Assessment of Overall Quality of Prevention of mother-to-child Transmission of HIV Service in Adama Town, Oromia Region

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Addis Abeba Universty


Background: Sub-Saharan Africa in which Ethiopia is a part remains the most seriously affected region with AIDS in the year 2007. More than 60% of all new HIV infections are occurring in women, infants, and young children in this region. In 2005 alone, an estimated 540,000 children were newly infected with HIV, with approximately 90% of these infections occurring in this region. Objective: To assess quality of PMTCT services and client satisfaction in private and public health facilities in Adama city, Oromia Region. Methodology: A facility based cross-sectional study which involved quantitative and qualitative approach was conducted from September 2008 to June 2009. It involved 423 pregnant women and 31 health providers. Results: From all pregnant women interviewed, 74.7% of them were found to be fully satisfied with the PMTCT service they received. Only 39% of the clients understood the counseling on MTCT and PMTCT. Not more than 90% of the pregnant women were counseled and accepted HIV testing and partners of 6.34% of the pregnant women were tested for HIV. The average duration of stay of clients with their health care provider was 12.8 minutes where the standard is 15 minutes. The average clients' waiting time was 41.5 minutes and 21.5 minutes in private health facilities and governmental health facilities respectively. From women of reproductive age group who were infected with the virus, 18% of them were counseled on family planning and started to use family planning. About 97% of the HEIs had received ARV prophylaxis. Cotrimoxazole prophylaxis was started at two months of age for 87.4% of the HEIs. More than half (60%) of the pregnant women came to the center they visited after being recommended to come by their friends or partners. Clients gave more weight to the ethical approach of providers to express their degree of satisfaction. Only two third of the health providers who are directly involved in PMTCT services received training on VCT for PMTCT. From the providers’ side the most eminent problems were lack of training to update PDF Creator - PDF4Free v2.0 viii themselves with current knowledge/skills, lack of feedback on job performance and lack of incentive for the additional burden added to them. The national PMTCT guideline was available and in use in only two among the eight health facilities assessed. Conclusion: About two third (74.7%) of the clients were fully satisfied with the PMTCT service they received. Little more than half (52%) of pregnant women were counseled on MTCT and PMTCT. Less stay of health providers with the clients, long waiting time of clients, unavailability of advanced medical equipments and laboratory tests, lack of conformation to the national PMTCT guideline, and poor infrastructure were the most significant factors which compromised the quality of PMTCT services. Lack of family planning service provision together with HIV/AIDS services and lack of male involvement in PMTCT services were also among the factors which compromised the achievement of the PMTCT program. Recommendation: Offering counseling on MTCT and PMTCT to all pregnant women, to deliver quality and comprehensive PMTCT interventions by reducing clients’ waiting time as much as possible, enabling women to communicate with their partners about HIV testing, offering strong supportive supervision to health facilities and capacity building, and creating a strong link between HIV/AIDS and reproductive health services are crucial to improve the quality of PMTCT services.



Assessment of Overall Quality of Prevention