child health (WHO, 2010). In Sub Saharan Africa, an estimation of 2.3 million children were living with HIV /AIDS in 2010, and an estimation of 14.8 million children were orphaned due to AIDS. In the same year, an estimated 350,000 children were newly infected with HIV. Over 90% of these infections occur through mother-to-child transmission (MTCT). Without effective intervention, half of the infected children won’t make it to their second birthday. With effective prevention, the risk of MTCT can be reduced to less than 2%-5%. But without intervention, the risk of transmission ranges from 20% to 45% (UNAIDS, 2010).

Prevention of mother to child transmission of HIV/AIDS (PMTCT) refers to a comprehensive management approach aimed at the well-being of all women of reproductive age, provision of HIV screening for all women, prevention of new infections among infants born to HIV positive mothers and management of HIV positive mothers (Nnam and Brou, 2007). This program was born following the increase prevalence of infant mortality, with HIV ranked as the fifth cause. 90% of HIV infection in children is transmitted from mother to child (vertical transmission) during pregnancy, labor, delivery and breastfeeding (Abou and Grent, 2008).Without treatment, antiretroviral therapy (ART) the likelihood of HIV passing from mother to child is 15-45%, 5-10% during pregnancy, 10-20% during labor and delivery and 10-20% during breastfeeding (Graham, 2000). To prevent the transmission of HIV from mother to baby, WHO promotes a comprehensive strategic approach that includes four components: the prevention of new infections in parents, avoiding unwanted pregnancies in HIV infected women, preventing transmission of HIV from an infected mother to her infant and care, treatment and support for mothers living with HIV, their children and families. It primarily includes the provision of antiretroviral prophylaxis to the mother to reduce the risk of MTCT through rigorous PMTCT program (UNICEF, 2007). PMTCT programs require women and their infants to receive a cascade of interventions including uptake of antenatal services and HIV testing during pregnancy, use of ART by pregnant women living with HIV/AIDS, safe child birth practices and appropriate infant feeding, uptake of infant HIV testing and other post-natal healthcare services (UNAIDS, 2004). MTCT rate is less than 1% through perinatal prevention of MTCT in high income countries (WHO, 2013a). In low income and middle income countries, PMTCT program coverage remains low and consequently transmission rate high (Msuya, 2009).

The prevention of MTCT plays a major role in limiting the number of children being infected by HIV. Without any intervention, 20-50% of infant would be infected; 5-10% during pregnancy, 10-20% during labor and delivery and 5-20% through breast feeding. By implementing PMTCT program the overall risk can be reduced to less than 2% (WHO, 2007).In Cameroon for example with a population of 19.9 million as at 2006, Cameroon faces one of the most severe HIV epidemics in west and Central Africa. Adult prevalence rated at 4.3%, about 610,000 people live with AIDS and 37,000 died from AIDS in 2009. Here women are disproportionately affected; prevalence of 5.6% versus 2.9% in men. Approximately 54,000children under 14years of age are infected and a staggering total of 330,000 children loss at least a parent to AIDS (Gross, 2014).In 1986, the government of Cameroon responded to the HIV epidemic by creating the National AIDS Control Committee (NACC) with a national goal of virtual elimination of MTCT by 2015 as targeted in the 2009-2015 national strategic plan and the Cameroon national plan to eliminate new HIV infections in children and keep mothers alive (Ekanen, 2014).In 2011 a global plan was launched to reduce the number of new infections through MTCT (PMTCT) by 90% by 2015 (WHO, 2013a).

1.2 Problem Statement

Prevention of Mother to Child Transmission of HIV/AIDS in Sub-Saharan Africa has already suffered a defeat owing to the gap between global politics and local realities (Maman, 2001). Over the last four decades the knowledge of HIV/AIDS has increased and so have the number of people affected (Sweeney, 2005). In 2010, reports from the National AIDS Control Committee (NACC) of Cameroon showed that about 7,300 babies were born HIV positive due to MTCT (Ministry of Public Health, National AIDS Control Committee, 2010). Worldwide 2.5-3.5 million children die AIDS related deaths; this causes shortfalls in the achievements of the 4th and 5th millennium development goals (Newell, 2006). The prevalence of pediatric HIV continues to be on the rise inspite so much national and international efforts. For these reasons, the investigators felt the need to assess the challenges faced by nurses and midwives in eliminating MTCT of HIV/AIDS.

1.3 General Objectives

To assess the challenges faced by nurses and midwives in delivering the prevention of mother-to-child-transmission of HIV/AIDS services in Muyuka District hospital, Cameroon.

1.3.1 Specific Objectives

1. To assess the knowledge of nurses and midwives on MTCT of HIV/AIDS.
2. To investigate knowledge of nurses and midwives on PMTCT of HIV/AIDS.
3. To find out the challenges they face in delivering PMTCT services.

1.4 Research Questions

1. Are nurses and midwives knowledgeable on MTCT of HIV/AIDS?
2. Are nurses and midwives knowledgeable on PMTCT of HIV/AIDS?
3. Do nurses and midwives face any challenges in delivering PMTCT services?