Knowledge and behaviour of nurse/midwives in the prevention of vertical transmission of HIV in Owerri, Imo State, Nigeria: a cross-sectional study

Educational needs assessment of medical and midwifery students about prevention of mother-to-child transmission of HIV: a cross-sectional study

Mother-to-child transmission (MTCT), is an important way of acquired immune deficiency virus (AIDS) transmission. Medical and midwifery students need to have sufficient knowledge in terms of MTCT. The aim of this study was to evaluate the educational needs of these students regarding MTCT of HIV. This cross-sectional study was conducted on 120 medical (extern and intern) and midwifery Bachelor (semester 4 and above) and Master students in Gonabad University of Medical Sciences in 2019. The real needs questionnaire on MTCT AIDS and the perceived needs questionnaire on MTCT were used for need assessment evaluation. Majority of the participants were female (77.5%) and single (65%). Study participants included 48.3% medical and 51.7% midwifery students. High real educational need was reported by 63.5% of medical and 36.5% of midwifery students. More than half of the participants (59.2%) felt a great need for education on MTCT of HIV. OF the areas of real educational needs, the highest and lowest scores were related to the areas of prevention and symptoms, respectively. Students in higher semesters had the highest percentage of real need compared to other students (p = 0.015). The real need for MTCT of HIV prevention was higher among medical students compared to midwifery students (p = 0.004). The observed high real and perceived needs of students, especially in the higher semesters and the field of medicine, necessitates the re-examination of their educational curricula.

A CROSS-SECTIONAL ASSESSMENT OF PHARMACISTS' KNOWLEDGE, ATTITUDE AND PRACTICE OF PREVENTION OF MOTHER-TO-CHILD TRANSMISSION OF HIV IN TWO NIGERIAN TEACHING HOSPITALS

Background

The pharmacological component of prevention of mother-to-child transmission (PMTCT) services involves the provision of antiretroviral agents (ARVs) to the mothers and/or their babies at any stage of pregnancy. This study assessed the knowledge, attitude and practice (KAP) of Pharmacists about PMTCT.

Materials and Methods

A questionnaire-based cross-sectional study was conducted among consenting Pharmacists at Ahmadu Bello University Teaching Hospital (ABUTH) and University of Nigeria Teaching Hospital (UNTH). Completed questionnaires were collated and analyzed using SPSS Version-25 with appropriate descriptive and inferential statistics. P-values less than 0.05 were considered to be statistically significant.

Results

A total of 77 Pharmacists participated in the study, with 54(70.13%) being from ABUTH. In ABUTH, 15(33.3%) Pharmacists identified as being females, against 16(69.6%) in UNTH. Majority (40,95.2%) of the Pharmacists in ABUTH had less than 10 years working experience as against 8(34.8%) in UNTH. Forty-eight (88.9%) respondents knew the correct meaning of PMTCT. The Pharmacists in ABUTH and UNTH had mean knowledge scores of 58.70±2.88% and 52.17±6.19%, respectively; t(75)=1.094, p=0.760. In ABUTH and UNTH, 16(69.6%) and 22(42.3%) Pharmacists, respectively, strongly agreed that PMTCT can prevent future infections in the infants. Their mean attitude scores were 69.65±1.22% (ABUTH) and 74.09±1.68% (UNTH); t(73)=-2.063, p=0.487. For practice, 4(5.33%) Pharmacists in both hospitals very often dispensed PMTCT drugs, while 37(70.83%) counseled PMTCT treatment-naïve patients.

Conclusion

The Pharmacists assessed in both hospitals had a fair knowledge of PMTCT services. Their attitudes to PMTCT was very good, although only a few of them had experience in providing care for PMTCT patients.

Barriers in Implementing the PMTCT in Moretele Sub-District, South Africa: An Exploratory Study

The Prevention-of-Mother-To-Child Transmission (PMTCT) program was introduced to prevent vertical transmission of HIV from a mother to her infant through pregnancy, labor, and breastfeeding. Therefore, it is critical for the program to be accessible in primary health care facilities across the globe to increase treatment uptake and to eliminate child and maternal mortality rates caused by HIV infections. However, barriers are still being experienced by some nurses while implementing PMTCT around Moretele sub-district in the North West Province (NWP). Hence, this qualitative study explored and described the factors influencing the implementation of PMTCT. A qualitative, exploratory-descriptive design was followed. Ten participants were selected purposively, and each participant was interviewed individually using WhatsApp video calling. All participants were made aware of their voices being recorded; data saturation was reached on the eighth participant as no new information evolved. Data were analyzed using Tesch's method of qualitative data analysis. The findings revealed that factors that influenced PMTCT implementation were due to patient, management, and staff-related factors. Moreover, these factors impacted the provision of effective patient care. The findings of this study show that much still needs to be done to achieve and sustain the PMTCT implementation goal. Therefore, the training of nurses should be of paramount importance. They should be provided and equipped with the necessary resources, support, and encouragement to offer and ensure quality health care. Furthermore, the government should ensure that policies and guidelines are regularly monitored and evaluated.

Midwives' Educational Needs in Iran: A Narrative Review

Background

Midwives have a major role in the improvement of health indicators in every country. In order for midwives to be able to play their role well, they must have sufficient updated knowledge. For this purpose, it is necessary to review their educational needs. The aim of the present research was to review Iranian studies that have investigated midwives' educational needs.

Materials and Methods

In this narrative review, PubMed, Scopus, Web of Science, Google Scholar, ProQuest, Ovid, SID, and Magiran databases were searched for the full texts of Iranian studies published in Persian and English languages in the period of 2000-2018. Review, descriptive, and interventional articles consistent with the research aim were included in this study.

Results

Of the 53 found articles, 23 articles that were relevant to midwives' educational needs in Iran were investigated. The findings of the studies showed that the educational needs of the midwives can be categorized into the four groups of knowledge and performance, communication skills, occupational rules/regulations, and religious rules.

Conclusions

The results showed that midwives in Iran have different educational needs. Because the midwifery practice leads to the promotion of public health, it is imperative that midwives have comprehensive knowledge and the skills necessary for providing optimal care. In order to achieve this, short-term and long-term training programs tailored to the needs of midwives are recommended.

Healthcare workers' behaviors and personal determinants associated with providing adequate sexual and reproductive healthcare services in sub-Saharan Africa: a systematic review

BACKGROUND

Healthcare workers may affect the utilization of sexual and reproductive healthcare (SRH) services, and quality of care thereof, for example by their behaviours or attitudes they hold. This can become a hindrance to accessing and utilizing SRH services, particularly by young people, and thus a better understanding of these behaviours and associated factors is needed to improve access to and utilization of SRH services.

METHODS

A systematic review of literature was conducted to identify studies focusing on healthcare workers' behaviors and personal determinants associated with providing adequate SRH services in sub-Saharan Africa (January 1990 - October 2015). Five databases were searched until 30th October 2015, using a search strategy that was adapted based on the technical requirements of each specific database. Articles were independently screened for eligibility by two researchers. Of the 125-screened full-text articles, 35 studies met all the inclusion criteria.

RESULTS

Negative behaviours and attitudes of healthcare workers, as well as other personal determinants, such as poor knowledge and skills of SRH services, and related factors, like availability of essential drugs and equipment are associated with provision of inadequate SRH services. Some healthcare workers still have negative attitudes towards young people using contraceptives and are more likely to limit access to and utilization of SRH by adolescents especially. Knowledge of and implementation of specific SRH components are below optimum levels according to the WHO recommended guidelines.

CONCLUSIONS

Healthcare workers' negative behaviours and attitudes are unlikely to encourage women in general to access and utilize SRH services, but more specifically young women. Knowledge of SRH services, including basic emergency obstetric care (EmOC) is insufficient among healthcare workers in SSA.

TRIAL REGISTRATION

A protocol for this systematic review was registered with PROSPERO and the registration number is: CRD42015017509 .

Motor development of infants exposed to maternal human immunodeficiency virus (HIV) but not infected

BACKGROUND

To assess the motor development of infants exposed to maternal human immunodeficiency virus (HIV).

METHODS

Thirty infants were assessed in the period from November 2009 to March 2010 at the AIDS Reference and Training Centre, in São Paulo, Brazil. The assessment instrument used in the research was the Alberta Infant Motor Scale (AIMS). All 30 infants used the antiretroviral drug properly for 42 consecutive days, in accordance with the protocol of the World Health Organization.

RESULTS

Out of the total number of infants, 27 (90%) had proper motor performance and 3 (10%) presented motor delay, according to the AIMS.

DISCUSSION

This study demonstrated that only 10% of the assessed group had developmental delay and no relation with environmental variables was detected, such as maternal level of education, social and economic issues, maternal practices, attendance at the day care center, and drug use during pregnancy. It is important to emphasize the necessity of studies with a larger number of participants.

Decentralization of access to antiretroviral therapy in Cameroon: correlates of HIV physicians' knowledge in HIV care

BACKGROUND

Good knowledge in HIV care among physicians is a necessary prerequisite to effective antiretroviral therapy (ART) scaling-up in Sub-Saharan Africa.

METHODS

Between September 2006 and March 2007, a 27-item knowledge questionnaire was proposed to all HIV physicians working in 27 hospitals throughout six provinces of Cameroon. Physicians' responses were compared between the three levels of decentralization of the Cameroonian healthcare delivery system (χ(2) and Fisher tests). Correct responses were summed to build a knowledge score. Factors significantly associated with a higher score were identified using linear regression.

RESULTS

In total, 93 physicians filled in the questionnaire. Level of knowledge was globally good (median score 23), with no significant difference between the three levels of decentralization. Gaps in knowledge were observed regarding the use of cotrimoxazole and the follow-up of ART-treated patients. Main factors independently associated with a higher knowledge score included training, involvement in therapeutic committees, satisfactory collaboration with other practitioners and establishment of strong relationships between patients and patients' associations.

CONCLUSIONS

Overall knowledge in HIV care is good among HIV physicians working at all three levels of decentralization of healthcare in Cameroon. However, a national training policy should be set up to improve knowledge and practices in both ART follow-up and specific situations such as paediatric HIV. Collaboration between caregivers and external resources involved in HIV care should also be encouraged.

The International Confederation of Midwives essential competencies for basic midwifery practice. an update study: 2009-2010

OBJECTIVE

a 2-year study was conducted to update the core competencies for basic midwifery practice, first delineated by the International Confederation of Midwives in 2002. A competency domain related to abortion-related care services was newly developed.

DESIGN

a modified Delphi survey process was conducted in two phases: a pilot item affirmation study, and a global field survey.

SETTING

a global survey conducted in 90 countries.

PARTICIPANTS

midwifery educators or clinicians associated with midwifery education schools and programmes located in any of the ICM member association countries. Additional participants represented the fields of nursing, medicine, and midwifery regulatory authorities. A total of 232 individuals from 63 member association and five non-member countries responded to one or both of the surveys. The achieved sample represented 42% of member association countries, which was less than the 51% target. However, the sample was proportionally representative of ICM's nine global regions.

MEASUREMENTS

survey respondents expressed an opinion whether to retain or to delete any of 255 statements of midwifery knowledge, skill, or professional behaviour. They also indicated whether the item should be a basic (core) item of midwifery knowledge or skill that would be included as mandatory content in a programme of midwifery pre-service education, or whether the item could be added to the fund of knowledge or acquired as an additional skill by those who would need or wish to include the item within the scope of their clinical practice.

FINDINGS

a majority consensus of .85 was required to accept the item without further deliberation. An expert panel made final decisions in all instances where consensus was not achieved. The panel also amended the wording of selected items, or added new items based on feedback received from survey respondents. The final document contains 268 items organised within seven competency domains.

Knowledge of Pregnant Women on Mother-to-Child Transmission of HIV in Yaoundé

Introduction:

Mother–to-child transmission of HIV is a major public health problem in Cameroon. The aim of this study was to assess knowledge of pregnant women on HIV transmission and prevention, particularly the four pillars of mother-to-child transmission.

Materials and Methods:

This was a descriptive cross-sectional study from October 2008 to January 2009 at the Yaoundé Gynaecology-Obstetrics and Pediatric Hospital. All women presenting at the Ante-Natal Care (ANC) Clinic for the first time were included in the study after obtaining a verbal informed consent.

Results:

The ages of the 260 women included in the study ranged from 15 to 42 years. Almost 99% (257/260) of the women interviewed had heard about HIV. Respectively, 80.5% (209/260), 89.3% (232/260) and 81.2% (211/260) of the women cited pregnancy, delivery, and breastfeeding as risk periods for HIV transmission from mother to child. Use of the male condom, the female condom, abstinence, and faithfulness to a single partner were considered as effective methods of HIV prevention by 73% (190/260), 76% (198/260), 88% (229/260) and 46% (120/260) of respondents respectively. About 79% (64/81) of participants with higher education considered HIV infection to be contagious as opposed to 45.5% (5/11) of women with no formal education (P = 0.008).

Conclusion:

Our data suggest that women have some good knowledge on the Prevention of Mother-To-Child Transmission (PMTCT) of HIV. Nevertheless, improving the formal educational level of these women may contribute to a further reduction of HIV transmission.

Experiences of stigma in healthcare settings among adults living with HIV in the Islamic Republic of Iran

Background

People living with HIV (PLHIV) sometimes experience discrimination. There is little understanding of the causes, forms and consequences of this stigma in Islamic countries. This qualitative study explored perceptions and experiences of PLHIV regarding both the quality of healthcare and the attitudes and behaviours of their healthcare providers in the Islamic Republic of Iran.

Methods

In-depth, semi-structured interviews were held with a purposively selected group of 69 PLHIV recruited from two HIV care clinics in Tehran. Data were analyzed using the content analysis approach.

Results and discussion

Nearly all participants reported experiencing stigma and discrimination by their healthcare providers in a variety of contexts. Participants perceived that their healthcare providers' fear of being infected with HIV, coupled with religious and negative value-based assumptions about PLHIV, led to high levels of stigma. Participants mentioned at least four major forms of stigma: (1) refusal of care; (2) sub-optimal care; (3) excessive precautions and physical distancing; and (4) humiliation and blaming. The participants' healthcare-seeking behavioural reactions to perceived stigma and discrimination included avoiding or delaying seeking care, not disclosing HIV status when seeking healthcare, and using spiritual healing. In addition, emotional responses to perceived acts of stigma included feeling undeserving of care, diminished motivation to stay healthy, feeling angry and vengeful, and experiencing emotional stress.

Conclusions

While previous studies demonstrate that most Iranian healthcare providers report fairly positive attitudes towards PLHIV, our participants' experiences tell a different story. Therefore, it is imperative to engage both healthcare providers and PLHIV in designing interventions targeting stigma in healthcare settings. Additionally, specialized training programmes in universal precautions for health providers will lead to stigma reduction. National policies to strengthen medical training and to provide funding for stigma-reduction programming are strongly recommended. Investigating Islamic literature and instruction, as well as requesting official public statements from religious leaders regarding stigma and discrimination in healthcare settings, should be used in educational intervention programmes targeting healthcare providers. Finally, further studies are needed to investigate the role of the physician and religion in the local context.

Poverty and maternal mortality in Nigeria: towards a more viable ethics of modern medical practice

Poverty is often identified as a major barrier to human development. It is also a powerful brake on accelerated progress toward the Millennium Development Goals. Poverty is also a major cause of maternal mortality, as it prevents many women from getting proper and adequate medical attention due to their inability to afford good antenatal care. This Paper thus examines poverty as a threat to human existence, particularly women's health. It highlights the causes of maternal deaths in Nigeria by questioning the practice of medicine in this country, which falls short of the ethical principle of showing care.

Since high levels of poverty limit access to quality health care and consequently human development, this paper suggests ways of reducing maternal mortality in Nigeria. It emphasizes the importance of care ethics, an ethical orientation that seeks to rectify the deficiencies of medical practice in Nigeria, notably the problem of poor reproductive health services.

Care ethics as an ethical orientation, attends to the important aspects of our shared lives. It portrays the moral agent (in this context the physician) as a self who is embedded in webs of relations with others (pregnant women). Also central to this ethical orientation is responsiveness in an interconnected network of needs, care and prevention of harm.

This review concludes by stressing that many human relationships involve persons who are vulnerable, including pregnant women, dependent, ill and or frail, noting that the desirable moral response is that prescribed by care ethics, which thus has implications for the practice of medicine in Nigeria.