CM CHAMA, JY YAHAYA, BB AJAYI

Transcription

1 THE KNOWLEDGE, ATTITUDE AND PRACTICE OF HEALTH WORKERS IN MAIDUGURI WITH REGARDS TO HIV/AIDS AND THE PREVENTION OF MOTHER TO CHILD TRANSMISSION (PMTCT) OF HIV 2 CM CHAMA, JY YAHAYA, BB AJAYI Background: Mother to child transmission of HIV accounts for over 90% of paediatric HIV infections. It is for this reason that the Federal Government of Nigeria launched the Prevention of Mother To Child Transmission (PMTCT) of HIV project in The University of Maiduguri Teaching Hospital (UMTH) was chosen as one of the six pioneer sites for this project. Objectives: This paper examines the knowledge, attitude and practice of health workers in the UMTH with regards to HIV/AIDS in general and PMTCT of HIV in particular. Methods: A structured questionnaire was administered to health workers within the UMTH. This was combined with in-depth interviews using a prepared topic guide. Results: The knowledge of the nature of HIV/AIDS and its mode of transmission by health workers was good. Most of the health workers also knew the major signs of HIV infection. However, there were misconceptions concerning the role of mosquito bites, contact with faeces/urine and even mere handshake with HIV/AIDS patients as means of HIV transmission. Conclusion: Radical restructuring of health institutions, training and retraining of health workers are required for a proper take off of the PMTCT of HIV programme. Key words: Knowledge, attitude, practice, HIV/AIDS, PMTCT INTRODUCTION Nigeria, like other countries in the sub region, is having its share of the burden of the global HIV/AIDS pandemic. Since 986 when the first HIV case was reported in a year old girl in Nigeria, the number of cases has continued to rise in alarming proportions. The result of the national HIV seroprevalence survey which was conducted in Nigeria in the year 2000 indicates that at least.8% of women attending antenatal clinics were infected with HIV. This prevalence was highest in the sexually active young women in the age group-2 years. Mother to child transmission (MTCT) of HIV accounts for 90% of paediatric HIV infections. An estimated 700,000 infants acquired the infection from their mothers in the year 2000 and approximately,600 babies 2 are born with the infection every day. There is a clear need for strategies to prevent further MTCT of HIV in developing countries. In order to effectively address the problem of PMTCT of HIV in Nigeria, the Federal Government in collaboration with United Nations Children's Fund (UNICEF) initiated a project on the PMTCT of HIV in Nigeria in The goal of the project was to generate appropriate information for the formulation of a national policy and implementation guidelines for a comprehensive Departments of Obstetrics and Gynaecology, 2 Community Medicine and Immunology. University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria. PMTCT of HIV intervention. The purpose of the project was to provide PMTCT of HIV services to women of reproductive age group in selected reproductive health facilities in Nigeria. The University of Maiduguri Teaching Hospital was one of the six pioneer sites chosen for this purpose. The research findings in this report constitute a component of the PMTCT of HIV/AIDS project, which contributes to the baseline data on the knowledge, attitude and practice (KAP) of Nigerian communities. MATERIALS AND METHODS The University of Maiduguri Teaching Hospital was the setting of the research. For the quantitative aspect, a structured questionnaire was administered to health workers recruited from the Departments of Obstetrics and Gynaecology, Paediatrics, Haematology, Medical Microbiology, Internal Medicine, Medical Laboratory Sciences and Social Works. The choice of these departments was based on their relevance to the PMTCT of HIV project. Majority of the health workers (4%) were between the ages of 0-9 years and nearly two-thirds were females (Table ). Nurses and midwives constituted the largest single professional group (4%) while medical practitioners and medical scientists constituted 24.% and Correspondence and reprint request to: Dr Calvin Chama, Department of Obstetrics & Gynaecology, University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria. calvin_chama@yahoo.co.uk Kanem journal of medical sciences. 2007;():-9

2 2.% respectively. The qualitative aspect of the research involved the use of in-depth interviews using an already prepared topic guide. Doctors, nurses, midwives, laboratory scientists and ward assistants were interviewed. Both methods were carefully applied in order to obtain reliable and relevant information that represented the KAP of the health workers. Table : Age and sex distribution of health workers in the study Age (Years) > 0 Males Female Total No. % No. % No. % For the purpose of this study, the major routes of HIV transmission are sexual intercourse with an infected individual, transfusion of infected blood and blood products and the sharing of syringes and needles. The major signs of HIV infection are significant weight loss, chronic diarrhoea and prolonged fever. The minor signs are persistent cough, generalized skin rashes, recurrent shingles, generalized lymphadenopathy and recurrent oral candidiasis. The Epi Info statistical software was used for quality control checks in data entry, editing and analysis. Frequency distributions were generated for categorical variables. RESULTS Knowledge: Knowledge of modes of transmission of HIV was generally good among health workers. About 90% of the respondents identified the major routes. There were, however, prevailing misconceptions on the role of mosquitoes, faeces/urine and patients clothes in HIV transmission. As much as % of health workers indicated sharing of clothing as a means of HIV transmission, while % indicated mosquito bites. Misconceptions were commoner among the social workers and other health workers than doctors and nurses (Table 2). Health workers were generally knowledgeable about the major signs of HIV/AIDS but did not know the minor signs (Table ) Table 2: Perceived modes of HIV transmission (N = 64) Perceived modes Frequency No. % Toilet seat 9 4 Transfusion of infected blood 4 84 Mosquito bite 20 Homosexual intercourse 6 88 Heterosexual intercourse 8 Hand shake 0 6 Infected mother to child Sharing clothes 7 Faeces/urine 24 8 During delivery 80 Through breast milk Kissing 2 Sharing injection needles Haircut 86 Utensils 9 4 N Total number of cases Table : Percentage of health workers who know the signs of HIV infection Category of health workers Medical practitioners Nurses/Midwives Medical Laboratory Scientists Social workers Other workers % knowing major signs % knowing minor signs 27 Attitude: A third of the health workers would want the patients isolated in hospital wards. Generally nurses had poorer attitude to People Living With HIV/AIDS (PLWHA) than doctors and medical scientists (Table 4).With regards to HIV in pregnancy, most doctors were of the opinion that pregnancy should be continued and delivery conducted by Caesarean section (6%) rather than by normal delivery (0%). Nurses were of the opinion that delivery should be Kanem journal of medical sciences. 2007;():-9

3 normal (62%) rather than by Caesarean section (4%). Most health workers did not support termination of Table 4: Actions to be taken in HIV positive regnancy N : Number of cases; % in parenthesis Table : Infant feeding options advocated by health workers for HIV-infected mothers Chama et al DISCUSSION All over the world about half the number of People Living With HIV/AIDS (PLWHA) are women with the majority of them living in sub-saharan Africa. As of December 2002,.8% of women attending antenatal clinics (ANC) in 4 Nigeria were HIV positive. With 4- million children being born in Nigeria annually, the interaction between HIV infection and maternal and child health is expected to pose a great challenge to health care and social systems in the country. By the end of 2002, there were approximately 849,000 orphans resulting from AIDS with 7,000 established paediatric AIDS in Nigeria. Over 90% of HIV infected children acquired the infection from their mothers. It is therefore glaring that health workers in Nigeria will have to buckle up to face the challenges of HIV/AIDS epidemic. The health workers will have to be in the forefront in educating the people, caring for the infected and supporting both the infected and affected. Our study shows that the majority of the health workers are young women and men 0-9 years (4%) and the youth years (%). Such age groups constitute the backbone of the work force of the society and are therefore a promising pool of manpower to face the challenges of our time. This finding is similar to other reports from other parts of this country. HIV is largely transmitted through heterosexual intercourse 6 in Nigeria and most health workers correctly knew this fact (82-89%). Blood transfusion and mother to child transmission (MTCT) are other important routes of HIV transmission and 76-84% of the health workers also knew these. However, a significant number of health workers had s o m e m i s c o n c e p t i o n s regarding the mode of transmission of HIV. Some believed that HIV could be transmitted through kissing (%), mosquito bites (20%), from toilet seats (4%) and even by mere hand shake (%). The major signs of HIV infection are a weight 7 Kanem journal of medical sciences. 2007;():-9

4 loss of more than 0%, chronic diarrhoea and persistent fever, while minor signs include persistent cough, recurrent herpes zoster, oral candidiasis, generalized 7 lymphadenopathy, skin rashes, Kaposi's sarcoma, etc. Health workers were generally knowledgeable about the major signs but did not know the minor signs. This was similar to findings from other parts of the country. With regards to attitude, many health workers indicated that they were not afraid of AIDS and 90% of doctors would not mind attending to AIDS patients. A third of the respondents would want AIDS patients to be isolated in the hospital wards. Generally, nurses had poorer attitudes towards people living with HIV/AIDS than doctors and medical scientists. This is of concern because nurses spend more time with patients than any other category of health workers. The attitude of health workers to pregnant women was rather encouraging. Majority of the health workers (6%) would allow the pregnant HIV-positive mother to continue the pregnancy and deliver normally. A good proportion of the health workers (60%) would counsel them before offering them voluntary testing. About 70-78% of the health workers also knew that avoidance of invasive procedures such as episiotomy, administration of antiretroviral drugs (ARV) and avoidance of breastfeeding would reduce the rate of vertical transmission of HIV. Some 6% of doctors would offer elective caesarean section to prevent MTCT but this opinion was rather low among the nurses (4%). Although caesarean section is known to reduce MTCT irrespective of whether the mother had ARV 8, 9, 0 or not, its value in the developing world will have to be individualized as cost and availability of trained manpower will have to be considered. Pregnancy termination as an option for HIV positive women is generally not a favoured option among health workers. In-depth interviews revealed inadequacy of infrastructure for confidential counselling and testing. The clinics were perceived by the health workers as not youth friendly and since majority of the HIV infected are young people, it would be difficult to reach them if the clinics were not designed to meet their needs. The problem of HIV/AIDS is entangled and intertwined with several other issues. In fact, the problem of MTCT of HIV is only a small part of the big problem. Prevention of mother to child transmission (PMTCT) of HIV/AIDS cannot be executed in isolation from the general strategy against HIV prevention in Nigeria. The problem of voluntary counselling and testing (VCT) and the issues of stigmatization must be first dealt with. There is serious stigma attached to those who have HIV in many communities. An effort to present HIV/AIDS as any other disease has not worked. AIDS patients still face discrimination in our communities. In order for the PMTCT programme to succeed, a holistic strategy which considers the various problems of HIV/AIDS simultaneously must be adopted. Isolating a small part of the whole such as PMTCT of HIV will not work well. Women need to know more about HIV and specifically the problem of transferring it to their babies. A lot of effort must be put into training of health workers in order to make them to be aware of the awesome responsibilities planned for them for implementing sensitive aspects of the PMTCT. The need for health workers to be gender friendly, respect confidentiality of clients, make supplies easily available and accessible cannot be over emphasized. Education strategies should be participatory as this will create opportunities for open discussion and encourage feedback from participants about HIV/AIDS and PMTCT. PLWHA should be an essential tool for both education and research. Effective monitoring of PMTCT should be part and parcel of its implementation. With effective monitoring, anomalies will be identified early and corrected. The increasing menace of HIV infection in Sub-Saharan Africa in the face of dwindling economic resources requires an urgent need for expansion of VCT facilities as an integral part of the prevention strategies. This has been shown to be effective in some, 2, countries. Radical restructuring of the health institutions and health workers through training and other efforts that address the current inadequacies is required before PMTCT programme could be effectively and successfully implemented. REFERENCES Federal Ministry of Health, Abuja. The national seroprevalence survey of HIV among antenatal women in UNAIDS report on the global HIV/AIDS epidemic, Geneva, 999. WHO/UNAIDS HIV/AIDS epidemic update, Geneva, Federal Ministry of Health, Abuja. The national seroprevalence survey of HIV among antenatal women in National Population Commission Abuja, National Demographic and Health Survey Federal Ministry of Health, Abuja. The national seroprevalence survey of HIV among antenatal women in World Health Organization; training guide for HIV/AIDS counselling, The International Perinatal HIV Group on the mode of delivery and the risk of vertical transmission of HIV type-; a meta-analysis of prospective cohort studies. N Eng J Med 999; 40: Coll O, Hernandez M, Boucher CAB. Vertical HIV- transmission correlates with a high viral load at 8 Kanem journal of medical sciences. 2007;():-9

5 delivery. J Acquired Immune Def Syndr 997;: American College of Obstetricians and Gynaecologists Committee opinion on scheduled caesarean section and the prevention of vertical transmission of HIV, Number 24, Washington DC, May Pool R, Nyanzi S, Whitworth JA. Attitudes to voluntary counselling and testing for HIV among pregnant women in rural South-West Uganda. AIDS Care 200;(): Maman S, Mbwambo J, Hogan NM, Kilonzo GP, Sweat M. Women's barriers to HIV- testing and disclosure: challenges for HIV VCT. AIDS Care 200; (): Abdullah MF, Young T, Bitalo L, Coetzee N, Myers JE. Public Health Lessons from a pilot programme to reduce mother-to-child transmission of HIV- in Khayelitsha. S Afr Med J 200; 9 (7): Kanem journal of medical sciences. 2007;():-9