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Hampanda K, Scandlyn J, Fasano M, Matenga TFL, Onono M, Odwar TO, Mutale W, Shankalala P, Chi BH, Turan JM, Abuogi LL. Money, chores and emotional support: Kenyan and Zambian fathers' perceptions of male partner involvement in maternal and infant health within the context of HIV. CULTURE, HEALTH & SEXUALITY 2024; 26:747-762. [PMID: 37694847 DOI: 10.1080/13691058.2023.2249078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 08/10/2023] [Indexed: 09/12/2023]
Abstract
In sub-Saharan Africa, involving male partners in the prevention of mother-to-child transmission of HIV improves maternal and infant outcomes. Male involvement is typically conceptualised as male partners attending antenatal care, which is difficult for many men. Little is known about how men view their involvement in family health within the context of HIV, particularly outside of clinic attendance. Through interviews with 35 male partners of pregnant or postpartum women living with HIV in Kenya and Zambia, this study elicited perceptions of male involvement in maternal and infant health in families affected by HIV. Men supported the importance of clinic attendance but reported conflicts with the need to work and fulfil their role as the family's financial provider. Providing money for necessities was deemed more critical for their family's health than clinic attendance. Men's involvement was conveyed through various other supportive actions, including helping with household chores and providing emotional support (showing love and reducing women's stress). Future strategies to promote male partner involvement in the prevention of mother-to-child transmission of HIV and maternal and child health should build upon the actions men view as most meaningful to promote their family's health within their real-world life circumstances and cultural context, particularly their role as financial providers.
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Affiliation(s)
- Karen Hampanda
- Obstetrics and Gynaecology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Jean Scandlyn
- Health and Behavioural Sciences and Anthropology, University of Colorado, Denver, CO, USA
| | - Marcella Fasano
- Obstetrics and Gynaecology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | | | - Maricianah Onono
- Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Tobias O Odwar
- Impact Research and Development Organization (IRDO), Kisumu, Kenya
| | - Wilbroad Mutale
- School of Public Health, University of Zambia, Lusaka, Zambia
| | | | - Benjamin H Chi
- Obstetrics and Gynaecology, University of North Carolina, Chapel Hill, NC, USA
| | - Janet M Turan
- Health Care Policy and Organization, School of Public Health, University of Alabama, Birmingham, AL, USA
| | - Lisa L Abuogi
- Paediatrics, School of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
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Triulzi I, Somerville C, Sangwani S, Palla I, Orlando S, Mamary HS, Ciccacci F, Marazzi MC, Turchetti G. Understanding the meanings of male partner support in the adherence to therapy among HIV-positive women: a gender analysis. Glob Health Action 2022; 15:2051223. [PMID: 35416763 PMCID: PMC9009925 DOI: 10.1080/16549716.2022.2051223] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Previous literature reports that low male partner support is a barrier to women's adherence and retention in HIV care programs. OBJECTIVE This qualitative study explored the relationships between partners to understand what is meant by male partner support in adherence of HIV-positive women in four healthcare facilities in Southern Malawi. METHODS We conducted 8 semi-structured focus group discussions (FGDs) with 73 participants (40 men and 33 women) and 10 in-depth interviews (IDIs) between August 2018 to December 2019. Participants were HIV-positive patients, healthcare workers (HCWs), expert patients (EPs), and couples attending the clinic. All data were digitally recorded, transcribed verbatim, and analysed using a gender-responsive grounded theory approach. RESULTS This study confirms previous literature, which suggests male partner support is expressed by providing access to transport to the clinic and accompaniment to appointments. However, we found that men can also control access to resources and decision-making. Support is more complex than previous literature reported and, in some cases, gender norms significantly limit women's capacity to engage in care independently of male support since women need male partner permission to access the resources to attend clinics. CONCLUSIONS This paper suggests that restrictive male-partner gender norms limit women's power to engage in care. Most importantly, the gender analysis reveals that what previous literature describes as male partner support can sometimes hide male partner control in permitting access to resources to attend health facilities. For this reason, policies enhancing male support should consider the gender power relationship between partners to avoid reinforcing gender inequality.
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Affiliation(s)
- Isotta Triulzi
- Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Claire Somerville
- Gender Center, Graduate Institute of International and Development Studies, Geneva, Switzerland
| | | | - Ilaria Palla
- Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Stefano Orlando
- Department of Biomedicine, University of Tor Vergata, Rome, Italy
| | | | - Fausto Ciccacci
- UniCamillus, Saint Camillus International University of Health Sciences, Rome, Italy
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Mweemba O, Zimba C, Chi BH, Chibwe KF, Dunda W, Freeborn K, Maman S, Matenga TFL, Phanga T, Rosenberg N, Mutale W. Contextualising men's role and participation in PMTCT programmes in Malawi and Zambia: A hegemonic masculinity perspective. Glob Public Health 2021; 17:2081-2094. [PMID: 34375155 DOI: 10.1080/17441692.2021.1964559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study sought to explore and contextualise the man's role in antenatal services, and the barriers and strategies for engaging men in prevention of mother-to-child HIV transmission (PMTCT). We conducted 143 interviews with pregnant and breastfeeding women, male partners, health workers and policy makers in Malawi and Zambia. We employed thematic and critical discourse analysis using the hegemonic masculinity perspective. We found that men's roles in PMTCT reflected hegemonic masculinities. As breadwinners, men supported their partners with material and financial resources. As decision makers, men were involved in decision making on the health of their partners. As social protectors, men supported their partners in accessing and adhering to antenatal care, HIV treatment and care. Barriers and challenges to male involvement in antenatal care were often the result of conflict between the clinic operating hours and men's working hours, the perception of antenatal care services as female spaces, and men's fear of HIV testing. Proposed strategies to increase male engagement in PMTCT included sensitising men about HIV and pregnancy; engaging leaders and employers, providing services outside working hours, and providing incentives. We conclude that men's role and participation in PMTCT services are an extension and adaptation of hegemonic masculinities.
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Affiliation(s)
- Oliver Mweemba
- Department of Health Promotion and Education, School of Public Health, University of Zambia, Lusaka, Zambia
| | | | - Benjamin H Chi
- Department of Obstetrics and Gynaecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kasapo F Chibwe
- Department of Health Promotion and Education, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Wezi Dunda
- UNC Project-Malawi, Tidziwe Centre, Lilongwe, Malawi
| | - Kellie Freeborn
- Department of Obstetrics and Gynaecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Suzanne Maman
- Department of Health Behaviour, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tulani Francis L Matenga
- Department of Health Promotion and Education, School of Public Health, University of Zambia, Lusaka, Zambia
| | | | - Nora Rosenberg
- Department of Health Behaviour, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Wilbroad Mutale
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
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M'baya Kansinjiro B, Nyondo-Mipando AL. A qualitative exploration of roles and expectations of male partners from PMTCT services in rural Malawi. BMC Public Health 2021; 21:626. [PMID: 33789639 PMCID: PMC8011175 DOI: 10.1186/s12889-021-10640-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 03/17/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Prevention of mother-to-child transmission of HIV (PMTCT) is effective in curbing rates of HIV infection in children because its interventions reduce the rates of transmission during pregnancy, in labour, and in breastfeeding. Male involvement (MI) greatly influences uptake and adherence to PMTCT services. Lack of clarity on the roles and expectations of men in PMTCT is one of the main barriers to MI. The main aim of the study was to explore the roles and expectations of male partners from PMTCT services in Malawi. METHODS This was a descriptive qualitative study that involved men whose partners were either pregnant or breastfeeding a child, health care workers working in PMTCT services for over six months, and traditional leaders. We conducted 9 in-depth interviews and 12 key informant interviews from January to March 2018. All interviews were audio-recorded, transcribed, and translated. Thematic analysis was employed to analyze data. RESULTS The subjective and community norms and attitudes of men towards PMTCT provide the context in which male partners define the specific roles they render and the services they expect from PMTCT services. The roles of men in PMTCT service were contextualized in what is socially acceptable and normalized in the setting and include supportive roles expressed as accompanying the wife to attend; antenatal care services, Dry blood sample collection (DBS) when its due, keeping appointments when is due to take the ARVs, providing financial support; HIV prevention behavior change and decision-making roles. The desired services within PMTCT include health assessment such as checking their weight; blood pressure; blood sugar and promotion activities such as education sessions that are provided in a male-friendly manner that is in tandem with existing socio-cultural norms and attitudes of men towards such services. CONCLUSION The roles of male partners in PMTCT services are underpinned by subjective norms and what is socially acceptable within a specific context. The services that men require from PMTCT services are influenced by their attitudes and beliefs towards PMTCT interventions. Services should be male-tailored provided in an atmosphere that allows and accepts male partners to exercise their roles in PMTCT services.
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Affiliation(s)
- Beatrice M'baya Kansinjiro
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, Blantyre, Malawi
| | - Alinane Linda Nyondo-Mipando
- Department of Health Systems and Policy, School of Public Health and Family Medicine, College of Medicine, Blantyre, Malawi.
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Sakala D, Kumwenda MK, Conserve DF, Ebenso B, Choko AT. Socio-cultural and economic barriers, and facilitators influencing men's involvement in antenatal care including HIV testing: a qualitative study from urban Blantyre, Malawi. BMC Public Health 2021; 21:60. [PMID: 33407298 PMCID: PMC7789341 DOI: 10.1186/s12889-020-10112-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 12/21/2020] [Indexed: 01/14/2023] Open
Abstract
Background Male partner involvement in antenatal care (ANC) is associated with positive maternal and neonatal outcomes. However, only a handful of men attend ANC with their partners. This study aimed to understand the underlying barriers and facilitators influencing men’s ANC attendance including HIV testing in Blantyre, Malawi. Methods Data were collected during a formative qualitative study of a cluster-randomised trial. Six focus group discussions (FGDs) with 42 men and women and 20 in-depth interviews (IDIs) were conducted at three primary health centres in urban Blantyre, Malawi. FGD participants were purposively sampled with IDI participants subsequently sampled after FGD participation. Thematic analysis was used to analyse the data. Results The economic requirement to provide for their families exerted pressure on men and often negatively affected their decision to attend ANC together with their pregnant partners despite obvious benefits. Peer pressure and the fear to be seen by peers queueing for services at ANC, an environment traditionally viewed as a space for women and children made men feel treated as trespassers and with some level of hostility rendering them feeling emasculated when they attend ANC. Health system problems associated with overall organization of the ANC services, which favours women created resistance among men to be involved. An association between ANC and HIV testing services discouraged men from attending ANC because of their fear of testing HIV-positive in the presence of their partners. The availability of a male friendly clinic offering a private, quick, supportive/sensitive and flexible service was considered to be an important incentive that would facilitate men’s ANC attendance. Men described compensation to cover transport and opportunity cost for attending the clinic as a motivator to attending ANC services and accepting an HIV test. Conclusion Peer and economic influences were the most influential barriers of men attending ANC and testing for HIV with their pregnant partners. Addressing these socio-economic barriers and having a male friendly clinic are promising interventions to promote male ANC attendance in this setting. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-10112-w.
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Affiliation(s)
- Doreen Sakala
- Public Health Group, Malawi-Liverpool-Wellcome Clinical Research Programme (MLW), Blantyre, Malawi
| | - Moses K Kumwenda
- Public Health Group, Malawi-Liverpool-Wellcome Clinical Research Programme (MLW), Blantyre, Malawi.,Helse Nord TB Initiative, College of Medicine, Blantyre, Malawi
| | - Donaldson F Conserve
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Arnold School of Public Health, Columbia, SC, USA
| | - Bassey Ebenso
- University of Leeds, Institute of Health Sciences, Leeds, UK
| | - Augustine T Choko
- Public Health Group, Malawi-Liverpool-Wellcome Clinical Research Programme (MLW), Blantyre, Malawi.
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Wexler C, Brown M, Maloba M, Goggin K, Mabachi N, Kamau Y, Gautney B, Koech S, Lagat S, Finocchario-Kessler S. Women's preferences, expectations, and experiences with male partner support throughout prevention of mother to child transmission of HIV services: a mixed-methods study. AIDS Care 2020; 33:1059-1067. [PMID: 33300370 DOI: 10.1080/09540121.2020.1859444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Male involvement in prevention of mother to child transmission of HIV (PMTCT) care improves maternal and child outcomes. We conducted a mixed-methods study at two Kenyan government hospitals. We quantitatively assessed women's expectations and preferences for male partner involvement in PMTCT and male partner attendance at PMTCT appointments. Qualitative interviews with women during the postpartum period assessed types of support women received from their male partners. At enrollment, most participants wanted (75%) and expected (69%) male partners to attend appointments; yet, only 9% had a male partner attend any appointments. Most women agreed that their partner would: support them financially (81%), help follow doctor's guidance (61%), support a hospital-based delivery (85%), and want to receive text messages (68%). Expectations and preferences varied by women's characteristics, most notably experiences with mistreatment, disclosure status, and knowledge of male partner's HIV status. In qualitative interviews, instrumental (financial) support was the most frequently discussed type of support. Male partners also provided informational support by reminding women of medication or appointments. Women reported a variety of ways in which their male partners supported them through PMTCT; however, there was a gap between women's expectation for male partner attendance and the level of male attendance achieved.
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Affiliation(s)
- Catherine Wexler
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Melinda Brown
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - May Maloba
- Global Health Innovations, Nairobi, Kenya
| | - Kathy Goggin
- Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, MO, USA.,School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Natabhona Mabachi
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Yvonne Kamau
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Sharon Koech
- Kenya Medical Research Institute, Nairobi, Kenya
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Al-Mujtaba M, Sam-Agudu NA, Torbunde N, Aliyu MH, Cornelius LJ. Access to maternal-child health and HIV services for women in North-Central Nigeria: A qualitative exploration of the male partner perspective. PLoS One 2020; 15:e0243611. [PMID: 33301478 PMCID: PMC7728451 DOI: 10.1371/journal.pone.0243611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 11/24/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND In much of sub-Saharan Africa, male partners play influential roles in women's access to maternal-child healthcare, including prevention of mother-to-child transmission of HIV services. We explored male partner perspectives on women's access to maternal-child healthcare in North-Central Nigeria. METHODS Three focus groups were conducted with 30 men, purposefully-selected on the basis of being married, and rural or urban residence. Major themes explored were men's maternal-child health knowledge, gender power dynamics in women's access to healthcare, and peer support for pregnant and postpartum women. Data were manually analyzed using Grounded Theory, which involves constructing theories out of data collected, rather than applying pre-formed theories. RESULTS Mean participant age was 48.3 years, with 36.7% aged <40 years, 46.7% between 41 and 60 years, and 16.6% over 60 years old. Religious affiliation was self-reported; 60% of participants were Muslim and 40% were Christian. There was consensus on the acceptability of maternal-child health services and their importance for optimal maternal-infant outcomes. Citing underlying patriarchal norms, participants acknowledged that men had more influence in family health decision-making than women. However, positive interpersonal couple relationships were thought to facilitate equitable decision-making among couples. Financial constraints, male-unfriendly clinics and poor healthcare worker attitudes were major barriers to women's access and male partner involvement. The provision of psychosocial and maternal peer support from trained women was deemed highly acceptable for both HIV-positive and HIV-negative women. CONCLUSIONS Strategic engagement of community leaders, including traditional and religious leaders, is needed to address harmful norms and practices underlying gender inequity in health decision-making. Gender mainstreaming, where the needs and concerns of both men and women are considered, should be applied in maternal-child healthcare education and delivery. Clinic fee reductions or elimination can facilitate service access. Finally, professional organizations can do more to reinforce respectful maternity care among healthcare workers.
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Affiliation(s)
- Maryam Al-Mujtaba
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Nadia A. Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Federal Capital Territory, Nigeria
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Pediatric and Adolescent HIV Unit, Prevention, Care and Treatment Department, Institute of Human Virology Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Nguavese Torbunde
- Pediatric and Adolescent HIV Unit, Prevention, Care and Treatment Department, Institute of Human Virology Nigeria, Abuja, Federal Capital Territory, Nigeria
| | - Muktar H. Aliyu
- Department of Health Policy and Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Llewellyn J. Cornelius
- School of Social Work and College of Public Health, University of Georgia Athens, Athens, Georgia, United States of America
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Moshi FV, Kibusi SM, Fabian F. Exploring factors influencing pregnant Women's attitudes, perceived subjective norms and perceived behavior control towards male involvement in maternal services utilization: a baseline findings from a community based interventional study from Rukwa, rural Tanzania. BMC Pregnancy Childbirth 2020; 20:634. [PMID: 33076859 PMCID: PMC7574556 DOI: 10.1186/s12884-020-03321-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 10/08/2020] [Indexed: 01/14/2023] Open
Abstract
Background Although male involvement enhances obstetric care-seeking behavior, the practice of male involvement in developing countries remains unacceptably low. Male involvement in maternal services utilization can be influenced by the attitude, subjective norm, and perceived behavior control of their female partners. Little is known about factors influencing pregnant women’s attitudes, perceived subjective norms, and perceived behavior control towards male involvement in maternal services utilization. Methods A baseline community-based cross-sectional study whose target was pregnant women were performed from 1st June until 30th October 2017. A three-stage probability sampling technique was employed to obtain a sample of 546 pregnant women. A structured questionnaire that hinged the Theory of Planned Behavior was used. The questionnaire explored three main determinants of male involvement, which were: attitudes towards male involvement, perceived subjective norms towards male involvement, and perceived behavior control towards male involvement. Results After adjusting for the confounders, factors influencing positive attitude towards male involvement were age at marriage [19 to 24 yrs.,(AOR = 1.568 at 95% CI =1.044–2.353), more than 24 yrs. (AOR = 2.15 at 95% CI = 1.150–1.159)]; education status [primary school (AOR = 1.713 at 95% CI = 1.137–2.58)] and economic status [earning more than one dollar per day (AOR = 1.547 at 95% CI = 1.026–2.332)]. Factors influencing perceived subjective norms was only age at marriage [19 to 24 yrs., (AOR = 1.447 at 95% CI = 0.970–2.159), more than 24 years, (AOR = 2.331 at 95% CI = 1.261–4.308)]; factors influencing perceived behavior control were age at marriage [more than 24 years (AOR = 2.331 at 95%CI = 1.261–4.308)], and the intention to be accompanied by their male partners (AOR = 1.827 at 95%CI = 1.171–2.849). Conclusion The study revealed that women who were married at an older age were more likely to have a positive attitude, subjective norms, and perceived behavior control towards male involvement in maternal services utilization than those who were married at a young age. Pregnant women who had primary education and earn more than a dollar per day were more likely to have positive attitudes towards male involvement than poor and uneducated pregnant women. The study recommends an interventional study to evaluate the influence attitude, subjective norms, and perceived behavior control on male involvement in maternal services utilization.
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Affiliation(s)
- Fabiola V Moshi
- Department of Nursing and Midwifery, College of Health Sciences of the University of Dodoma, P.O. Box 259, Dodoma, Tanzania.
| | - Stephen M Kibusi
- Department of Public Health, College of Health Sciences of the University of Dodoma, P.O Box.259, Dodoma, Tanzania
| | - Flora Fabian
- Department of Biomedical Sciences, College of Health Sciences of the University of Dodoma, P.O Box.259, Dodoma, Tanzania
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Iliyasu Z, Galadanci HS, Muhammad B, Yadudu FZ, Kwaku AA, Salihu HM, Aliyu MH. Correlates of HIV-Positive Fathers' Involvement in Prevention of Mother-to-child Transmission Programs in Northern Nigeria. Curr HIV Res 2020; 18:443-457. [PMID: 32778029 DOI: 10.2174/1570162x18666200810133347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/08/2020] [Accepted: 07/17/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The involvement of men in prevention of mother-to-child HIV transmission (PMTCT) programs could accelerate the elimination of vertical transmission. Yet, little research has focused on HIV-positive male partners. This study determined the predictors of male partners' PMTCT knowledge and involvement in a tertiary hospital in northern Nigeria. METHODS A clinic-based sample of 401 HIV-positive male partners of women who delivered within 12 months prior were interviewed using structured questionnaires. PMTCT knowledge and involvement scores were computed. Adjusted odd ratios (AOR) for predictors were derived from multivariate logistic regression models. RESULTS The proportion of respondents with adequate PMTCT knowledge was 40.9%. Less than half (43.6%) of the respondents participated in PMTCT, with median involvement score of 2.00 (interquartile range, IQR = 0, 5.0). One quarter of respondents (25.7%, n =103) reported >1 sex partners, 10.5% consistently used condoms, and 20.7% had disclosed to all partners. Fathers' involvement in PMTCT was predicted by paternal education (AOR = 0.30; 95% Confidence Interval (CI): 0.12-0.77, no formal vs. post-secondary), HIV-positive child (AOR = 3.85; 95%CI: 1.41-10.54, yes vs. no), treatment duration (AOR = 4.17; 95%CI: 1.67-10.41, ≤1 vs. ≥10 years), disclosure to partner(s) (AOR = 1.21; 95%CI: 1.15-3.52, 'disclosed to all' vs. 'not disclosed'), condom use (AOR = 5.81; 95%CI: 3.07-11.0, always vs. never), and PMTCT knowledge (AOR = 0.62; 95%CI: 0.31-0.92, inadequate versus adequate). CONCLUSION The involvement of fathers in HIV PMTCT programs was low and predicted by paternal education, HIV-positive child, duration of antiretroviral treatment, disclosure to partner, consistent condom use, and level of PMTCT knowledge. Our findings will inform the development of policies to increase male partner involvement in PMTCT in Nigeria.
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Affiliation(s)
- Zubairu Iliyasu
- Epidemiology & Biostatistics Division, Department of Community Medicine, Faculty of Clinical Sciences, College of Health Sciences, Bayero University, Kano, Nigeria
| | | | - Bashir Muhammad
- Epidemiology & Biostatistics Division, Department of Community Medicine, Faculty of Clinical Sciences, College of Health Sciences, Bayero University, Kano, Nigeria
| | - Fatima Z Yadudu
- School of Medicine, University of Kentucky, Lexington, KY, United States
| | - Aminatu A Kwaku
- Epidemiology & Biostatistics Division, Department of Community Medicine, Faculty of Clinical Sciences, College of Health Sciences, Bayero University, Kano, Nigeria
| | - Hamisu M Salihu
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, United States
| | - Muktar H Aliyu
- Department of Health Policy and Vanderbilt Institute for Global Health,Vanderbilt University Medical Center, Tennessee, United States
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Kashaija DK, Mselle LT, Mkoka DA. Husbands' experience and perception of supporting their wives during childbirth in Tanzania. BMC Pregnancy Childbirth 2020; 20:85. [PMID: 32039718 PMCID: PMC7011545 DOI: 10.1186/s12884-019-2715-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 12/30/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND In order improve the quality of birth care and women satisfaction with birthing process it is recommended that every woman should be offered the option to experience labour and childbirth with a companion of her choice. Involving husbands who are decision makers in the household may a play role in reducing maternal mortality which is unacceptably high despite the targeted goal to reduce this mortality up to three quarters as targeted in the MDGs by 2015. This is still addressed in the Sustainable Development Goals (SDGs) of 2015/30. This study aimed to explore the experiences and perceptions of husbands' support of their wives during pregnancy, labour and deliveries in Tanzania. METHODS Qualitative descriptive study design was employed; involving men aged between 24 and 63 years. Participants were selected purposefully at the clinic and in labour ward of SekouToure Regional Referral Hospital (SRRH). The in-depth interview, guided by semi structured interview guide was used to collect the audio recorded and hand written information. Data were analysed using qualitative content analysis. RESULTS Nine semi-structured interviews were conducted with husbands of women attended for antenatal care and those came for deliveries. Four themes emerged; Demonstrating care, love and affection, adopting modern life style, observing women's right and meeting social economic difficulties. Husbands' support to their partners is a good behaviour practiced during matrimonial lives. Husbands who support their partners during pregnancy and delivery consider themselves as being modern men as they at home take duties beside their usual tasks to let their wives have adequate time to rest during pregnancy. Poor road infrastructure makes difficult to get transport to the healthcare facility especially when labour is imminent. Also ward infrastructure is not supportive to accommodate husbands when they accompany their wives to the healthcare facility. CONCLUSIONS The healthcare settings in low income countries need to accommodate men during the routine antenatal and intranatal care for the positive outcome of labour and delivery. Educating men on importance of active involvement in reproductive and child health services is important. Exploratory research should be conducted to understand how education and urbanisation affects men involvement in maternal and child health specifically in the low income countries.
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Affiliation(s)
- Denis Kampayana Kashaija
- Department of Obstetrics and Gynecology, SekouToure Regional Referral Hospital, PO Box 132, Mwanza, Tanzania.
| | - Lilian Teddy Mselle
- Department of Clinical Nursing, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania
| | - Dickson Ally Mkoka
- Department of Clinical Nursing, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania
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Mabachi NM, Brown M, Sandbulte M, Wexler C, Goggin K, Maloba M, Finocchario-Kessler S. Using a Social Support Framework to Understand How HIV Positive Kenyan Men Engage in PMTCT/EID Care: Qualitative Insights From Male Partners. AIDS Behav 2020; 24:18-28. [PMID: 30877581 PMCID: PMC6745277 DOI: 10.1007/s10461-019-02451-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Greater male partner involvement in Prevention of Mother to Child Transmission (PMTCT) and Early Infant Diagnosis (EID) is associated with improved outcomes. Perceived low social support for the mother can negatively impact the uptake of PMTCT/EID services. Most research relies on women's reports of the types and quality of male partner support received versus what is desired. This qualitative study examines Kenyan male partners' reported social support provision pre- and post-partum from their own perspective. The study was embedded within intervention development studies in Kenya designed to develop and pilot a PMTCT module of a web based system to improve EID. Focus groups were conducted with male partners of pregnant women with HIV and elicited feedback on male partner involvement in maternal and child care and factors affecting participation. Interviews were analyzed within a theoretical social support framework. Participants described providing tangible support (financial resources), informational support (appointment reminders) and emotional support (stress alleviation in the face of HIV-related adversity). African conceptualizations of masculinity and gender norms influenced the types of support provided. Challenges included economic hardship; insufficient social support from providers, peers and bosses; and HIV stigma. Collaboration among providers, mothers and partners; a community-based social support system; and recasting notions of traditional masculinity were identified as ways to foster male partner support.
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Affiliation(s)
- Natabhona M Mabachi
- Department of Family Medicine, University of Kansas Medical Center, Mailstop 3064, 4125 Rainbow Blvd., Kansas City, KS, 66160, USA.
| | - Melinda Brown
- Department of Family Medicine, University of Kansas Medical Center, Mailstop 3064, 4125 Rainbow Blvd., Kansas City, KS, 66160, USA
| | - Matthew Sandbulte
- Department of Family Medicine, University of Kansas Medical Center, Mailstop 3064, 4125 Rainbow Blvd., Kansas City, KS, 66160, USA
| | - Catherine Wexler
- Department of Family Medicine, University of Kansas Medical Center, Mailstop 3064, 4125 Rainbow Blvd., Kansas City, KS, 66160, USA
| | - Kathy Goggin
- Children's Mercy Kansas City, Health Services and Outcomes Research, Kansas City, MO, USA
| | - May Maloba
- Global Health Innovations, Nairobi, Kenya
| | - Sarah Finocchario-Kessler
- Department of Family Medicine, University of Kansas Medical Center, Mailstop 3064, 4125 Rainbow Blvd., Kansas City, KS, 66160, USA
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Hampanda K, Abuogi L, Musoke P, Onono M, Helova A, Bukusi E, Turan J. Development of a Novel Scale to Measure Male Partner Involvement in the Prevention of Mother-to-Child Transmission of HIV in Kenya. AIDS Behav 2020; 24:291-303. [PMID: 31152357 PMCID: PMC6885105 DOI: 10.1007/s10461-019-02546-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Male partner involvement is an important factor in prevention of mother-to-child transmission (PMTCT). Yet, poor conceptualization has hindered optimal assessment of male involvement. We created and evaluated a brief 10-item male partner involvement scale using principal components analysis and scree plots, Cronbach's alpha, and linear regression with survey data from postpartum women with HIV (n = 200) in Kenya. The scale had a two-factor structure: male encouragement/reminders and active participation. The overall scale and the encouragement/reminders sub-scale displayed strong internal reliability. In the multivariable models, the scales were positively associated with constructive relationship dynamics, HIV status disclosure, and couple HIV testing and counseling, and negatively associated with internalized HIV stigma. The encouragements/reminders sub-scale was also negatively associated with a new HIV diagnosis during pregnancy. This work furthers the conceptualization of male partner involvement in PMTCT and provides a valid measure to assess male involvement as a pathway to better PMTCT outcomes.
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Affiliation(s)
- Karen Hampanda
- Department of Community and Behavioral Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, 80045, USA.
- Center for Global Health, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA.
| | - Lisa Abuogi
- Center for Global Health, Colorado School of Public Health, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
- Department of Pediatrics, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Pamela Musoke
- School of Public Health, University of Alabama at Birmingham, Birmingham, USA
| | - Maricianah Onono
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Anna Helova
- School of Public Health, University of Alabama at Birmingham, Birmingham, USA
| | - Elizabeth Bukusi
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Janet Turan
- School of Public Health, University of Alabama at Birmingham, Birmingham, USA
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13
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Lavender T, Wakasiaka S, Chimwaza A, Wood R, Omoni G, Mukhwana R, McGowan L, Chimala E, Omari J, Edozien L. A qualitative study of partner engagement in HIV testing in Malawi and Kenya. CULTURE, HEALTH & SEXUALITY 2019; 21:1131-1145. [PMID: 30624135 DOI: 10.1080/13691058.2018.1542509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 10/26/2018] [Indexed: 06/09/2023]
Abstract
In low-income settings, partner engagement in HIV testing during pregnancy is well recognised, but uptake remains low. To understand why men fail to engage, 76 in-depth, individual interviews were conducted with women (n = 23), men (n = 36) and community stakeholders (n = 17) in Malawi and Kenya. Transcribed data were analysed thematically. Male engagement was verbally supported. However, definitions of 'engagement' varied; women wanted a shared experience, whereas men wanted to offer practical and financial support. Women and stakeholders supported couples-testing, but some men thought separate testing was preferable. Barriers to couples-testing were strongly linked to barriers to antenatal engagement, with some direct fear of HIV-testing itself. The major themes identified included diverse definitions of male engagement, cultural norms, poor communication and environmental discomfort - all of which were underpinned by hegemonic masculinity. Couples-testing will only increase when strategies to improve reproductive health care are implemented and men's health is given proper consideration within the process. As social norms constitute a barrier, community-based interventions are likely to be most effective. A multi-pronged approach could include advocacy through social media and community forums, the provision of tailored information, the presence of positive role models and a welcoming environment.
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Affiliation(s)
- Tina Lavender
- Division of Nursing Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Sabina Wakasiaka
- School of Nursing Sciences, University of Nairobi, Nairobi, Kenya
| | - Angela Chimwaza
- Kamazu College of Nursing, University of Malawi, Malawi, Malawi
| | - Rebecca Wood
- School of Health Care, University of Leeds, Leeds, UK
| | - Grace Omoni
- School of Nursing Sciences, University of Nairobi, Nairobi, Kenya
| | - Raheli Mukhwana
- Maternity Department, Kenyatta National Hospital, Nairobi, Kenya
| | - Linda McGowan
- School of Health Care, University of Leeds, Leeds, UK
| | - Eveles Chimala
- Kamazu College of Nursing, University of Malawi, Malawi, Malawi
| | - Jerusa Omari
- Maternity Department, Kissi Training and Referral Hospital, Kissi, Kenya
| | - Leroy Edozien
- Manchester Academic Health Science Centre and Saint Mary's Hospital, Manchester NHS Foundation Trust, Manchester, UK
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Muwanguzi PA, Nassuna LK, Voss JG, Kigozi J, Muganzi A, Ngabirano TD, Sewankambo N, Nakanjako D. Towards a definition of male partner involvement in the prevention of mother-to-child transmission of HIV in Uganda: a pragmatic grounded theory approach. BMC Health Serv Res 2019; 19:557. [PMID: 31399088 PMCID: PMC6688339 DOI: 10.1186/s12913-019-4401-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 08/05/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Male partner involvement has been shown to increase mothers' uptake of Prevention of Mother-to-Child Transmission of HIV (PMTCT) and improve maternal and infant HIV treatment outcomes. Currently, male involvement in PMTCT is measured primarily through men's attendance at HIV testing and counselling which may not be a true reflection of their engagement. This study therefore set out to explore the meaning of male partner involvement and propose a definition and theoretical model of this concept in PMTCT in Uganda. METHODS Eight focus group discussions and five in-depth interviews were conducted with couples at three public health facilities and community members in the health facility catchment areas in Uganda. The study employed a grounded theory approach underpinned by the pragmatic philosophical paradigm. Data were analyzed using the constant comparative method, performing three levels of open, axial, and selective coding. RESULTS Of the 61 participants, 29 (48%) were male and the majority 39 (63.9%) were in long term marital relationships, while about half were self-employed 29 (47.5%). Three themes emerged for the meaning of male involvement in PMTCT (a) HIV treatment support (b) economic support and (c) psychosocial support. HIV treatment support included adherence support, couples' HIV counseling and testing, and clinic attendance during and after pregnancy. Participants expressed that men were engaged in PMTCT when they offered economic support by providing basic needs and finances or when they included their female partners in financial planning for the family. Psychosocial support arose from the female participants who defined male involvement as family support, perceived societal recognition and emotional support. Emotional support also included the absence of harm resulting from women's disclosure of HIV test results to their male partner. CONCLUSIONS This study proposes a new definition for male partner involvement in PMTCT in Uganda. The definition extends beyond men's clinic attendance and HIV testing and counselling. Further research should seek to develop and validate tools to accurately measure male partner involvement as the next step in the development of interventions to improve PMTCT outcomes.
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Affiliation(s)
- Patience A. Muwanguzi
- Department of Nursing, School of Health Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Joachim G. Voss
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH USA
| | - Joanita Kigozi
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Alex Muganzi
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Tom Denis Ngabirano
- Department of Nursing, School of Health Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Nelson Sewankambo
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Damalie Nakanjako
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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