Poor Adherence to the Integrated Community Case Management of Newborn and Child Illness Protocol in Rural Ethiopia

Ethiopia has adopted the Integrated Community Case Management of Newborn and Child Illness (iCMNCI) strategy to expand access to neonatal and child health services. This study assessed compliance with the iCMNCI case management protocol at the primary care settings. A descriptive cross-sectional assessment was conducted in eight districts of Benishangul-Gumuz Region from April to December 2019, and 1,217 sick children aged 2 to 59 months and 43 sick young infants aged 0 to 2 months who sought clinical consultation at the 236 health posts were selected purposively. Trained supervisors reviewed the medical records of two most recent cases from each illness category to quantify the extent to which health workers correctly assessed, classified, treated, and followed up cases per the iCMNCI guidelines. A total of 32,981 children sought clinical consultation of whom 31,830 (96.5%) were aged 2 to 59 months, and 1,151 (3.5%) were young infants aged 0 to 2 months. Of the 1,217 selected children, 426 (35%) had pneumonia, 287 (23.6%) malaria, 501 (41.2%) diarrhea, and 3 (0.2%) had malnutrition. Nearly two-thirds 306 (72%) of pneumonia cases were correctly classified as having had the disease and 297 (70%) were correctly treated for pneumonia; 213 (74%) were correctly classified as having had malaria and 210 (73%) were correctly treated for malaria; and 393 (78%) were correctly classified as having had diarrhea and 297 (59%) were correctly treated for diarrhea. Generally, the current practices of child illness assessment, classification, and treatment have deviated from iCMNCI guidelines. Future interventions should support frontline health workers to comply strictly with case management protocols through training, mentorship, and supervision.

Knowledge of pregnant women on mother-to-child transmission of HIV, its prevention, and associated factors in Assosa town, Northwest Ethiopia

Introduction

HIV/AIDS is a leading cause of death of children in sub-Saharan African countries. Almost all HIV-positive children acquire infection through mother-to-child transmission (MTCT) of HIV. Successful intervention toward prevention of mother-to-child transmission (PMTCT) and achieving the goal of eliminating the new HIV infection is highly dependent on everyone; especially, women of child-bearing age should have accurate and up-to-date knowledge about HIV transmission, risk of transmission to babies, and possible interventions. However, knowledge of MTCT of HIV, its prevention, and associated factors among women was not well studied in Benshangul Gumuz Region (Ethiopia).

Methods

A facility-based cross-sectional study was conducted involving 398 pregnant women who attended antenatal care services at governmental health institutions from February to March 2014 in Assosa town. Based on the flow of antenatal care attendants, the calculated sample size was proportionally allocated to the health facilities before data collection. Following this, systematic sampling method was used, and data were collected using an interviewer-administered questionnaire. Bivariate and multivariate binary logistic regression analysis was done using SPSS version 20 statistical packages.

Result

A total of 386 pregnant women participated with a response rate of 97%, and 222 (57.5%) of them had full knowledge about the three critical modes of HIV transmission from mother to child, but only 67 (17.4%) knew the possible prevention methods. Knowledge on MTCT of HIV was positively associated with women who had sufficient knowledge on HIV/AIDS (adjusted odd ratio [AOR] =2.86, 95% confidence interval [CI] =1.54–5.32), women who had a favorable attitude to provider-initiated HIV counseling and testing (AOR =2.19, 95% CI =1.22–3.92), and women who did not expect any partner’s reaction to positive HIV test result after testing (AOR =1.58, 95% CI =1.01–2.49). Correspondingly, knowledge on PMTCT of HIV was positively associated with women who had sufficient knowledge on HIV/AIDS (AOR =2.64, 95% CI =1.24–5.65), women who had favorable attitude toward provider’s counseling and testing (AOR =4.27, 95% CI =1.95–9.34), and women who did not expect any partner’s reaction to positive HIV test result after testing (AOR =3.56, 95% CI =1.58–8.01).

Conclusion

Knowledge on MTCT and its prevention among women is low in the study area. We recommend more efforts to be exerted on improving women’s knowledge of PMTCT of HIV.

Acceptability of provider-initiated HIV testing as an intervention for prevention of mother to child transmission of HIV and associated factors among pregnant women attending at Public Health Facilities in Assosa town, Northwest Ethiopia

BACKGROUND

Despite more efforts for prevention of mother to child HIV transmission, still there are problems with provider-initiated HIV testing. This study was done to assess the acceptance rate of provider-initiated HIV testing among antenatal care attendants and its associated factors.

METHODS

Institutions based cross sectional study with a sample size of 398 was conducted from February to March 2014 in two health facilities in Assosa town. Proportional allocation of the sample size of health facilities followed by systematic sampling method was done; data were collected using an interviewer administered questionnaire. Bivariate and multivariate regression analysis was employed using SPSS version 20.

RESULTS

A total of 386 pregnant women participated with response rate 97 % and 312 (80.8 %) of them accepted provider-initiated HIV testing. The odds of acceptance of provider-initiated HIV testing was higher among rural residents (AOR 4.04; 95 % CI 1.24-13.11) than urban. It was also higher among students (AOR 6.00; 95 % CI 1.45-24.75), merchants (AOR 4.43; 95 % CI 1.18-16.68) and employed women (AOR 2.15; 95 % CI 1.08-4.30) than housewives. Pregnant women who had no stigmatized attitude towards people living with HIV/AIDS were more likely to accept testing (AOR 3.54; 95 % CI 1.23-10.16) than who had a strong stigmatized attitude. In addition, those who planned to disclose their test results from their husbands were higher odd of acceptance (AOR 14.85; 95 % CI 4.60-47.94) than who secreted.

CONCLUSION

Acceptance of provider-initiated HIV testing among pregnant women attending for antenatal care services was relatively high. Mothers from urban residence, occupational satus being housewives, stigmatization and not having a plan to disclose the status of test results were negatively affect the acceptance of provider-initiated HIV testing. During counselling sessions, antenatal care providers should focus on barriers of provider-initiated HIV testing such as residence, occupational status, stigmatized attitudes and disclosure status of results of HIV tests.