The Implications of Policy Changes on the Uptake of a PMTCT Programme in Rural Malawi: First Three Years of Experience

Overview

Journal Glob Health Action

Specialty Public Health

Date 2009 Dec 23

PMID 20027274

Citations 30

Authors

Fyson Kasenga

Peter Byass

Maria Emmelin

Anna-Karin Hurtig

Affiliations

Soon will be listed here.

Abstract

Objective: To study the implications of policy changes on the demand for antenatal care (ANC), HIV testing and hospital delivery among pregnant women in rural Malawi.

Design: Retrospective analysis of monthly reports.

Setting: Malamulo SDA hospital in Thyolo district, Makwasa, Malawi.

Methods: Three hospital-based registers were analysed from 2005 to 2007. These were general ANC, delivery and Prevention of Mother to Child Transmission (PMTCT) registers. Observations were documented regarding the introduction of specific policies and when changes were effected. Descriptive analytical methods were used.

Results: The ANC programme reached 4,528 pregnant mothers during the study period. HIV testing among the ANC attendees increased from 52.6 to 98.8% after the introduction of routine (opt-out) HIV testing and 15.6% of them tested positive. After the introduction of free maternity services, ANC attendance increased by 42% and the ratio of hospital deliveries to ANC attendees increased from 0.50:1 to 0.66:1. Of the HIV-tested ANC attendees, 52.6% who tested positive delivered in the hospital and got nevirapine at the time of delivery.

Conclusions: Increasing maternity service availability and uptake can increase the coverage of PMTCT programmes. Barriers such as economic constraints that prevent women in poor communities from accessing services can be removed by making maternity services free. However, it is likely, particularly in resource-poor settings, that significant increases in PMTCT coverage among those at risk can only be achieved by substantially increasing uptake of general ANC and delivery services.

Citing Articles

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Chiya H, Naidoo J, Ncama B Afr J Prim Health Care Fam Med. 2018; 10(1):e1-e10.

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References

Beauregard C, Solomon P . Understanding the experience of HIV/AIDS for women: implications for occupational therapists. Can J Occup Ther. 2005; 72(2):113-20. DOI: 10.1177/000841740507200206. View

El-Bassel N, Gilbert L, Wu E, Chang M, Gomes C, Vinocur D . Intimate partner violence prevalence and HIV risks among women receiving care in emergency departments: implications for IPV and HIV screening. Emerg Med J. 2007; 24(4):255-9. PMC: 2658230. DOI: 10.1136/emj.2006.041541. View

De Cock K, Fowler M, Mercier E, de Vincenzi I, Saba J, Hoff E . Prevention of mother-to-child HIV transmission in resource-poor countries: translating research into policy and practice. JAMA. 2000; 283(9):1175-82. DOI: 10.1001/jama.283.9.1175. View

Tarwireyi F . Implementation of the prevention of mother-to-child transmission of HIV programme in Zimbabwe: achievements and challenges. Cent Afr J Med. 2006; 50(9-10):95-100. View

Ghosh J, Kalipeni E . Women in Chinsapo, Malawi: vulnerability and risk to HIV/AIDS. SAHARA J. 2007; 2(3):320-32. DOI: 10.1080/17290376.2005.9724857. View

Manzi M, Zachariah R, Teck R, Buhendwa L, Kazima J, Bakali E . High acceptability of voluntary counselling and HIV-testing but unacceptable loss to follow up in a prevention of mother-to-child HIV transmission programme in rural Malawi: scaling-up requires a different way of acting. Trop Med Int Health. 2005; 10(12):1242-50. DOI: 10.1111/j.1365-3156.2005.01526.x. View

Druce N, Nolan A . Seizing the big missed opportunity: linking HIV and maternity care services in sub-Saharan Africa. Reprod Health Matters. 2007; 15(30):190-201. DOI: 10.1016/S0968-8080(07)30337-6. View

James C, Hanson K, McPake B, Balabanova D, Gwatkin D, Hopwood I . To retain or remove user fees?: reflections on the current debate in low- and middle-income countries. Appl Health Econ Health Policy. 2006; 5(3):137-53. DOI: 10.2165/00148365-200605030-00001. View

Thorsen V, Sundby J, Martinson F . Potential initiators of HIV-related stigmatization: ethical and programmatic challenges for PMTCT programs. Dev World Bioeth. 2008; 8(1):43-50. DOI: 10.1111/j.1471-8847.2008.00227.x. View

10.

Newell M . Current issues in the prevention of mother-to-child transmission of HIV-1 infection. Trans R Soc Trop Med Hyg. 2005; 100(1):1-5. DOI: 10.1016/j.trstmh.2005.05.012. View

11.

Bajunirwe F, Muzoora M . Barriers to the implementation of programs for the prevention of mother-to-child transmission of HIV: a cross-sectional survey in rural and urban Uganda. AIDS Res Ther. 2005; 2:10. PMC: 1277814. DOI: 10.1186/1742-6405-2-10. View

12.

Chandisarewa W, Stranix-Chibanda L, Chirapa E, Miller A, Simoyi M, Mahomva A . Routine offer of antenatal HIV testing ("opt-out" approach) to prevent mother-to-child transmission of HIV in urban Zimbabwe. Bull World Health Organ. 2007; 85(11):843-50. PMC: 2636259. DOI: 10.2471/blt.06.035188. View

13.

Witter S, Arhinful D, Kusi A, Zakariah-Akoto S . The experience of Ghana in implementing a user fee exemption policy to provide free delivery care. Reprod Health Matters. 2007; 15(30):61-71. DOI: 10.1016/S0968-8080(07)30325-X. View

14.

Lindgren T, Rankin S, Rankin W . Malawi women and HIV: socio-cultural factors and barriers to prevention. Women Health. 2005; 41(1):69-86. DOI: 10.1300/J013v41n01_05. View

15.

. Introduction of routine HIV testing in prenatal care--Botswana, 2004. MMWR Morb Mortal Wkly Rep. 2004; 53(46):1083-6. View

16.

Chandrasekaran V, Krupp K, George R, Madhivanan P . Determinants of domestic violence among women attending an human immunodeficiency virus voluntary counseling and testing center in Bangalore, India. Indian J Med Sci. 2007; 61(5):253-62. View

17.

Doherty T, Chopra M, Nkonki L, Jackson D, Greiner T . Effect of the HIV epidemic on infant feeding in South Africa: "When they see me coming with the tins they laugh at me". Bull World Health Organ. 2006; 84(2):90-6. PMC: 2626538. DOI: 10.2471/blt.04.019448. View

18.

du Lou A, Brou H, Djohan G, Tijou-Traore A . [Refusal of prenatal HIV-testing: a case study in Abidjan (Côte d'Ivoire)]. Sante. 2008; 17(3):133-41. DOI: 10.1684/san.2007.0081. View

19.

Castetbon K, Leroy V, Spira R, Dabis F . [Preventing the transmission of HIV-1 from mother to child in Africa in the year 2000]. Sante. 2000; 10(2):103-13. View

20.

Ngwena C, Cook R . HIV/AIDS, pregnancy and reproductive autonomy: rights and duties. Dev World Bioeth. 2008; 8(1):iii-vi. DOI: 10.1111/j.1471-8847.2008.00231.x. View