GENERATING MORE INFORMATION ON SELF AUDITING SERVICES BY PROVIDERS AND HEALTH CARE WORKERS

GENERATING MORE INFORMATION ON SELF AUDITING SERVICES BY PROVIDERS AND HEALTH CARE WORKERS

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CHAPTER ONE

INTRODUCTION

1.1     Background to the Study

Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) has a devastating effects and is currently a complication of pregnancy worldwide with more than 700,000 children infected annually. Mother–To–Child Transmission (MTCT) of the virus is responsible for more than 90% of these case in children under 15 years (United States AIDS, 2012).

Mother–To–Child Transmission (MTCT) of HIV can occur during pregnancy, labour and delivery, or breastfeeding. During pregnancy, about 5 – 8% of babies become infected through transmission across the placenta. Labour and delivery pose the greatest risk for transmission (10 – 20% of exposed infant). Breastfeeding also exposes the infant to HIV transmission particularly if prolonged (18-24 months). The additional risk of HIV infection when and infant is breast fed is around 15-25% World Health Organization (WHO, 2013) in collaboration with other non-governmental organization like global fund, president’s emergency plan for Aids relief (PEPFAR) etc.

Feasible and affordable interventions now exist to reduce the rate of MTCT by 50% (Population Reports, 2010). The Prevention of Mother–To–Child Transmission (PMTCT) protocol begins at pre-test counseling, continues through the HIV test, result and enrolment for the intervention and at hospital delivery.

Hospital delivery ensures that both mother and baby receive the intervention (Nevira Pine) at the time. Maternal Nevirapine is administered at the beginning of labour, while the baby dose is given within 72 hours after delivery.

In 2012, around 400,000 children aged under 15 became infected with HIV (UNAIDS, 2013). Almost all of these infections occur in low and               middle-countries, and more than 90% are the result of Mother-To-Child-Transmission during pregnancy and delivery or breastfeeding. Without interventions, there is a 20-45% chance that a baby born to a HIV- infected mother will become infected (De Cock et al; 2011).

In 2006, the proportion was 23% and by 2009 an estimated of 53% of pregnant women living with HIV in low and middle income countries received antiretroviral drugs to prevent HIV transmission to their infants World Health Organization/United Nations International Children Fund (WHO/UNICEF, 2011).

In Southern African where HIV is very widespread among pregnant women, Botswana leads the way. High quality PMTCT services are provided in all of the country’s public facilities through the maternal and child health/family planning system which serves over 95% of the pregnant women (US Global Aids, 2012).

Sub-Sahara African has continued to bear the greatest burden of the HIV/AIDS epidemic. Seventy percent of the estimated 37.8 million people living with HIV, 70 percent of the 4.8 million are new infections, 77 percent of the 2.9 million are HIV deaths and 90 percent of the 2.1 million children infected with HIV in 2003 were from sub-Saharan African. 630,000 children were infected with HIV, and out of these, 90 percent occurred is                   Sub-Saharan African.

The high prevalence of HIV in women of reproductive age group and the high fertility rates contribute to the comparatively high prevalence of transmission of HIV to infants.

The high prevalence of MTCT of HIV is threatening to reverse the gains of the child survival strategy in the African continent (Federal Ministry of Health, (FMOH, 2010).

In Nigeria, the prevalence of HIV infection among pregnant mothers is estimated at 30% and is reversing the recent gains of child survival programmes, thereby increasing infant and child mortality rates University of Abuja Teaching Hospital Gwagwalada (FMOH, 2009). This has necessitated the increment of prevention of mother – to – child – transmission program sites from 11 in 2002 to 622 in 2009 (University of Abuja Teaching Hospital Gwagwalada, 2009). In March 2010 there was presidential directive to increase coverage of prevention of mother – to child – to 30% by the end of 2010 and 50% by 2013, based on 2009 WHO recommendations, FCT sentinel report have indicated highest HIV prevalence (10.6%). It is estimated that 24,620 pregnant women are infected with HIV FCT Ministry of Health, 2009). About 7,000 babies are infected with HIV from their mothers annually in the FCT.

A total of 438 HIV positive mothers enrolled for the PMTCT Ante-natal Clinic in 2012 at University of Abuja Teaching Hospital Gwagwalada and are beneficiaries of the PMTCT programme, out of the 438, only 337 continued attending the antenatal clinic to the end where the researchers carried out the studies. Studies have indicated inadequate counseling and dropout at different service delivery points in implementing PMTCT protocol, posing the need for research to find reasons for such action (Chorba, 2003; Chopra, 2003; Mazahin, 2001; Preble and Piwoz, 2003; US AIDs, 2005).

Soudi et al; (2009) found that a total of 438 HIV Positive mothers enrolled for the PMTCT ante-natal clinic in 2012, at University of Abuja Teaching Hospital Gwagwalada and are beneficiaries of the PMTCT programme, out of the 438, only 337 continued attending the antenatal clinic to the end whose the researchers carried out the studies. Studies have indicated inadequate counseling and dropout at different service delivery points in implementing PMTCT protocol, posing the need for research to find reasons for such action (Chorba, 2003; Chopra, 2003; Mazhini, 2001; Preble & Piwoz, 2003; USAIDS, 2005).

Court Saudi, et al, (2009) found that MTCT knowledge was incomplete, as those interviewed stated that all mothers transmit HIV to their babies through breast feeding. Mothers lack information on the prevention of transmitting of HIV from an infected mother to her child, as well as measures that exist to reduce the risk of transmission. Chopra (2007) concluded that health care workers needed additional MTCT training and support materials to enable them to provide counseling, appropriate information and advice to client about HIV and breastfeeding options.

Literature on utilization of PMTCT services is limited, and this study aimed at generates more information.

HIV in children is a major problem in developing or resources poor countries. About 277,000 children live with HIV representing 11% of the global pediatric HIV burden in Nigeria. Also over 65,000 to 117,000 of HIV infected children are delivered annually. About 8% of child mortality is related to HIV infection.

This is a result of failed implementation Prevention of Mother to Child Transmission (PMTCT) (FMOH, 2008).

In FCT the prevalence of HIV infection in pregnant women is estimated at 24,620, up to 1868 (1.04% statistically insignificant) received antiretroviral for prophylaxis.

There were 3,328 (1.86%) HIV positive pregnant women receiving infant feeding counseling and support (Federal Ministry of Health, 2009). This reversing the recent gains of child survival programme thereby increasing infant and child mortality rates. Defaulting hospital appointments can be attributed to so many factors, such as:

Finance unsatisfactory quality of service, transportation etc. thus it is important to carry out this study so as to unveil the quality of services offered by PMTCT clinic as perceived by clients attending the services which will go along way to reducing the incidence of HIV/AIDS in Federal Capital Teritary (FCT).

Understanding clients perspectives would also help to know whether the services are being delivered in accordance with their needs and if not then the need to improvement.

1.2     Statement of the problem                        

The burden of HIV infection has now become a burning issue word wide divide. An estimated million people are now living with the virus on planet earth with 2,000 babies getting infected daily. Majority of all new infections in diverse setting have helped reduce the HIV infectors rate. The national HIV zero prevalence has proven that the infection does yield to determined and connected intervention.

Nigeria’s 2005 HIV zero-prevalence rate of 4.4% through an improvement over the 2003 rate us still too high and unacceptable.

During the year 2004 in Nigeria alone about 100,000 babies were likely to contract HIV from their mothers (UNAIDS< 2007).

The PMTCT intervention remains the only sure and feasible hope in the problems of early infant HIV diagnosis. Therefore, to lay much emphasis on prevention rather than care and treatment, in a nutshell the greatest unmet need remains the PMTCT of HIV (UNAID, 2005).

1.3     Statement of Purpose

Literature on utilization of PMTCT services is limited as such this study is aimed at generating more information on self auditing services by providers and health care workers. The study will also provide and the hospital might make appropriate policy measures to improve and maintain the implementation of PMTCT services.

1.4     Significance of the Study

Finding of the study will be of tremendous importance to the citizens, General hospitals, Primary Health Care Centres, the researcher, stake holders and implementing partners as it will provide the need information knowledge and feedback on the PMTCT programme at University of Abuja Teaching Hospital Gwagwalada.

It will also provide an opportunity for improvement of the services provided and increase the knowledge of the community on the availability of PMTCT services. Its package and intervention strategies will help to dispel some erroneous beliefs and practices on the use of antiretroviral drugs (ARVS) that encourage or promote HIV/AIDS transmission.

1.5     Broad Objective

The objective of this study is to assess the implementation of PMTCT of HIV in Nigeria from 2011 to 2015. A case study of University of Abuja Teacher Hospital Gwagwalada. 

Specific Objectives

(1) To determine the progressive level or implementation of PMTCT in University of Abuja teaching Hospital Gwagwalada.

(2) To identify the number of available skilled manpower for the implementation of PMTCT.

(3) To find out the type of services being render at the PMTCT site.

(4) To identify the number of clients patronage at the PMTCT services at University of Abuja Teaching Hospital Gwagwalada.

1.6     Research Question

(1) What is the progressive level of implementation of PMTCT in UATH?

          (2) What is the number of available qualified skilled

          (3) What type do university of Abuja Teaching Hospital Gwagwalada render    PMTCT services?

(4) What are the client patronages of PMTCT at University of Abuja       Teaching Hospital Gwagwalada PMTCT?      

1.7     Operational Definitions

          - HIV –Human immunodeficiency virus that cause AIDS

          - AIDS – Acquired immunodeficiency syndrome (the most advance stage of      HIV infection)

          - Antiretroviral – (ARV) A medication for the treatment of various stages        of the HIV. Different antiretroviral drug act at various stages of the HIV life      cycle

- Mother – To – Child – Transmission – is vertical transmission or is the transmission of an infection from a mother to her child during pregnancy, child birth and beast feeding.

Prevention of mother to child transmission: is information about preventing mother to child transmission.

-         Ante-natal Clinic- is a place where care is given to a pregnant woman from the time pregnancy is confirmed till delivery.

-         Highly Active – Antiretroviral therapy: A combination of three drugs from at least two classes of antiretroviral and managing HIV positive patients

-         Information source: this is considered as the means by which clients receive PMTCT information and was measured by categorizing different sources.

-         Opportunistic infection (OI): a disease caused by a micro-organism that does not normally cause illness in a person with a healthy immune system, but that may cause serious disease when the immune system is weakened.

-         CD4 count: A test measures the number of CD4 cells in the blood, thus affecting the state of a immune system. A normal count in a health adult is 600 – 1200 cells/mm.




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