Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-23T01:12:40.308Z Has data issue: false hasContentIssue false
  • English
  • Français

BARRIERS TO PREVENTION OF MOTHER-TO-CHILD TRANSMISSION OF HIV SERVICES IN UGANDA

Published online by Cambridge University Press:  09 November 2009

A. K. MBONYE ,
K. S. HANSEN ,
F. WAMONO  and
P. MAGNUSSEN
A. K. MBONYE
Affiliation:
Department of Community Health, Ministry of Health, Kampala, Uganda
K. S. HANSEN
Affiliation:
Health Policy Unit, London School of Hygiene and Tropical Medicine, UK
F. WAMONO
Affiliation:
Institute of Statistics and Applied Economics, Makerere University, Kampala, Uganda
P. MAGNUSSEN
Affiliation:
Faculty of Life Sciences, Centre for Health Research and Development, University of Copenhagen, Denmark
Get access Rights & Permissions [Opens in a new window]

Summary

Understanding care-seeking practices and barriers to prevention of mother-to-child transmission (PMTCT) of HIV is necessary in designing effective programmes to address the high disease burden due to HIV/AIDS in Uganda. This study explored perceptions, care-seeking practices and barriers to PMTCT among young and HIV-positive women. A household survey (10,706 women aged 14–49 years), twelve focus group discussions and 66 key informant interviews were carried out between January and April 2009 in Wakiso district, central Uganda. Results show that access to PMTCT services (family planning, HIV counselling and testing and delivery at health units) was poor. Decision making was an important factor in accessing PMTCT services. Socioeconomic factors (wealth quintile, age, education level) and institutional practices also influenced access to PMTCT. Overall, having had an HIV test was highest when both men and women made decisions together or when women were empowered to make their own decisions. This was significant across wealth quintiles (p=0.0001), age groups (p=0.0001) and education levels (p=0.0001). The least level of HIV testing was when men made decisions for their spouses; and this was the case with family planning and deliveries at health units. Other barriers to PMTCT were fear of women and male spouses to have an HIV test and the perception that HIV testing is compulsory in antenatal clinics. In conclusion, to increase access to PMTCT among women, especially the young, poor and least educated, there is a need to empower them to make decisions on health seeking, and also to empower men to support their spouses to make good decisions. Other barriers like fear of having an HIV test should be addressed through appropriate counselling of clients.

Type
Research Article
Information
Journal of Biosocial Science , Volume 42 , Issue 2 , March 2010 , pp. 271 - 283
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ahorlu, C. K. (1997) Malaria related beliefs and behavior in Southern Ghana: implications for treatment, prevention and control. Tropical Medicine and International Health 2, 488–499.Google Scholar
Andersen, R. (1968) A Behavioural Model of Families' Use of Health Services. Research Series No. 25, Centre for Health Administration, University of Chicago.Google Scholar
Andersen, R. M. (1995) Revisiting the behavioral model and access to medical care: does it matter? Journal of Health and Social Behavior 36, 1–10.Google Scholar
Bwambale, F. M., Ssali, S. N., Byaruhanga, S., Kalyango, J. N. & Karamagi, C. A. (2008) Voluntary HIV counseling and testing among men in rural western Uganda: implications for HIV prevention. BMC Public Health 8, 263.Google Scholar
Chamberlain, J., Watt, S., Mohide, P., Muggah, H., Trim, K. & Bantebya-Kyomuhenda, G. (2007) Women's perception of self-worth and access to health care. International Journal of Gynecology and Obstetrics 98, 75–79.Google Scholar
Dawson, S., Sanderson, L. & Tallo, V. L. (1993. The Focus Group Manual: Methods for Social Research in Tropical Disease. No. 1. TDR/SERAMSR/92.1. TDR WHO, Geneva.Google Scholar
Feeley, F., Connelly, P. & Rosen, S. (2007) Private sector provision and financing of AIDS treatment in Africa: current developments. Current HIV/AIDS Report 4, 192–200.Google Scholar
Goddard, M. & Smith, P. (2001) Equity of access to health care services: theory and evidence from the UK. Social Science and Medicine 53, 1149–1162.CrossRefGoogle ScholarPubMed
Golooba-Mutebi, F. & Tollman, S. M. (2007) Confronting HIV/AIDS in a South African village: the impact of health-seeking behavior. Scandinavian Journal of Public Health 69, 175–180.Google Scholar
Heggenhougen, H. K., Hackenthal, V. & Vivek, P. (2003) The Behavioral and Social Aspects of Malaria Control: An Introduction and Annotated Bibliography. Special Program for Research & Training in Tropical Diseases (TDR), WHO, Geneva.Google Scholar
Kohn, R. & White, K. L. (1976) Health Care: An International Study. Oxford University Press, London.Google Scholar
McCombie, S. C. (1996) Treatment seeking for malaria: a review of recent research. Social Science and Medicine 43, 933–945.CrossRefGoogle ScholarPubMed
McConnell, M., Bakaki, P., Eure, C., Mubiru, M., Bagenda, D., Downing, R. et al. (2007) Effectiveness of repeat single-dose Nevirapine for prevention of mother-to-child transmission of HIV-1 in repeat pregnancies in Uganda. Journal of Acquired Immune Deficiency Syndrome 46, 291–296.Google Scholar
Mbonye, A. K., Neema, S. & Magnussen, P. (2006) Treatment seeking practices for malaria in pregnancy among rural women in Mukono District, Uganda. Journal of Biosocial Science 38, 221–237.Google Scholar
Ministry of Health (1999) National Health Policy. Ministry of Health, Box 7272, Kampala, Uganda.Google Scholar
Ministry of Health (2006) Policy Guidelines for Prevention of Mother-to-Child Transmission. Ministry of Health, Box 7272, Kampala, Uganda.Google Scholar
Ministry of Health & Macro International (2006) HIV/AIDS Sero-Behavioural Survey 2004–2005. Ministry of Health and Macro International, Inc.Google Scholar
Ministry of Health & Macro International (2008) Uganda Service Provision Assessment Survey 2007: Key Findings on HIV/AIDS and STIs. Ministry of Health and Macro International, Inc.Google Scholar
Mooney, G. H. (1983) Equity in health care: confronting the confusion. Effective Health Care 1, 179–185.Google Scholar
Montgomery, C. M., Lees, S., Stadler, J., Morar, N. S., Ssali, A., Mwanza, B. et al. (2008) The role of partnership dynamics in determining the acceptability of condoms and microbicides. AIDS Care 20, 733–740.Google Scholar
Palmer, N., Mills, A., Wadee, H., Gilson, L. & Schneider, H. (2003) A new face for private providers in developing countries: what implications for public health? Bulletin of the World Health Organization 81, 292–297.Google Scholar
Ruebush, T. K., Kern, M. K., Campbell, C. C. & Oloo, A. J. (1995) Self treatment of malaria in a rural area of Western Kenya. Bulletin of the World Health Organization 73, 229–236.Google Scholar
Rutstein, S. O. & Kierstein, J. (2004) The DHS Wealth Index. Comparative Reports, No. 6, Macro International, Inc.Google Scholar
Uganda Bureau of Statistics (2006) The Uganda Demographic and Health Survey. Uganda Bureau of Statistics, Kampala, Uganda.Google Scholar
Uganda Bureau of Statistics (2008) The Statistical Abstract. Uganda Bureau of Statistics, Kampala, Uganda.Google Scholar
Uplekar, M. (2003) Involving private health care providers in delivery of TB care: global strategy. Tuberculosis 83, 156–164.Google Scholar