KNOWLEDGE AND ATTITUDES OF PREGNANT WOMEN REGARDING PMTCT

OF HIV INFECTION IN THE JIMMA UNIVERSITY SPECIALIZED HOSPITAL

BY

GENET ETEFA

A RESEARCH PROPOSAL SUBMITTED TO DEPARTMENT OF

HEALTH OFFICERS, COLLEGE OF PUBLIC HEALTH AND MEDICAL
SCIENCES, JIMMA UNIVERSITY IN PARTIAL FULFILLMENT OF THE
REQUIREMENTS FOR THE BACHELOR OF SCIENCE DEGREE IN
PUBLIC HEALTH.

APRIL, 2014

JIMMA ETHIOPIA.
1
KNOWLEDGE AND ATTITUDES OF PREGNANT WOMEN REGARDING PMTCT
OF HIV INFECTION IN THE JIMMA UNIVERSITY SPECIALIZED HOSPITAL

BY

GEET ETEFA

ADVISOR: ASERESASH

APRIL, 2014

JIMMA ETHIOPIA.

2
ABSTRACT
Background: HIV/AIDS is currently a major public health problem in Ethiopia and mother to
child transmission (MTCT) is responsible for 90% of childhood HIV infections. The transmission
of HIV from infected mothers to babies could occur during antenatal period, as well as during
delivery and breastfeeding (postnatal period). Since breastfeeding is essential for child survival,
it is also necessary to assess mothers’ knowledge and attitude towards HIV transmission and its
prevention during breastfeeding.
Objectives:knowledge and attitudes of pregnant women regarding PMTCT of HIV infection in
the Jimma University Specialized Hospital.
Methods: A cross sectional, descriptive study will be conducted to assess knowledge and attitude
towards MTCT and its’ preventive methods on postnatal mothers who delivered at Jimma
University Specialized Hospital, from April, 2014. A structured, pre-tested questionnaire will be
used for data collection.
Conclusion and Recommendation: Based on the finding conclusion will be made and
recommendation will be forwarded to concerned body.

i
ABBREVIATION
ANC: Ante Natal Care
ART: Antiretroviral Treatment
HIV: Human Immunodeficiency virus
JU: Jimma University
MOH: Minstery of Health
MTCT: Mother to Child Transmission
PCR: Polymerase Action Reaction
PLWHIV: People Living With HIV/AIDS
PMTCT: Prevention of mother to child transmission
WHO: World Health Organization

ii
 ACKNOWLEDGEMENT

First and foremost I would like to thank GOD, the most gracious, in helping me everything
needed in my life in general and accomplish this task in particular.

Second I would like to give my heart full thanks to my advisor in this study that encourages me
to do good proposal to make my expectation to be true.

I thank Jimma University for giving me this chance to undertake this research.

iii
Table of Contents page
ABSTRACT.....................................................................................................................................................i
ABBREVIATION............................................................................................................................................ii
ACKNOWLEDGEMENT.................................................................................................................................iii
CHAPTER ONE: INTRODUCTION..........................................................................................................1
1.1. Background of the study.............................................................................................................1
1.2. STATEMENT OF PROBLEM.........................................................................................................2
1.3. SIGNIFICANCE OF THE STUDY..................................................................................................3
CHAPTER TWO: LITRATURE REVIEW.................................................................................................4
2.1. LITRATURE REVIEW....................................................................................................................4
CHAPTER THREE: OBJECTIVE..............................................................................................................8
3.1. GENERAL OBJECTIVE.................................................................................................................8
3.2. Specific objective.............................................................................................................................8
CHAPTER FOUR: RESEARCH METHOD...............................................................................................9
4.1. Study area and period.......................................................................................................................9
4.2. Study Design....................................................................................................................................9
4.3. Population.......................................................................................................................................9
4.3.1. Source population:.....................................................................................................................9
4.3.2. Study population.......................................................................................................................9
4.4. Study Variables...............................................................................................................................9
4.4.1. Independent Variables...............................................................................................................9
4.4.2. Dependent variables................................................................................................................10
4.5. Sample size and sampling technique...........................................................................................10
4.5.1. Sample size..............................................................................................................................10
4.5.2. Sampling technique.................................................................................................................10
4.6. Data Collection Techniques.........................................................................................................10
4.7. Data Quality Control....................................................................................................................10
4.8. Data Processing, Analysis and Presentation...............................................................................11
4.9. Ethical Consideration...................................................................................................................11
4.10. Limitation of the Study...............................................................................................................11
4.11. Dissemination of the findings.....................................................................................................11
4.12. Operational Definitions..............................................................................................................11
CHAPTER FIVE: PROJECT WORK PLAN AND PROJECT BUDGET PROPOSAL...........................12

iv
 5.1. PROJECT WORK PLAN...............................................................................................................12
5.2. PROJECT BUDGET PROPOSAL.................................................................................................13
ANNEX I: References...............................................................................................................................14
Annex II: Dummy table.............................................................................................................................17
ANNEX III: QUESTIONNAIRE..............................................................................................................21

v
 CHAPTER ONE: INTRODUCTION
1.1. BACKGROUND OF THE STUDY
Human immunodeficiency virus (HIV) infections and acquired immunodeficiency syndrome
(AIDS) have risen to alarming proportions worldwide. HIV/AIDS has claimed millions of lives,
inflicting pain and grief, causing fear and uncertainty, and threatening the economy of severely
affected nations. According to UNAIDS, there were 40 million adults and children living with
HIV/AIDS worldwide and 5 million people were newly infected with HIV worldwide.
Approximately 10% of the world’s population infected with HIV lives in sub-Saharan Africa
(13).

Vertical transmission of HIV can occur before (intra uterine), during (intra-partum), or after
delivery (through breast-feeding). It is generally accepted that 30-40% of newborns are infected
in utero as evidenced by positive viral culture or polymerase chain reaction (PCR) tests within
the first week of life. The mechanisms of transmission appear to be exposure to infected blood
and cervico-vaginal secretions in the birth canal where HIV is found in high titers during late
gestation and during delivery. Breastfeeding is also an important transmission route in
developing countries (6).
The World Health Organization (WHO) promotes a threepronged approach to reduce MTCT of
HIV. Therefore: the prevention of new infections in parents, avoiding unwanted pregnancies in
HIV infected women (primary preventions) and preventing transmission of HIV from an infected
mother to her infant (secondary preventions) (3).

HIV is the leading cause of mortality among women of reproductive age worldwide and is a
major contributor to maternal, infant and child morbidity and mortality. Without treatment, one
third of children living with HIV die before they reach one year of age and over 50% die by the
second year of life. In 2008, an estimated 1.4 million pregnant women living with HIV in low-
and middle-income countries gave birth, 91% of whom reside in sub-Saharan Africa(7).

Many women do not participate in PMTCT programs. Missed opportunities to offer, or low
uptake of voluntary counseling and testing (VCT) during routine ANC; refusal to be tested for
HIV both by pregnant women and partners; inadequate acceptance of ART offered to HIV+

1
women at ANC; poor adherence to "take-home" antiretroviral drugs (ARV) for mother and
newborn when given to HIV+ women at ANC; insufficient use of facility-based delivery where
improved obstetric practices can be used and antiretroviral therapy (ART) for mother and
newborn can be supervised; low coverage of newborns with ART even when delivered in
facility; and non-receipt of HIV test results have been studied as barriers to participation. The
reason whyless than one third of pregnant women who receive HIV positive test results
eventually starttaking antiretroviral prophylaxis is not examined well (28, 29).

2
1.2. STATEMENT OF PROBLEM
Despite improvements in PMTCT services over the years, MTCT of HIV infections is high
especially in sub-Saharan Africa. In 2009 alone around 400,000 children less than 15yrs became
infected with HIV and 1.3 million children and adults died of AIDS. Almost all of these
infections occur in sub Saharan Africa, and more than 90% are as a result of mother-to-child
transmission (MTCT) during pregnancy, labor/delivery, and breastfeeding (31).

Studies done in Uganda and Tanzania on awareness and knowledge about HIV and PMTCT in
pregnant women, in southwestern Tanzania shows a low level of knowledge on MTCT during
pregnancy and moderate knowledge on the risk of breastfeeding and MTCT (32).

MTCT of HIV is an overwhelming source of HIV infections in young children and is also the
cause of high infant mortality rates. It is approximated that 20% - 30% of women attending
prenatal care in South Africa are HIV-positive. In the absence of intense prevention of MTCT,
probably 25% -35% of babies born to HIV-positive mothers will be infected. The proper
management of pregnant mothers can save a third of the babies during prenatal care, labour and
the puerperal care. Mpumalanga, like all the other provinces in South Africa, has the duty to
reduce the incidence of MTCT (8).

Antiretroviral drugs in prevention of mother-to-child transmission of HIV/AIDS (PMTCT)

services in order to protect the unborn children from getting HIV infection from their HIV
positive mothers; which is usually termed as Mother-To Child /Transmission (MTCT) of HIV.
Despite the availability of PMTCT services, the uptake is low. However little information is
available on mother's knowledge about PMTCT and their attitude towards PMTCT services.

It is therefore important that knowledge and attitudes of women regarding PMTCT of HIV
infection be explored to reduce the high infant mortality rate and the incidence of PMTCT of
HIV infections, in order to develop preventive programmes on PMTCT HIV/AIDS at Jimma
University Specialized Hospital.

3
1.3. SIGNIFICANCE OF THE STUDY

The purpose of this study will be to assess the knowledge and attitude about HIV MTCT among
pregnant women. Knowledge of the interventions of PMTCT is important, so that pregnant
women can be aware and through motivation they can have a positive attitude towards PMTCT.

However there were a number of factors that influenced knowledge and attitude of the pregnant
women in this study. These included socio- demographic characteristics such as age, marital
status, educational level and the occupation.

It is hoped that this study will assist to increase knowledge, attitude and practice of pregnant
women on PMTCT of HIV infections at Jimma University Specialized Hospital. Health
Professional will also benefit from the study as guidelines and recommendations pertaining to
PMTCT will update their knowledge and skills regarding this phenomenon.

4
 CHAPTER TWO: LITRATURE REVIEW
2.1. LITRATURE REVIEW
A global overview of the HIV/AIDS epidemic indicates that 42 million people are at present
living with HIV/AIDS, of which 19.2 million are women and 3.2 million are children under 15
years of age (1). The commonest route of HIV infection for HIV-positive children less than 5
years is through mother-to-child transmission (MTCT), which occurs when an HIV positive
woman passes the virus to her baby. MTCT can occur during pregnancy, labour, delivery or
breastfeeding.

An estimated 600,000 new borns worldwide are infected through mother to child transmission
each year (>1600 new born infected each day) and 90% of them live in sub-Saharan Africa (4,
5).
Rates of transmission of HIV from mothers to children have varied in different parts of the
world. Most studies in the US and Europe have documented transmission rates in untreated
women to be between 12-30%. In contrast, transmission rates in Africa and Haiti were reported
to be higher (25%-52%) (6).

According to WHO, since the start of the epidemic, over 12.2 million women worldwide have
been infected with HIV and women account for 42% of the 30.6 million adults now living with
the disease. Because of the particular vulnerability of women, the risk of women contracting HIV
is rising worldwide. These figures continue to increase in industrialized and developing
countries. In sub-Saharan Africa there are already 6 women with HIV for every 5 men, and close
to 80% of women infected, are African (10).

In 2005, around 700,000 children under 5 years of age became infected with HIV worldwide,
mainly through MTCT. About 90% of these MTCT infections occurred in Africa where AIDS is
beginning to reverse decades of steady progress in child survival. An estimated 420,000 children
were newly infected with HIV in 2007, the vast majority of them through MTCT (14, 16).

5
HIV/AIDS represents one of the major health and social challenges facing South Africa today.
Over 5.5 million people are infected with HIV and the majority of those infections are in the
reproductive age group, newborn infants and children under the age of one year (14).
A study done in South Africa revealed that babies who were exclusively breastfed were
significantly less likely to become infected with HIV/AIDS in the first three months compared to
babies on mixed feeding (15).

Kanabus& Noble state that without treatment, around 15 - 30% of babies born to HIV-positive
women will become infected with HIV during pregnancy, labour and delivery while 5 - 20% of
babies will become infected through breastfeeding. Theprobability that an HIV-positive
woman’s baby will become infected is approximately 25 - 45%. At the end of 1999, it was
estimated that there were approximately 4.2 million HIV-positive South Africans, almost half of
whom were women in their reproductive years. It is estimated that there are 50,000 HIV-positive
children whose HIV transmission was contracted primarily through MTCT (16).

Researchers in some parts of sub Saharan Africa conducted various studies on PMTCT of HIV
todetermine coverage, to see problems and challenges and find out solutions for
programmaticeffectiveness. In Coast Provincial General Hospital (CPGH), Mombassa, Kenya,
MarleenTemmerman et.al made a hospital based observational study over one year period among
3564pregnant women with first-ANC visit to review coverage of the nevirapine in the existing
PMTCT model. They found a counseling rate of 71% and a testing rate of as high as 97% (19).

In 2003-2004, Kampala, Uganda Marina Giuliano et.al made evaluation of a five-year

performance of a Hospital PMTCT programme to identify potential reasons affecting its uptake.
They found a76.0 % testing rate and a 79.9% acceptance of test result (20).

In Zimbabwe, Freddy Perez et.al estimated PMTCT programme uptake using routine monitoring
data collected over 2½ years period. It was found that 92.9% were counseled and 74.3% received
posttest counseling, whileonly 24% received complete mother–child antiretroviral prophylaxis
(21).

6
Thomas M Painter et.al in Abidjan, Ivory cost, made a clinic based qualitative interview of
27HIV positive pregnant women over 8 months’ time. In that study, negative experiences
thatpregnant women had had while interacting with programme staff or to their views about
theprogramme was an important barrier for returning back. Some women are dissatisfied with
howHIV testing had been explained—horrible consequences of the disease emphasized (23).

On the otherhand, in Kampala, Uganda show that among the challenges with the
PMTCTprogramme are staff shortage, overworked and under-motivated staff (24).

In Kigali, Rwanda a 13months prospective cohort study of factors associated with failure to
return for HIV post-testcounseling in pregnant women revealed that the only variable
significantly associated with failureto return for post-test counseling was a positive HIV test
result (25).

In a cross sectional studyconducted among pregnant women following ANC in Tanzania on

attitudes to voluntarycounseling and testing, the major concern of women was for the reaction of
their male partners tothe possibility of a positive HIV test and low confidence in the
confidentiality of HIV testing (26).

Other team of investigators has also identified that enrolment in to PMTCT programme
werelower in married or cohabitating women than single women (27).
A study in Burkina Faso revealedthat up to as much as 53% of pregnant women declared not to
know the existence of MTCT risk,reminding the existence of wide knowledge gap (19).
In a community-based survey on knowledgeand attitude towards VCT in northwest Ethiopia on
992 residents, it was indicated that most of theinterviewed individuals were lacking the correct
knowledge on mode of transmission andprevention measures (20).

Similarly, in a one year According to the Ethiopian Federal Ministry of Health (2002) 2.2 million
people are living with AIDS in Ethiopia, of which, 1.1 million are women. The number of
children <15 years of age living with HIV/AIDS was 200,000 (2).

7
Cohortof 3136 ANC attendee in Malawi 96% were pre-test counseled and 95% underwent
HIVtestingas well as post-test counseling (12).

In Ethiopia, as in any Sub-Saharan African country, the problem of mother to child HIV
transmission is one of a widespread problem that breaks intergenerationallink. The 2003 HIV
prevalence is higher among women (5.0%) thanmen (3.8%) and is higher in urban (12.6%) than
in rural (2.6%) population (MOH,2004) and also on children under 15. Ethiopia’s population is
young with 44 percent under 15 years.The prevalence of HIV infection among pregnant women
in Ethiopia was found to be 17.8%, 17.5% and 15.1% in 1996, 1997 and 1999 respectively
yielding an average of 16.8%. In urban Ethiopia the average prevalence of HIV among pregnant
women is estimated to be 13% (17).

In Ethiopia, over 80% of the cases of HIV are found between the age of 20 and 49 years, the
most economically active group of the population. A survey from the Ministry of Health showed
that certain population groups are at higher risk than others. Commercial sex workers, long
distance truck drivers and the military were found to have been the most severely affected. In
addition, sero prevalence data based on ANC surveillance in Addis Ababa among 15-24 years
pregnant women showed that HIV prevalence is about 11% in 2003 after having a peak at
approximately 24% in 1995 (18).

8
 CHAPTER THREE: OBJECTIVE
3.1. GENERAL OBJECTIVE
The aim of this study will be to assess theknowledge and attitudes of pregnant
womentowardsPMTCT of HIV infection in the Jimma University Specialized Hospital.
3.2. Specific objective
To assess knowledge of pregnant women with regard to PMTCT of HIV infection.
To identify attitudes of pregnant women regarding toPMTCT of HIV infection.
To asses association between socio demographic of pregnant women onPMTCT of HIV
infection

9
 CHAPTER FOUR: RESEARCH METHOD
4.1. Study area
This study will be conducted in Jimma University Specialized Hospital which is found in South
Western Ethiopia, in Oromia regional state, Jimma zone, in Jimma town from Dec,1-30, 2013.
The town is located 352 Kilometers South West of Addis Ababa and has total surface area of
4,623 hectares. The town has a temperature that ranges from 20-30 oC and the average annual
rainfall of 800-2500mm3 and the town has an altitude of 1750-2000m above sea level.

Jimma University Specialized Hospital is a teaching hospital with 65 physicians, 20 pharmacist

and pharmacy technicians, 613 nurses (Diploma Nurse, BSc. Nurse, and MSc), 21 medical
laboratory and laboratory technicians, 10 radiographers and radiologists and 15 patient
registration clerks and others like anesthetists, physical therapists. The study was conducted from
April 25 to May 15, 2014
4.2. Study Designand period
Facility based cross sectional study design will be conducted on pregnant mothers came for ANC
follow up in Jimma University Specialized Hospital from April 25 to May 15, 2014. Data will be
collected from all pregnant mothers’ come for ANC follow up during the study period by using
structured questionnaire. Confidentiality to any information disclosed by the pregnant mothers
will be ensured.
4.3. Population

4.3.1. Source population:

The study populations will bepregnant women.

4.3.2. Study population

The study population will be pregnant women and come Jimma University Specialized Hospital
during the study period.

10
4.4. Study Variables

4.4.1. Independent Variables

 Age
 Religion
 Ethnicity
 Marital status
 Age at first marriage
 Educational status
 Occupation
 Monthly income

4.4.2. Dependent variables

 Knowledge of MTCT
 Attitude of MTCT
 Voluntary counseling for PMTCT

4.5. Sample size and sampling technique

4.5.1. Sample size

All pregnant women came for ANC follow up from during the study period will be taken as a
sample.

4.5.2. Sampling technique

Convenient sampling techniques will be used.
4.6. Data Collection Techniques
Data will be collected by Face to face interview through structured questionnaire. Before the data
collection health officer interns who work in Jimma University Specialized Hospital Family
planning will be trained, in order to have common understanding on each question. The data
collection will be supervised by the principal investigator.
4.7. Data Quality Control
To ensure the quality of the data, standard questionnaire English version for actual data
collection purpose. Then, the principal investigator will be supervise the data collection process.
The questionnaires will be pretested prior to data collection. The quality of data will be assured

11
by properly designing and pre-testing of the questionnaire, proper training of the interviewers
and supervisors of the data collection procedures, proper categorization and coding of the
questionnaire. Every day, questionnaires will be reviewed and checked for completeness by
principal investigator and the necessary feedback offered to data collectors in the next morning
before data collection.
4.8. Data Processing, Analysis and Presentation
The collected data will be checked for completeness, and arranged then analyzed manually by
using scientific calculator. Finally the data will be presented by text, table’s pie chart and
graphs...
4.9. Ethical Consideration
Permission will be obtained from CBE office and the Hospital. Official letter from Jimma
University will be submitted to Hospital further more; data collectors will be secure verbal
consent from respondents during data collection.
4.10. Limitation of the Study
Recall bias of the respondents
Budget
4.11. Dissemination of the findings
A copy of the finding of the result will be disseminated to Zonal health burue and other policy
maker.
4.12. Operational Definitions
 Knowledge: the act or conditions of knowing something with considerable degree of
familiarly gained through experience of contact or association with the individual or
things know
o Good knowledge: those respondents who are able score > 75% of total
knowledge questions
o Fairly knowledge: those respondents who are able to score 60-74% of total
knowledge questions.
o Not knowledgeable: those respondents who are able to score <60% of total
knowledge questions.

 Attitude: a persistent disposition to act either positively or negatively towards a

situation

12
 o Positive Attitude: those respondents who are able score > 75% of total
attitude questions towards the infection prevention practice.
o Negative attitude: is those respondents who are able to score 60- 74% of total
attitude questions.

CHAPTER FIVE: PROJECT WORK PLAN AND PROJECT

BUDGET PROPOSAL
5.1. PROJECT WORK PLAN
Activities 2014
Jan Feb March April May June
Proposal dev’t& submission
of proposal
Pretest and training data
collectors
Data collection

Data analysis

Submission of final draft

report
Report submission

13
5.2. PROJECT BUDGET PROPOSAL

Items Price(Birr) Quantity needed Total price Remark

(Birr)

Stationary

Duplicating 80 00 1 80 00
paper

Pen 3 00 5 15 00

Pencil 1 00 10 10 00

Eraser 2 00 2 4 00

Printing& 100 00 100 00

Photocopy

Sharper 2 0 4 8 0

CD 5 0 2 10 0

Total 227 0

Personnel cost

Perdium Total day Total Remark

price
One day

Secretary 50 3 150

Data collector 20 7 700 For 5 person

Total 850

Contingence 54

Grand total 1131

14
ANNEX I: References
1. UNAIDS, Report on the Global HIV/ AIDS Epidemic, December 2002.
2. UNAIDS, Report on the National HIV/ AIDS Epidemic, December 2002.
3. McIntyre J, Gray G. What can we do to reduce MTCT of HIV? British Medical Journal
2002; 26 Jan, No. 7331:218-221
4. Working Group Report of AIDS and infectious disease PMP, and mother to child
transmission of HIV, ActaPaediatrica 2001; 90: 1337-1339.
5. Lynne M, Munderi M, Paula, Mofenson. Safety of Antiretroviral prophylaxis of perinatal
transmission of HIV Infected pregnant women and their children. Journal of AIDS 2002
Jun 1; 30 (2): 200-15.
6. Yogev R and Chadwick E G, Acquired Immune Deficiency Syndrome, Nelson Text
Book of Pediatrics, 17th Edition: 1109-1121
7. UNAIDS, UNICEF, WHO. Children and AIDS: second stocktaking report. Actions and
progress. UNAIDS 2008. Available at:
http://www.unicef.org/media/files/ChildrenandAIDS-Second_Stocktaking_Report.pdf
8. Department of Health. 2009. Mpumalanga Health Programmes-HIV/AIDS.
http://www.mpumalanga.gov.za. Htm. Retrieved on May 31, 2009.
9. UNAIDS, 2003. Report on Global AIDS Epidemic. Geneva. Available from
http:www.unaids.org. Accessed September 08, 2008.
10. World Health Organization. 2009. Guidelines for a Public Health Approach. Geneva.
BMS Publishers.
11. Maputle, MS &Jali, MN. 2008. Pregnant Women’s Knowledge About Mother-To-
Child Transmission (MTCT) of HIV Infection Through Breast Feeding. Curationis
31(1):45-51.
12. Kasinga, F, Mogotlane, SM & van Rensburg, GH. 2008. Knowledge of Pregnant
Women on Transmission of HIV Infection Through Breast Feeding. PubMed,
UNISA
13. UNAIDS, 2003. Report on Global AIDS Epidemic. Geneva. Available from
http:www.unaids.org. Accessed September 08, 2008.
14. Department of Health. 2004. National HIV and Syphillis antenatal sero-prevalence
survey. Pretoria: Government Printers.

15
15. Engender Health, 2007. Preventing HIV Infection: from file://E:\HIV 6 Purpose of This
Module. Htm. Retrieved on April 04, 2008.
16. Kanabus, A & Noble, R. 2008. Prevention of Mother – To – Child Transmission of
HIV: from Worldwide Web: hhtp://www.avert.org/motherchid.htm. Retrieved on April
03, 2008.
17. Ministry of Health (MOH). (2004). AIDS in Ethiopia. Fifth Edition, June 2004.Addis
Ababa.
18. Ministry of Health (MOH). (2002). National guideline for voluntary HIV counseling and
testing. April 2002.Addis Ababa.
19. Temmerman, Marleen; Quaghebeur, Ann; Mwanyumba, Fabian; Mandaliya, Kishor:
AIDS - Volume 17(8) May 23, 2003 p 1239- 1242 Mothe.htm; Copyright © Lippincott
Williams and Wilkins.
20. Marina Giuliano; Michele Magoni; Luciana Bassani; Pius Okong;
PraxedesKitukaNamaganda; Saul Onyango; A theme issue by, for, and about Africa
Results from Uganda.htm (Internet search on April 12, 2006); BMJ 2005; 331:778 (1
October), doi: 0.1136/bmj.331.7519.778
21. Freddy Perez, TarisaiMukotekwa, Anna Miller, Joanna Orne-Gliemann, Monica
Glenshaw, InamChitsike and Franc¸oisDabis; first 18 months of experience; journal of
Tropical Medicine and International Health; volume 9 no 7 pp 774–783 July 2004; ©
2004 Blackwell Publishing Ltd.
22. M. Manzi, R. Zachariah, R. Teck, et al; Tropical Medicine and International Health;
volume 10 No 12 pp 1242–1250 December 2005.
23. Thomas M Painter, Kassamba L Diaby, Danielle M Matia, et al; qualitative interview
study; BMJ 2004; 329:543 (4 September), doi: 10.1136/bmj.329.7465.543.
24. Nuwagaba-Biribonwoha H., Mayon-White R.T., Okong P., Carpenter L.M. Prevention of
Mother-to-Child HIV Transmission (PMTCT) Programme in Uganda; Kampala, Uganda.
25. Ladner J, Leroy V, Msellati P, Nyiraziraje M, De Clercq A, Van de Perre P, Dabis F.
Medical Information Unit, Centre Hospitalier de Kigali, Rwanda; Kigali, Rwanda, 1992-
1993. AIDS. 1996 Jan; 10(1):69-75. Medical Information Unit, Centre Hospitalier de
Kigali, Rwanda.

16
 26. P. Urassa, R. Gosling, R. Pool, H. Reyburn; Attitudes to voluntary counseling and testing
prior to the offer of Nevirapine ; AIDS Care: Volume 17, Number 7 / October 2005;
Pages: 842 – 852; (C) 2004 Lippincott Williams and Wilkins, Inc. © 2004 Lippincott
Williams and Wilkins, Inc. Volume 17(3), June 2004, pp 247-252.
27. Integrating PMTCT and Safe Motherhood Programs: A Behavior Change Perspective ©
2005 Academy for Educational Development - CHANGE Project 1875 Connecticut Ave.,
NW, Washington, D.C. 20009-5721. Internet Search on 1/3/2006.Full text at:
designsc@aed.org.
28. Experiences of Prevention of Mother-to-Child Transmission of HIV in Rural Tanzania 19
November 2004 (internet search on Jan 18, 2006).
29. Ky-Zerbo, K A Sanou, I Sombié, D Ouédraogo, S Ouédraogo; Knowledge of women
consulting in primary health care services on MTCT of HIV in Bobo-Dioulasso, Burkina
Faso;
30. ShitayeAlemu, NuruAbseno, GetuDegu, YaredWondimkun and Solomon Amsalu; A
community based study in northwest Ethiopia. Ethiop.J.Health Dev.2004; 18(2).
31. UNAIDS. Report on global AIDS epidemic: UNAIDS; 2010
32. Gundel H, Katja S, Ilaria M, Chris B, Paulina M et al. Analyzing awareness and
knowledge of Mother to Child Transmission and its prevention in Uganda and Tanzania;
2009.

Annex II: Dummy table

Table 1: Socio demographic characteristics of the Ante Natal Care AttendantsJimma University
Specialized Hospital

17
Variables Frequency Percentage
Age (years)
15-19
20-24
25-29
30-34
35-39
40-45
Residence
Urban
Rural
Religion
Orthodox Christian
Islam
Protestant
Catholic
Others
Marital Status
Married
Single
Divorced
Widowed
Educational Level
Illiterate
Grade 1-6
Grade 7-10
Grade 11-12
Higher education
Occupation
House wife

18
 Farmer
Government employee
Private employe
Daily Laborer
Merchant
Others
Husbands’ Occupation*
Government employee
Farmer
Daily Laborer
Merchant
Self-employed in small scale
Private employe
Others

Table 2: Outcome of major events in the ANC-PMTCT service among pregnantwomen in

Jimma University Specialized Hospital
ANC follow up Frequency Percentage
Voluntary HIV Counseling provided Yes
No
Undergone HIV testing Yes
No
Result for HIV Positive
Negative

Table 3: knowledge of pregnant mothers on MTCT of HIV/AIDS in Jimma University

Specialized Hospital

19
 Variables Frequency Percentage
First Source of Information on HIV/AIDS:
Social Ceremonies
Health workers
Mass media
News paper
Others
Knowledge of HIV/ AIDS / MTCT of HIV:
AIDS- a curse sent from God:
Yes
No
MTCT of HIV during pregnancy:
Yes
No
MTCT of HIV during Labor and delivery:
Yes
No
MTCT of HIV during breast feeding:
Yes
No
Know other mode of HIV transmission
Yes
No

Table 3:Attitude of pregnant mothers on MTCT of HIV/AIDS in Jimma University Specialized

Hospital

Variables Frequency Percentage

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 HIV related Behavior and Beliefs
Fear of being identified as HIV
positive in the community:
Yes
No
Perception of Others' Attitudes
towards PLWHA:
Outcast them or consider as
people who are cursed
Care for them like any other
sick person
Attitude towards PMTCT Services
Positive attitude
Negative attitude
Response to PMTCT Counseling and MTCT
Prevention:

Positive attitude
Negative attitude

ANNEX III: QUESTIONNAIRE

Part I: Socio demographic characteristics of the Ante Natal Care AttendantsJimma University
Specialized Hospital

21
1. Age in years___________
2. Residence
a. Rural
b. Urban
3. Religion
a. Orthodox
b. Muslim
c. Protestant
d. Catholic
e. Others
4. Marital status
a. Married
b. Single
c. Divorced
d. Widowed
5. Educational status
a. Illiterate
b. Grade 1-6
c. Grade 7-10
d. Grade 11-12
e. Higher education
6. Occupational status
a. House wife
b. Farmer
c. Government employee
d. Private employee
e. Daily Laborer
f. Merchant
g. Others
7. Husbands’ Occupation
a. Government employee

22
 b. Farmer
c. Daily Laborer
d. Merchant
e. Self-employed in small scale
f. Private employee
g. Others
Part II: Majorevents in the ANC-PMTCT service among pregnantwomen in Jimma University
Specialized Hospital
1. Voluntary for HIV counseling and testing
a. Yes
b. No
2. Under gone HIV testing
a. Yes
b. No
3. HIV testing result
a. Positive
b. Negative
Part III:Knowledgeof pregnant mothers on MTCT of HIV/AIDS in Jimma University
Specialized Hospital
1. First Source of Information on HIV/AIDS:
a. Social Ceremonies
b. Health workers
c. Mass media
d. News paper
e. Others
2. Can HIV infected women get pregnant?
a. Yes
b. No
3. All babies born to HIV infected mothers will acquire the infection?
a. Yes
b. No
4. Are drugs available to prevent MTCT of HIV?

23
 a. Yes
b. No
5. Knowledge of HIV/ AIDS / MTCT of HIV:AIDS- a curse sent from God:
a. Yes
b. No
6. MTCT of HIV during pregnancy:
a. Yes
b. No
7. MTCT of HIV during Labor and delivery:
a. Yes
b. No
8. MTCT of HIV during breast feeding:
a. Yes
b. No
9. Know mode of HIV transmission
a. Yes
b. No

Part VI: Attitude of pregnant mothers on MTCT of HIV/AIDS in Jimma University Specialized
Hospital
1. HIV related Behavior and Beliefs Fear of being identified as HIV positive in the community:
a. Yes
b. No
2. Perception of Others' Attitudes towards PLWHA:
a. Outcast them or consider as people who are cursed
b. Care for them like any othersick person
3. Attitude towards PMTCT Services
a. Positive attitude
a. Negative attitude

Thank you!

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