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Factors affecting access and utilization of PMTCT services in Nairobi province, Kenya

Document type: mthesis
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Abstract: INTRODUCTION: Mother to child transmission (MTCT) of HIV, the main route of HIV infection to the infant. An estimated 50,000 to 60,000 infants get the HIV infection annually in Kenya through their mothers. For this reason Kenya rolled out a countrywide Prevention of Mother to Child Transmission (PMTCT) programme to reduce the HIV infection to the children. Though most public ante natal clinics in Nairobi are offering PMTCT services, it is evident that many pregnant women are not accessing or utilizing the PMTCT services causing “missed opportunities” which is the reason for this study. OBJECTIVE: To determine the factors affecting access and utilization of PMTCT services in Nairobi and to suggest recommendations to improve access and utilization of PMTCT services. METHODOLOGY: Literature review was conducted through web and manual searches. Also PMTCT data from the Nairobi Provincial Medical Office’s health management information database as well as reports from the National office were used. The Andersen model of health service utilization was used in identifying and reviewing factors that hinder pregnant women from accessing and utilizing PMTCT in a four categories: Individual, socio-cultural, health system and policy factors. FINDINGS: The analysis of the available three years PMTCT data found gaps in all the levels of services delivery, from the time the mother comes to the antenatal clinic (ANC) until they exit to go for delivery. Literature review revealed that low education and poor understanding of the PMTCT services, fear of knowing one’s HIV status and the powerlessness of the women to make decision about their health were the individual reasons while, Socio-cultural reasons were stigma and discrimination, the marginalized position of the woman in the family and society. The health system’s findings were poor working conditions, shortage of health care providers, high workload, lack of training, low morale, inadequate infrastructure and occasional stock-outs of Nevirapine. Policies and guidelines were not easily available at service delivery points to guide service provision. CONCLUSION: There is a high rate of missed opportunities for PMTCT services in pregnant women at the public antenatal clinics in Nairobi and private health facilities are inaccessible due to their high cost. Nairobi province annual PMTCT data for the three years 2005-2007 revealed that between 20-32% of the mothers and over 50%-80% of the babies missed to get the Nevirapine prophylaxis among other interventions. RECOMMENDATIONS: Creation of awareness on the importance of PMTCT to women and the general community should be given eminence. Health systems need to be strengthened and more health personnel be recruited to adequately cover the high workload. Procurement procedures should be streamlined to ensure there are no stock-outs of Nevirapine. Specific PMTCT policies should be formulated and the currently guidelines need to be periodically reviewed and updated.
Authors: Karia, J.M.
Country: Kenya
Category: Research
Department: Development Policy & Practice
Institute: KIT (Royal Tropical Institute)
Keywords: HIV and AIDS , disease prevention and control , reproductive health , health services
Language: eng
Organization: KIT - Royal Tropical Institute
PAGE: vii, 39
Year: 2008
Region: East Africa
Right: © 2008 Karia
Subject: Health and Nutrition
Title: Factors affecting access and utilization of PMTCT services in Nairobi province, Kenya
Training: Master of Public Health / International Course in Health Development (ICHD)