JINKA UNIVERSITY

COLLEGE OF NATURAL AND COMPUTATIONAL SCIENCE

DEPARTMENT OF STATISTICS

MOTHER TO CHILD TRANSMISSION OF HIV/ AIDS ASSOCIATED

FACTOR IN JINKA TOWN HEALTH FACILITIES, SOUTH OMO ZONE,
SOUTH ETHIOPIA, 2020

BY: ROBERA TESFAYE (BSc.)

ADVISORS: TEGENU (M.Sc.)

JUNE, 2023

JINKA, ETHIOPIA
 ACKNOWLEDGEMENTS

First of all, I would like to thank almightily God for strengthening me in all the
way and who made me capable to do this paper.

My sincere thanks and appreciation will also go to the following people:

 The participants, thank you for your co-operation. Without you this study
would not have been possible.
 My colleagues, thank you for sharing ideas and your constant
encouragement to carry on with the study.
 Thank you to all of those who helped me during my study.
 I would also like to thank my family who honoured my process and
motivate me to this level and giving me there love and support during my
study.
May our heavenly father bless you all.

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TABLE OF CONTENTS

Contents Page
ACKNOWLEDGEMENT.....................................................................................................................................i
Abbreviations…………………………………………………………………………………………………………...iii
Abstract…………………………………………………………………………………….…………………………..….iv
CHAPTER 1: INTRODUCTION.......................................................................................................................1
1.1. Background ..................................................................................................................................................1
1.2. Statement of the problem .......................................................................................................................2
1.3. OBJECTIVES ..................................................................................................................................................3
1.3.1 General objective: .....................................................................................................................3
1.3.2. Specific objectives: .................................................................................................................3
1.4. Significance of the study..........................................................................................................................3
1.5 Scope of the study……………………………………………………………..…………………………….....…3
CHAPTER 2: LITERATURE REVIEW .........................................................................................................4
2.1 Introduction .................................................................................................................................................4
2.2 Mother-to-child transmission of HIV ................................................................................................4
2.3 Risk Factors Associated with MTCT of HIV ....................................................................................5
CHAPTER 3: DATA AND METHODOLOGY…..........................................................................................8
3.1. Study area ....................................................................................................................................................8
3.2 Study design and period ........................................................................................................................8
3.3 Source population and Study population .......................................................................................8
3.3.1 Source population ...................................................................................................................8
3.3.2 Study population .....................................................................................................................8
3.4. Inclusion and Exclusion criteria…………………………………………….……………..……………….9
3.4.1. Inclusion Criteria……………………………………………………..………….………………..9
3.4.2. Exclusion Criteria……………………………………………………………………………….…9
3.5. Sampling Size Determination and Sampling Technique…………………………….…………..9
3.5.1. Sample Size Determination…………………………………………………………………….9
3.5.2 Sampling Technique………………………………………………………………………………..9
3.5 Sample size determination and Sampling technique .................................................................9
3.5.1 Sample size determination ..................................................................................................9
3.5.2 Sampling technique .................................................................................................................9
3.6. Study Variable……………………………………………………………………………………………………..10
3.6.1 Dependent Variable .................................................................................................................10
3.6.2 Independent Variables ...........................................................................................................10

Time schedule and Budget Plan Time schedule……………………………………………………………………..11

Budget plan……………………………………………………………………………………………………………..….12

References…………………………………………………………………………………………………………………..13

ii
Abbreviations

AIDS: Acquired Immunodeficiency Syndrome

ANC: Antenatal care

AOR: Adjusted Odds Ratio

ART: Anti-Retroviral Therapy

BSc: Bachelor of Science

CPT: Co-trimoxazole preventive therapy

DBS: Dry blood spot

DNA/PCR: Deoxyribonucleic acid / Polymerase Chain Reaction

EDHS: Ethiopian Demographic Health Survey

FP: Family Planning

HEIs: HIV exposed infants

HAART: Highly Active Anti-Retroviral Therapy

HIV: Human Immunodeficiency Virus

LBW: Low birth weight

MTCT: Mother to child transmission

MUAC: Mid upper arm circumference

NGO: Non-Governmental Organization

PMTCT: Prevention of mother-to-child transmission

SNNPR: South Nation Nationalities and People Republic

SPSS: Statistical Package for Social Science

WLHIV: women living with HIV

iii
 Abstract
Background: HIV/AIDS can affect all age groups, but is the leading infectious cause of pediatrics
morbidity and mortality in the world. A vast majority of HIV infections in children under the age of
15 were through mother to child transmission. In Ethiopia, MTCT accounts for 95 percent of
childhood HIV infections but risk of transmission increases significantly if the mother is untreated

Objective: To assess rate of Mother- to - Child Transmission of HIV and associated factors among
exposed infants on follow-up in Jinka town health facilities, South omo zone, South Ethiopia, 2020.

Methodology: A retrospective cohort study was employed among 230 exposed infants in Jinka
general hospital and millennium health center at Jinka. Medical records of HIV- exposed infant and
their mothers enrolled at PMTCT clinics in the study institution and registered from September/2014
to August /2018 were extracted using data extraction sheet after getting ethical clearance from the
Institutional review board of Addis Ababa University. The data was entered in Epi Data 4.2 version
and exported to SPSS version 25 for final analysis. Bivariate and multivariable logistic regression
were used to identify predictors of HIV vertical transmission. Significance was considered at P-value
< 0.05 in the multivariable analysis.

iv
 CHAPTER 1
INTRODUCTION

1.1. Background

Human immunodeficiency virus (HIV) is a major global health emergency. Since 1981, acquired
immunodeficiency syndrome (AIDS) first reported, an estimated number of 39 million people have
died of AIDS-related diseases globally. It has also appealed the lives of millions and has left behind
hundreds of thousands of orphans. Sub –Saharan Africa is the most affected region in the global
AIDS epidemic(1,2).
HIV/AIDS can affect all age groups, but is the leading infectious cause of pediatrics morbidity and
mortality in the world(3). It is estimated that 160,000 new HIV infections were reported among
Children <15 years, mostly from developing countries(4)
A vast majority of HIV infections in children under the age of 15 were trough mother to child
transmission (MTCT), which is also known as “vertical transmission”, which means the virus is passed
to the child when they are in their mother's womb or as they pass through the birth canal, or
through breastfeeding(5). MTCT of HIV is a core public health challenge for Sub-Saharan African
countries. In Ethiopia, MTCT accounts for 95 percent of childhood HIV infections but risk of
transmission increases significantly if the mother is untreated (5). Even though the magnitude of
transmission depend upon the presence and duration of breastfeeding, ART and other interventions
can reduce this risk (5,6).
In 2009, prior to the launch of the Global Plan, the overall transmission rate (including during the
breastfeeding period) was 28% in 21 priority countries including Ethiopia and it has been halved to
14% in 2014, (7).The expansion and closer integration of HIV, maternal and child health, and sexual
and reproductive health services are urgently needed to control new HIV(8).
For this reason, Prevention of mother-to-child transmission (PMTCT) programs got emphasis in all
countries. The program provides a variety of services for women of reproductive age living with or at
risk of HIV to keep their health and stop their infants from acquiring HIV. The services should be
offered before conception, and throughout pregnancy, labor and breastfeeding and should include
early infant diagnosis and ART initiation as soon as possible (5).
After implementation of Option B+, around 91% of the 1.1 million women receiving antiretroviral
drugs as part of PMTCT. Option B+ is a guideline which released in September 2015 by WHO, which
recommends all pregnant women living with HIV be immediately provided with lifelong treatment
regardless of CD4 count (9). This guideline provides a greater guarantee that women in need of
treatment will receive a fully suppressive triple ARV regimen. This can also minimize the risks of
infant infection and increase the benefit to their own health, and avoid carelessly receiving a
suboptimal ARV prophylaxis intervention, particularly in settings with limited access to CD4
testing(10).
In some countries, more infant infections are now occurring during the postnatal period due to
breastfeeding rather than pregnancy or labor due to the high rates of women who leave care(5). For
this reason, more effective counselling and preparation of women testing positive for HIV during
pregnancy is needed before they start ART to improve adherence levels after they have given birth.
Social support group and peer support is particularly needed to help women handle with HIV-related

1
stigma and adhere to treatment(11). Around 1.4 million HIV infections among children were
prevented between 2010 and 2018 due to PMTCT programs(5).

1.2. Statement of the problem

HIV/AIDS remains the major infectious cause of pediatrics death worldwide. It is also a major global
health emergency, affecting all regions of the world, causing millions of deaths and suffering to
millions more(3). Based on global summary of AIDS epidemics in 2018, approximately 100,000 AIDS-
related deaths were reported among Children <15 years(4). Children living with HIV were about half
as likely as pregnant women to receive treatment (7). Such a great disparities should be addressed
urgently, because if they are not treated, 50% of the children living with HIV will die before their
second year birthday(11). There have been worrying rises in annual HIV infections and AIDS-related
mortality in key countries and entire regions. The annual number of new HIV infections has risen in
eastern Europe and central Asia (29% increase), the Middle East and North Africa (10% increase) and
Latin America (7% increase) (4).

Africa is the most seriously loaded continent where the spread of HIV has been enhanced by a
variety of factors, including widespread poverty, gender inequality, and health systems
weakness(2,4,5,8). Mother to child transmission plays a great role in new infection of children. Early
diagnosis and treatment of mothers is essential because the risk of mother-to-child transmission of
HIV is much higher among newly infected women who are not yet diagnosed and not on treatment.
The risk of HIV transmission from an untreated mother living with HIV to her child is as high as 15%
to 45%, depending upon the presence and duration of breastfeeding. However, appropriate
implementation of PMTCT can reduce this high transmission rate and enable us to make the final
HIV transmission rate to 5% or less among breastfeeding women and to 2% or less among non-
breastfeeding women by 2020(7,9). A slight progress has been shown in pediatric HIV diagnosis
from 2013 to 2014. Of an estimated 1.2 million HIV-exposed infants among the 21 priority countries
including Ethiopia, about 49% received a virologic test to determine their HIV status within the first
two months of life in 2014 compared to 40% in 2013. But there was less improvement on
antiretroviral therapy accessing. Of the 2.1 million children under 15 years of age living with HIV,
only 31% received antiretroviral therapy, compared to 27% in 2013 and 10% in 2009 (7).

Among the 23 priority countries, four countries reported treatment coverage among children was
60% or greater (Botswana, Kenya, Namibia and eSwatini) in 2016, this shows a good progress. But
there continues to be low ART coverage among children in the western and central Africa, with six
out of eight priority countries reporting treatment coverage in 2016 that was equal to or less than
25%(11). Due to a lack of treatment, 110,000 children died due to AIDS-related illnesses in 2017(12).
This goes in contrast with “treat all” recommendations which was launched in 2016 by WHO, which
call for immediate HIV treatment for everyone diagnosed with HIV infection. This guideline
recommends all people testing positive for HIV should start ART as soon as possible, and within 1
week (13). The prevalence of HIV in Ethiopia among reproductive age group (15–49) was 1% in
2017 and it shows an insignificant decrease from the number in 2015 (1.1%). Moreover, the number
of new HIV infection among children (0–14) was 2, 700 in 2018(2,4,5,8).

2
Even though EDHS 2011 report shows Prevalence of HIV was 0.9% in South Nation Nationalities and
People Republic (SNNPR), the prevalence of HIV in south Omo zone in Jinka town was 3.4% and 6.5%
among pregnant women attending PMTCT and male partners respectively in 2010/2011 and it was
high when we compared it with national HIV prevalence which is 2.1%(14).

Determining MTCT of HIV and associated factors is therefore highly beneficial for the intervention
activities and the prevention program that our country is thriving to achieve. There are many studies
have been conducted in relation to MTCT in Ethiopia, in spite of that the study that can clearly show
the mother- to-child transmission of HIV infection and its associated factor among exposed children
in Jinka town has not been previously conducted. Therefore, the aim of this study is to assess MTCT
of HIV and associated risk factors in Jinka town public health facilities.

1.3 OBJECTIVES

1.3.1 General objective:

To assess Mother- to - Child Transmission of HIV and associated factors among exposed infants on
follow-up in Jinka town health facilities, South omo zone, South Ethiopia, 2020.

1.3.2. Specific objectives:

To determine the magnitude of HIV transmission from mother to infant in Jinka town health
facilities, South omo zone, South Ethiopia To determine factors associated with HIV transmission
among HIV exposed infants

1.4. Significance of the study

This research could give crucial information since there is no study conducted on Mother to child
transmission of HIV infection in Jinka town. This study would help to fill the gap in identifying factors
which associate with MTCT HIV among exposed infants. This report could also be helpful for health
professionals working on PMTCT to improve their roles in providing quality care and to have HIV free
children for future. This study will be important to FMoH of Ethiopia, Non-Governmental
Organizations (NGOs), South Omo zone health office and other responsible bodies as an input in
checking the progress and achievement made regarding PMTCT and to have further intervention.
The study will serve as a source of information for other researchers who are interested to conduct
similar study based on primary data in the area and as a reference material.

1.5. Scope of the study

The scope of the study is limited to jinka town Health facilities, in SOUTH OMO ZONE, SOUTH
ETHIOPIA 2020

3
 CHAPTER 2
LITERATURE REVIEW

2.1 Introduction

Globally there were 37.9 million People living with HIV and 1.7 million was new infection in
2018/mid 2019. The contribution of under 15 children who was newly infected by HIV accounts
160,000. The majority of which are in sub-Saharan Africa. Every day there are approximately 1,500
new infections in children less than 15years of age, more than 90% of them occurring in the
developing world(1,11,15).

2.2 Mother-to-child transmission of HIV

Different scholars strived to write about the MTCT of HIV and associated factors among HIV exposed
children. For instance, a retrospective cohort study done in Amazonas, Brazil, reported an overall
6.6% (95% CI: 5.0–8.1) MTCT rate of HIV. According to this study the rate of MTCT of HIV decreased
from 7.5% in 2007–2008 to 3.2% in 2011(16). Similarly another prospective cohort study was
conducted in Zimbabwe in 2018, reported as, the national cumulative 18-month MTCT rate was
7.0%(17).

Additionally, a cross-sectional study, conducted at Levai Mbatha Community Health Centre in

Evaton, Gauteng Province, South Africa reported, rate of mother- to-child transmission of HIV was
4.9% (10/206) among HIV- exposed infants(18).

Another study, a secondary analysis of data collected from a previously published prospective cross-
sectional study, conducted at the University College Hospital Ibadan, Southwest Nigeria reported
that, prevalence of HIV among children was 10% (60/600), and 93.3% children acquired the
infection via mother-to-child transmission (19).

According to the study done at Dil Chora Referral Hospital, in Dire Dawa City Administration, mother
to child transmission HIV was 15.7%; most of them 55 (91.7%) were confirmed by DNAPCR(20).

Additional facility based cross-sectional study was conducted in the Tigray regional state showed
that among 340 exposed infants born to HIV seropositive mothers, the overall HIV prevalence was
found to be 2.1% (n=7). HIV positivity was higher in infants who did not take ARV prophylaxis

and whose mothers did not enroll to ART care and follow up and infants of mothers who did not
take PMTCT interventions during pregnancy or childbirth (P<0.05)(21).

Retrospective cohort study has conducted in selected health facilities of East and West Gojjam
Zones, Northwest Ethiopia showed that among 305 HIV-exposed infants,18 (5.9%) were confirmed
to be HIV-positive (95% CI). Children who were born from older mothers, infants whose mothers
didn’t get PMTCT intervention, and mothers who become pregnant after they were aware of their
HIV status were the factors associated HIV transmission to the infant.(22).

4
Similarly, the overall prevalence of DNA/PCR HIV positivity among children born to HIV positive
mothers in Oromia Regional State was 7.7%. This 7.7.% MTCTH was slightly lower than study
conducted in Amhara region (10.1%and Southwest Ethiopia(17%)(23–25).

In the same way, the research conducted in North West Ethiopia reported that, the prevalence of
MTCT of HIV was 3.8% which is lower in comparable with other study conducted in Ethiopia. This
may relate to option of PMTCT interventions in HEIs. In that study the participant were received
intervention with option B+ which resulted in a low MTCT of HIV as compared with previously
implemented options(26).

2.3 Risk Factors Associated with MTCT of HIV

Socioeconomic & Demographic factors

Amount of income can affect MTCT of HIV. In high income countries mother-to-child transmission
has been nearly eliminated as a result of effective voluntary testing and counseling, access to
antiretroviral therapy, safe delivery practices, and the widespread availability and safe use of breast
milk replacement feedings (5).

Facility-based cross-sectional survey conducted in Rwanda showed, from the total sample of 1639
infants with HIV test results, 26 infants were diagnosed Sero-positive. Infant born to mother age
older than 25 years and on ART are less likely to be HIV positive. Young mothers (< 25 years old) are
imagined to use PMTCT services less than older women(27).

In another study, place of residence affects MTCT of HIV. Infants born to HIV positive mothers from
rural residence were three times at higher risk of acquiring HIV infection than those born to

mothers from urban areas. This difference may be related to lack of access to ANC clinics providing
PMTCT services in rural areas compared to urban(20).

Obstetric factors

More of Africa Attention is focused on antiretroviral (ARV)-mediated PMTCT among HIVpositive

pregnant women. However, studies evaluate that prevention of unintended pregnancies is more
effective and efficient than prevention during pregnancy. In women living with HIV(WLHIV), there is
additional risk of HIV transmission to the child. ART drugs for HIVpositive women greatly reduce HIV
positive births, while ensuring family planning is more effective at a lower cost. It is imperative to
strengthen family planning services to reduce unintended pregnancy(28).

Among the obstetric factors, mode of delivery can affect the transmission rate. According to the
study done by De Andrade et al, 2016, elective caesarean section were associated with a significantly
lower odds of MTCT(16). Additionally, Antenatal prophylaxis in labour was found to be significantly
associated with peripartum transmission of HIV. Mothers who received prophylaxis during labour

5
were found to have a significant reduction in MTCT rates among their children compared with those
that did not receive prophylaxis in labour(18).

From the study done at Dil Chora Referral Hospital, in Dire Dawa City Administration, infants born at
home had a three times higher risk for HIV infection compared to those delivered at health
institutions. This could be because the risk of MTCT of HIV infection is minimized when attending
skilled delivery in health institutions as it avails opportunities to ARV prophylaxes to the mother
during labor and to the newborn right after birth. Regarding home deliveries in this study, 74% of
pregnant mothers received PMTCT and only 16% of newborns received ARV prophylaxis at birth(20).

Maternal health

PMTCT services should be offered before conception, and throughout pregnancy, labour and
breastfeeding. Keeping women and infants in PMTCT programs after delivery is challenging. In some
countries more infant infections are now occurring during the postnatal period due to breastfeeding
rather than pregnancy or labor due to the high rates of women who leave care.

Around 1.4 million HIV infections among children were prevented between 2010 and 2018 due to
PMTCT programs(5).

Even though most effective strategy to prevent MTCT of HIV infection is through creating public
awareness and educating people on HIV; its routes of transmission, methods of prevention and its
consequences if acquired, most women of child-bearing age in Mwizi sub-county of Uganda lacked
adequate knowledge to prevent MTCT despite high awareness of MTCT and the need for PMTCT.
Knowledge about PMTCT for rural women is needed. More training on techniques to reinforce
PMTCT messages is needed(29)

The study done in Zimbabwe found that time to initiate maternal ART was related to MTCT. It shows
that starting ART preconception and during pregnancy significantly reduced the risk of MTCT
throughout 18 months postdelivery by 88% and 58% respectively, compared to mothers without
ARVs. Mothers starting ART postdelivery had a 33% reduced MTCT risk compared to mothers
without ARV(17).

The findings of Systematic Reviews and Meta-Analyses in Ethiopia showed that HIV positive women
with no PMTCT intervention were more than seven fold more likely to have HIV positive child(30).

Child factors

In ideal situations, the provision of ARV prophylaxis and replacement feeding can reduce
transmission of HIV from an estimated 15- 45% with no intervention to around 1-2%. In high income
countries mother-to-child transmission has been nearly eliminated as a result of access to
antiretroviral therapy, safe delivery practices, and the widespread availability and safe use of breast
milk replacement feedings (5)

The study done by De Andrade et al, 2016, reported, being breastfed was significantly associated
with transmission of HIV infection(16). In contrast to this study, the study conducted in Zimbabwe
showed, with high coverage of maternal ART and infant prophylaxis, breastfeeding may not increase
MTCT risk (17).

6
According to the research conducted at South Africa, Infant feeding was identified as a major source
of infection. The transmission of HIV through breastfeeding is estimated to be about 10% but when
extended prophylaxis with 6 weeks of NVP is given, this transmission rate can be reduced by half(18)

As evidenced by study conducted in Zimbabwe, low birth weight (LBW) were one of the risk factors
associated with MTCT of HIV. According to this study HIV exposed infants (HEIs) with LBW were 2.6-
fold more likely to acquire HIV from their mothers compared to those with normal birth weight. This
is may be due to LBW infants are vulnerable for infection(17).

From the study done at Dil Chora Referral Hospital, in Dire Dawa City Administration, ARV
prophylaxis at birth was another determinant factor for MTCT of HIV infection. Infants who did not
receive ARV prophylaxis immediately after birth were 5.8 times at higher risk of being infected with
HIV than their counterparts(20).

Infants who did not receive co-trimoxazole preventive therapy (CPT) had 7 times more likely to be
HIV Positive than those received CPT. This is in line with other studies done in Ethiopia(20), and
Southwest Ethiopia(25) this would be due to the risk of bacterial infection and laceration that leads
to mucosal barrier breakage and subsequent promotion of viral entry to the blood stream and
progression of HIV infection(23).

Clinical factors

A cross-sectional study, conducted at Levai Mbatha Community Health Centre in Evaton, Gauteng
Province, South Africa finds maternal CD4 count as a one factor and it revealed that mothers with
CD4 count below 200cells/ μl are at increased risk of vertically transmitting HIV to their infants(18).

Other factors

Based on the Rwanda report ,not disclosing HIV status, not testing for syphilis during pregnancy and
preterm birth were significant risk factors for MTCT(27).

Even though the Malawi Ministry of Health introduced option B+ as earlier in 2011, which went
beyond WHO recommendations at the time, the overall MTCT rate was 3·7% and ranged from

1·4% in women who started ART before pregnancy to 19·9% in women not on ART. This a great
disparity shows that in spite of launching policies, MTCT can be minimized through optimal
implementation of PMTCT service, addressing HIV positive pregnant women to enrolled in PMTCT
clinic and early initiation of ART. To have a good outcome, the guideline for PMTCT required 100%
service provision(31).

In addition to that the research conducted in Adama town, Ethiopia, showed that implementation of
option B+ PMTCT service can reduce the probability of HIV transmission from mother to child. As
the research reported, the overall MTCT was 0.4% and from HIV exposed infants two died(32). This
gives a great hope to have zero new HIV infection in 2030 if option B+ PMTCT service has used
appropriately.

7
 CHAPTER 3
DATA AND METHODOLOGY

3.1. Study area

This study was conducted in South Omo zone, Jinka town, one of the fourteen zones in South Nation
Nationality and Peoples’ Region (SNNPR). The region is one of the nine region with lowest economic
growth. It is 750 KM south of Addis Ababa and 550Km away from the regional capital, Hawassa. The
zone is located in 4.430 – 6.460 North latitude & 35.790-36.060 South longitude. The climatic
condition ranges from Dega to Kola which constituted 34.4% of the zonal climatic condition. It was a
home for 16 tribes, magnificent cultural diversity and afro- traditionalism.

According to the zonal Health Department Annual report, now a day, Jinka town has one general
hospital and one Health center. Since 2006 the hospital has been giving integrated ANC- PMTCT
service for the pregnant women who have been following ANC service and there are 5 PMTCT
trained staff who are actively working in the department. In addition to this, the town has 1
functional health center which has been providing ANC- PMTCT service with 3 PMTCT trained staff.
The study was done at Jinka general hospital and Millennium health center.

3.2 Study design and period

Institutional based retrospective cohort study design was used from September/2014 to August
/2018 in Jinka town public health institutions.

3.3 Source population and Study population

3.3.1 Source population

The source population are all records of exposed infant-mother pair who were on follow-up at
PMTCT clinics in selected public health facilities in Jinka town.

3.3.2 Study population

The study population were records of exposed infants-mother pair who were on follow-up and
registered from September/2014 to August /2018 at PMTCT clinics and for which a confirmatory HIV
test was done.

8
3.4 Inclusion and exclusion Criteria

3.4.1 Inclusion Criteria

Infants whose mothers were enrolled in the PMTCT program and HIV exposed infants who had
confirmatory HIV test was included.

3.4.2 Exclusion Criteria

HIV exposed infant without confirmatory test during the study period (September/2014 to August
/2018) and who had no complete data was also be excluded.

3.5 Sample size determination and Sampling technique

3.5.1 Sample size determination

The sample size determined by using double population proportion formula considering the
following assumptions: 95% CI, power 80%, ratio of unexposed to exposed 1:1 and parameters:

P1: is percent of exposed with the outcome

P2: is percent of non-exposed with the outcome

in order to calculate the required sample size. Finally, it is calculated by using Epi info version 7
statistical package.

Table 1 Sample size determination by using double population proportion formula.

Variables Proportions Risk ratio References Sample size

Residence P1=36.6% 2.77 (20) Exposed=61
- Rural (P1) P2=13.2% Unexposed=61
- Urban (P2) Total=122

Duration of mothers P1 = 18.6% 3.26 (23) Exposed=115

ART treatment P2=5.7% Unexposed=115
- ≤4 weeks (P1) Total=230
- >4 weeks (P2)

ARV prophylaxis at birth P1 = 45.2% 0.16 (20) Exposed=26

- No (P1) P2= 7.38% Unexposed=26
- Yes (P2) Total=52

The total sample size obtained is 230.

9
3.5.2 Sampling technique

There are only two public health facilities (Jinka General hospital and Millennium Health center)
which are providing PMTCT services in Jinka town, and both are selected for the study. The total
sample needed is 230. From the total of 312 charts were registered at two health institution (Jinka
general hospital and millennium health center) during the study time, there were 245 charts were
registered at JGH and 67 charts were registered at the millennium health centers. The samples were
allocated proportionally and selected with simple random sampling.

S. No Period Total No. of registered Number of Total no. of

mother-infant pair sample selected samples selected
JGH MHC TOTAL JGH MHC JGH&MHC
1 2014-15 72 10 82 53 7 60
2 2015-16 70 12 82 51 9 60
3 2016-17 43 25 68 32 18 50
4 2017-18 60 20 80 45 15 60
Total 245 67 312 181 49 230

Proportionally 230 total sample size allocated for each health facilities with year-based allocation.

3.6 Study Variables

3.6.1 Dependent Variable

HIV sero-status of the baby

3.6.2 Independent Variables

Socio demographic characteristics (mother age, marital status, level of education, infant
age, sex of infant, birth weight),
Mothers (ANC follow-up, illness during pregnancy, ARV prophylaxis, ART adherence, CD4
count done, WHO clinical stage of HIV, maternal ARV intake prior to current pregnancy,
time of mother knew her sero-status, gestational age at the time of dx if newly diagnosed at
ANC)
Place of delivery and Mode of delivery, infant feeding practice,
Intake of ARV prophylaxis by infants.
Infants age at which DBS was done

10
 Time schedule and Budget Plan Time schedule

In order to finalize the paper work on time, it is necessary to prepare a work plan which guides him
to answer the question of what should be done on the specific time periods. The paper work plan
given below is the breakdown of the research project stages and the time schedule.

Table: 4.1 Activities and Time Schedule of the study

NO. Activity Time Schedule

1 Title selection March 21

2 Reviewing of literatures March 21–March31

3 Proposal writing April 1-April 23

4 Proposal submission April 27- April 29

5 Data collection May 3-May 16

6 Data analyze May 16-May 26

7 Data entry, coding, editing and processing May27-June 11

8 Submission of the research June 11-June 17

9 Research presentation June 17-June 20

Budget schedule
STATIONARY BUDGET REQUIREMENT AND PRE - ANALYSIS BUDGET.

PRE- ANALYSIS BUDGET

Table: 4.2 Pre- Analysis Budget of the study

Unit Trip
No Description No of tripe Cost Duration Total cost
birr
1 Internet service 5 10 Birr 3hr 150
2 For telephone 5 6 Birr 5hr 150
3 For coffee and tea 5 5Birr 5hr 125
Total 425

11
 STATIONARY BUDGET REQUIREMENT

Table: 4.3 Stationary Budget Requirements of the study

No Item Unit Amount Unit Price Total Birr

1 Paper Piece 80 1 80x1=80
2 Photo Copy for materials Page 80 2 80x2=160
3 Pen Number 4 15 4x15 =60
4 Binder Number 1 50 1x50=50
5 Ruler Number 1 15 1x15 =15
Tota 365
l

SUMMARY OF BUDGET BREAKDOWN

Table: 4.4 Summary of budget breakdown of the study

Expense category Total

Pre-analysis Budget 425
Stationary requirement budget 365
Grand total 790

12
 References

1. UNAIDS (Joint United Nations Programme on HIV/AIDS). The gap report. [Accessed 9 May 2019].
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