Background of the study area
The study was conducted in Sagamu local government area (SLGA) Ogun state, which is located in the South Western part of Nigeria. Sagamu local government area is one of the 20 local government area in Ogun state. It was carved out of the former Ijebu Remo local government in 1991 and has a total land area of 68.03
. It is bounded on the west by the Obafemi Owode local government area, on the east by both Ikenne and Odogbolu local government area and also shares a boundary with Ikorodu local government area of Lagos state in the south.
According to the 2006 census, the area has a population of 253,412 inhabitants which consists of mainly remo-speaking people of Ogun state. Other ethnic groups like the Hausas, Igbos and the Benue people are well represented. Most of the towns are either semi-urban or rural. Other major towns in the local government besides Sagamu include Ogijo, Sotubo, Ode-lemo, Emuren and Simawa. The local government has 15 political wards, 12 of which fall within the Sagamu metropolis. This area is a major transit region between the southwest, southeast and the northern part of Nigeria.
There are seven centers for primary health care services and five other health posts spread all over the local government area. There are 52 registered birth attendants and one general and a teaching hospital. As at the time of this study, those primary health care centers that provide antenatal services are located at Ogijo, Sabo and Makun (the other primary health care centers were no longer functional, due to logistic reasons). Conspicuous industrial establishments include the West African Portland Cement (WAPCO), Nulec industries, Sparkwest Nigeria Limited and branches of First bank, Guarantee trust bank, Wema bank and Zenith bank amongst others.
This was an analytical cross-sectional study that quantitatively explored the awareness, knowledge and utilization of PMTCT of HIV services by pregnant women. It also compared the knowledge and utilization of PMTCT services among the teenage pregnant women and the older women. All consenting pregnant women in their first pregnancy who attended the PHC centres during the 2
months study period for the first time were recruited into the study in order to assess the utilization of PMTCT services before awareness of pregnancy. The study sought for information prior to ANC attendance.
The minimum sample size required for the study was estimated to be 138 using the formula
where n is the sample size,
Zα is the standard normal deviate, set at 1.96 (for 95% confidence interval),
d is the desired degree of accuracy (taken as 0.050 and
p is the estimate of our target population having those particular characteristics. MTCT constitute about 10% of the national HIV (i.e. 0.1) burden (FMOH, 2005).
Adjustment for a 10% rate of non-responses and invalid responses yielded a final sample size of 152.
The medical officer of Health/Director of Primary Health care at Sagamu local government secretariat was approached and permission was obtained to conduct the study. Women who consented to take part in the study were interviewed using a structured questionnaire which was administered by trained interviewers. The interviewers were all female medical students rotating through the Community Medicine and primary health care department of the Olabisi Onabanjo University Teaching Hospital during the period of the study and one resident doctor that were involved with the medical care of the study participants. The data were collected on antenatal clinic days by the interviewers at the respective PHC centres. Completed questionnaires were scrutinized on the spot and at the end of the daily field sessions for immediate correction of erroneous entry. Consenting first time pregnant women were interviewed individually over a 10 to 15
minute period in a language they can understand before they were given any health talk. Data were collected over 2
months’ period with the interviewers visiting the centres simultaneously over the study period. (Most of them speak ‘pigeon’ English or Yoruba).
The instrument was a structured questionnaire consisting of 3 parts, namely:
Section A: includes information on socio-demographic data such as age, marital status, religion, employment status, ethnic group and educational status.
Section B: consists of HIV related knowledge, risk behaviour and safe sexual practices.
Section C: is made up of knowledge and utilization of PMTCT services which includes breastfeeding practices awareness of the means of transmission to the unborn child and where to access help when found to be positive.
Awareness was determined by simply asking such question as:
Can a pregnant woman infected with HIV/AIDS transmit the virus to her unborn child?
Knowledge was determined by such question as:
Mention how transmission of HIV/AIDS from mother-to-child can be prevented? Every respondent that correctly mention one or more ways was classified as knowledgeable.
Utilization of PMTCT services was defined as attendance in any PMTCT service provider center including voluntary counseling and testing [VCCT] prior to presentation for ANC at the PHC centre and was determined by such question such as:
Have you ever presented in any PMTCT center before?
The questionnaire was pretested among 30 women in their first pregnancies receiving antenatal care at primary health care facilities in Ikene local government, a nearby local government to the study area. Appropriate adjustments were then made to the questionnaire to improve its internal validity.
Criteria for inclusion
Subject must reside within Sagamu local government area (SLGA) of Ogun state.
Subject must be attending the PHC centre for the first time in the present pregnancy.
Subject must not have received prior health talk in the facility before interview
Ethical clearance was obtained from the Olabisi Onabanjo Teaching Hospital Ethics Board. Confidentiality on candidate’s information was maintained. Permission of the State Ministry of Health, HIV/AIDS Control Division was obtained before the commencement of the study.
At each of the selected study site, the matron and medical officer in-charge were informed for consent before the commencement of the study. The purpose, general content and nature of the study were explained to each respondent to obtain verbal and written consent before inclusion into the study.
The data was entered into SPSS statistical software version 12. Frequencies were generated for detection of errors (data editing). Percentages or means and standard deviation were computed for baseline characteristics of women interviewed. The data analysis focused on univariate frequency table and bivariate cross tabulations that identify important relationships between variables. Respondents were categorized into low and high socioeconomic status using location of resident as cut off. Those from slum areas were categorized as low and those from government reserve areas [GRA] and others were classified as high.
Teenage Pregnancy was as defined by WHO as pregnancy at less than 18
yrs of age.
The relationships between socio-demographic characteristics of the pregnant women and their knowledge and utilization of PMTCT of HIV services were examined through bivariate analysis, by computing odds ratio at 95% confidence level and chi squared and t-tests where appropriate. Predictor variables were restricted to outcome measures that were statistically significant. A p-value
0.05 or confidence limits which did not embrace unity (1) was considered as statistical significance.