Master of Science in Public Health

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Browsing Master of Science in Public Health by Subject "AIDS (Disease) -- Transmission -- Uganda"

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    Risk Factors Associated with HIV Infection Among Infants Below 24 Months Born to HIV Positive Mothers.
    (International Health Sciences University, 2012-09) Gloria, Kirungi Kusiima
    In order to eliminate infant HIV infection from mother to child, evidence based implementation strategies are needed to address the risk factors that are associated with this infection using limited resources and applicable to all stakeholders especially the parents of the infants Objective: To assess the infant, maternal and paternal risk factors associated with HIV infection among infants below 24 months born to HIV positive mothers Methods: An unmatched nested case control study was conducted at Mildmay Uganda, 370 HIV positive mothers with their biological infants below 24 months who had had a DNA-PCR test done in the last 6 months were enrolled in the study (cases- DNA-PCR positive infants, controls-DNAP-PCR negative infants).Data was collected using a structured questionnaire. Descriptive, bivariate and multivariate analyses were conducted on the infant, maternal and paternal factors that influence infant HIV infection. Results: Infant factors that showed a significant relationship with HIV infection among infants below 24 months born to HIV positive mothers were age (P=0.01) ,gender (P=0.09) , age at first DNA –PCR test (P<0.001), Infant and young child feeding option used in the first 8 weeks of life (p <0.001) ART status (p<0.001) , Immunization status (p=0.031) and duration of receiving Nevirapine syrup of the infant (p=0.002). Maternal factors that revealed a significant relationship with HIV infection of infants below 24 months born to HIV positive mothers were baseline viral load during pregnancy (p=0.046), Body Mass Index (p=0.008), receipt of ART during pregnancy (p<0.001), receipt of nutrition counseling (p=0.002) and disclosure of HIV status to spouse of the mother during pregnancy (p<0.001). Paternal factors that revealed a significant relationship with HIV infection of infants below 24 months born to HIV positive mothers were acceptance to test for HIV (p<0.001), HIV status (p<0.001), disclosure of HIV status to spouse (p<0.001) and receipt of ART (p<0.001). Multivariate analysis showed a significant relationship with HIV infection of infants below 24 months born to HIV positive mothers were mixed feeding the infant (OR: 4.971, 95%CI: 1.71 - 14.48, p=0.003), receipt of ART (NVP) of the infant (OR: 0.0062, 95%CI:0.002 - 0.019, p<0.001), mother not disclosing of HIV status to spouse (OR:2.736, 95%CI:1.074 – 6.971, p=0.035) and Father not disclosing of HIV status to spouse (OR:4.38, 95%CI:1.764 - 11.235, p=0.002). Conclusion: The infant factors that were found to be associated with HIV infection of infants 24 months and below born to HIV positive mothers were mixed feeding: The infants who are mixed fed are at a high risk of acquiring HIV from their HIV positive mothers than those who are not and receipt of Nevirapine (ART) syrup of the infant: infants who receive nevirapine syrup are less likely to acquire HIV infection than those who do not. Maternal factors found to be associated with infant HIV infection was disclosure: infants whose mothers did not disclose their HIV status to their spouses were at a higher risk of HIV infection than those whose mothers had disclosed their HIV status to their spouses. Paternal factors found to be associated with infant HIV infection was disclosure: infants whose fathers did not disclose their HIV status to their spouses were at a higher risk of HIV infection than those whose fathers had disclosed their HIV status to their spouses. Mixed feeding should be discouraged for all HIV positive mothers because of its associated risk of infant HIV infection. Mothers should be encouraged to exclusively breastfeed their infants. There is need to promote HIV testing and disclosure of spouses especially during pregnancy.
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    Usage and Access to Prevention of Mother to Child Transmission 'PMTCT' Services by Mothers.
    (International Health Sciences University, 2013-09) Juliet, Bavuga
    The study ‘Usage and Access to Prevention of Mother to Child Transmission (PMTCT) services by mothers’ set out to establish the link and barriers between access and usage to PMTCT services by mothers. It was conducted at Mulago National Referral Hospital. The specific objectives were: to determine the aspects influencing usage of PMTCT services, to identify the range of PMTCT services available; to explore the relationship between access and usage of PMTCT service; and to identify the barriers to access of PMTCT services by mothers. The study design was a descriptive cross-sectional survey. Qualitative and quantitative data was collected using semi-structured questionnaire interviews and Focus Group Discussions. 195 respondents attending PMTCT services consented to participate. The leading influencers towards PMTCT usage were: provision of free ARVs to mothers (95%), provision of health education (95%) then hospital delivery (83%) followed by quality counseling and same day HIV results with 80%. Partner involvement was rated the least (30%) influencer towards access and usage of PMTCT services at Mulago Hospital. Additionally, the range of services available to mothers were: PMTCT Counseling, HIV Testing, ARVs, Septrin prophylaxis, Junior ARVs syrup, family planning counseling and symptom management for PMTCT; direct effect on access and usage of PMTCT services was determined by increase in the distance from the nearest PMTCT clinic, education level (62%), attitudes (89%) towards health workers and economic status (87%) . However, age (78%); marital status (81%) and religion (69%) of the mother did not have significant effect on the usage of PMTCT services. The leading barriers to PMTCT access and usage were waiting time in the queue 96.4% stigma with 94.6%, routine counselling and testing (90%), distance 89.7% and poverty 85.7%. The study concluded that usage and access to PMTCT services is a complex and multi-dimensional matter involving various influencing factors. There was a broad range of PMTCT services provided to mothers at the Mulago National Referral Hospital and no provision of infant formula as an incentive to access the PMTCT service. The provision of access to PMTCT services alone was not sufficient to ensuring that mothers got a full range of services. Access influences usage since it followed that given access to a service mothers were keen to use it. Barrier removal alone was not sufficient either. Beyond access, the study compounded that barrier removal combined with improved access in combination, were necessary to solving the significant problem of MTCT of HIV. The major recommendations to improve access and usage of PMTCT services: deliberately increase support for girl child education; promote mother’s adult learning; women’s empowerment; provide incentives like free infant formula to mothers accessing the services; increase the number of mothers accessing services through decentralization of PMTCT services away from the center, in house refresher courses, train more service providers, strengthen awareness and sensitization programs and revise and refresh medical and nursing ethical conduct. Areas for further investigation were found to be the influence of age on accessing PMTCT services, the relation between range of PMTCT services and access, the impacts of PMTCT services on children and the effects of the socio-economic status on waiting time.