Dr. Mariama Mustapha is a disciplined and confident medical doctor, and currently a third year student of Masters of Medicine in Paediatrics and Child Health in the Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences. She has organized and participated in various workshops, health projects, and skills training, while serving as the Vice President and National Exchange Officer of the Medical Students’ Association- Sierra Leone (MSA-SL), branch of International Federation of Medical Students’ Association (IFMSA). She has over five years of post qualification experience in maternal and newborn health working in various hospitals in Sierra Leone and Uganda. She is dedicated to becoming a champion in promoting maternal and newborn health in Uganda and beyond.

Dissertation Title:  Utilization of prevention of mother-to-child transmission services by adolescent and young mothers attending Mulago Hospital

ABSTRACT

Background: Over 90% of HIV infection in children occurs through mother to child transmission (MTCT) of HIV. In order to eliminate Paediatric HIV infection, World Health Organization (WHO) recommends prevention of mother to child transmission (PMTCT) Option B plus (lifelong antiretroviral therapy for all pregnant and breastfeeding women living with HIV regardless of CD4 count or WHO clinical stage). In Uganda, 25% of girls have had a pregnancy by the age of 18 years. Moreover, adolescents have been noted to have poor utilization of health services. Adolescent and young mothers are therefore a vulnerable population which contributes significantly to shaping the future course of the HIV epidemic. However little is known about utilization of PMTCT services in this group.This study aimed to explore the utilization of PMTCT services by adolescents and young mothers attending Mulago National Referral Hospital, and to describe the factors that affect the optimal utilization of PMTCT services by these mothers.

Methods: This was an analytical and descriptive cross sectional study of 418 adolescent and young mothers, using quantitative and qualitative methods of data collection. An interviewer administered questionnaire was used to obtain information on maternal socio-demographic characteristics, HIV/AIDS and PMTCT-related knowledge, PMTCT utilization, and factors influencing utilization of PMTCT services. Twenty in-depth interviews with selected

adolescent and young mothers, and nine key informant interviews with health workers at the hospital were conducted to obtain an in-depth understanding of the context and factors influencing utilization of PMTCT services. Data was extracted and entered onto the Epidata version 3.1, exported and analyzed using STATA version 12. The overall proportion of participants who optimally utilized PMTCT services was determined using descriptive

statistics. The factors associated with optimal utilization of PMTCT services were determined by logistic regression. Qualitative data was analyzed manually using the content thematic approach.

Results: The median age of the mothers was 22 years (IQR 15-24 years). Of the 418 participants, 65 (15.5%) were HIV positive, and 353 (84.5%) were HIV negative. Only 30% (126/418) of the participants had optimally utilized PMTCT services. Utilization of PMTCT services was better among HIV positive mothers, with 83% (54/65) having utilized the services optimally, compared to only 20% (72/353) of the HIV negative mothers (p-value 0.001). Significant losses and delays occurred throughout the PMTCT cascade. The major reported factors motivating adolescent and young mothers to utilize PMTCT services included: the benefits of knowing ones HIV status, health of the unborn child, and counselling and support by health care staff. Stigma was the commonest reported barrier to adolescent and young mothers’ utilization of PMTCT services.

Conclusion: Optimal utilization of PMTCT services by adolescent and young mothers at 30% was low, especially among HIV negative mothers. Reported positive HIV status was significantly associated with optimal utilization of PMTCT services. The benefits of knowing ones HIV status, health of the unborn child, and counselling and support by health care staff were the major factors motivating adolescent and young mothers to utilize PMTCT services, while stigma was a key demotivating factor.

Recommendations: Special consideration should be given to adolescent and young women in the design of EMTCT programs, to improve the utilization of PMTCT services particularly among those found HIV negative at the first HIV test. Stigma as a barrier to the utilization of PMTCT services should be addressed. Counselling and health care support should emphasize on the benefits of PMTCT services since they motivate adolescent and young mothers to

utilize the services. More detailed studies should explore stigma and stigma prevention among this age group.

 

Contact: mamspha@yahoo.com