Journal of Family Medicine and Disease Prevention J Fam Med Dis Prev 10.23937/2469-5793 2469-5793 ClinMed International Library Wilmington, USA 10.23937 Client Satisfaction with Prevention of Mother to Child Transmission of HIV Services in Public Hospitals of Hadiya Zone, Southern Ethiopia Balcha B 10.23937/2469-5793/1510116 Institution based cross-sectional study design using quantitative data collection method was conducted in public hospitals from March 01 to April 10, 2017. A total of 423 pregnant women were consecutively interviewed until the required sample was obtained. The data was entered into Epi-data and analyzed using SPSS. Research Article 5 6 OPEN ACCESS 10.23937/2469-5793/1510116 Client Satisfaction with Prevention of Mother to Child Transmission of HIV Services in Public Hospitals of Hadiya Zone, Southern Ethiopia Bahailu Balcha College of Medicine and Health Sciences, School of Public Health, Wolaita Sodo University, Ethiopia Desta erkalo College of Medicine and Health sciences, School of Public Health, Wachamo University, Ethiopia Tilahun Beyene College of Medicine and Health Sciences, School of Public Health, Wolaita Sodo University, Ethiopia Bahailu Balcha
College of Medicine and Health Sciences, School of Public Health, Wolaita Sodo University, Ethiopia.
12 December 2019 Balcha B 2019 Client Satisfaction with Prevention of Mother to Child Transmission of HIV Services in Public Hospitals of Hadiya Zone, Southern Ethiopia J Fam Med Dis Prev 10.23937/2469-5793/1510116 2019 Balcha B © This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background

Prevention of mother-to-child transmission is a term used to describe a comprehensive package of services intended to reduce the risk of mother-to-child transmission of HIV. The vertical virus transmission from mother to child accounts for more than 90% of pediatric Acquired Immunodeficiency Syndrome. Published studies on the client satisfaction with PMTCT services' provision in Ethiopia are generally limited. Even fewer studies do examine client satisfaction with the PMTCT services. Therefore, this study is aimed to assess the client satisfaction with Prevention of Mother-to-Child Transmission of HIV services in public hospitals of Hadiya zone, southern Ethiopia 2017.

Methods

Institution based cross-sectional study design using quantitative data collection method was conducted in public hospitals from March 01 to April 10, 2017. A total of 423 pregnant women were consecutively interviewed until the required sample was obtained. The data was entered into Epi-data and analyzed using SPSS. Bivariate and multivariable logistic regression analyses were computed to see the predictors for satisfaction of clients on PMTCT service.

Results

About 89.8% clients were satisfied with PMTCT services provided at public hospitals. The client satisfaction with PMTCT services was associated with waiting time [AOR = 4.648, 95% CI = (2.183, 9.897)], counseling time [AOR = 3.748, 95% CI = (1.645, 8.537)] and counseling given by same counselor before and after HIV test [AOR = 0.193, 95%CI: (0.090, 0.412)].

Conclusion

Clients' satisfaction by PMTCT service is very high.

HIV, Prevention, Women, PMTCT (Prevention of Mother to Child Transmission of HIV)

Mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) entails transmission of HIV from an infected mother to her child. Also called "vertical" or "perinatal" transmission, MTCT can occur during pregnancy, labor, delivery, and breastfeeding [1].

Human immunodeficiency virus has devastated Africa. Over 25 million or 69% of global HIV cases are in Africa [1]. Of the 3.2 million children living with HIV in 2014, 91% live in Sub-Saharan Africa and 85% of HIV-positive pregnant women also live in the region [2].

From the time when the program introduced, tremendous achievements observed globally particularly in access to service. Accordingly, an estimated 966 000 women, or about two thirds (67%) of the pregnant women living with HIV in low- and middle-income countries, received at least some effective ARV drugs in 2013 [2].

Moreover, women in Sub Saharan Africa were disproportionately impacted by HIV epidemic, accounting for 58% of all people living with HIV in 2011. Similarly, in the year in 2011, 92% of pregnant women living with HIV and more than 90% of children who acquired HIV in 2011 live in this region [3].

Over 90% of pediatric AIDS cases are from MTCT [4]. PMTCT has four components: i) Primary prevention of HIV infection, ii) Prevention of unintended pregnancies among HIV-positive women, iii) Prevention of HIV transmission from women infected to their infants through treatment and care and iv) Support to women infected with HIV, their infants and their families [4].

Vertical virus transmission from mother-to-child accounts for more than 90% of pediatric AIDS. Due to poor quality PMTCT services, it is estimated that over 90% of childhood HIV infections result from the transmission of the virus from mothers to their children during and soon after birth [4].

Coverage of anti-retroviral (ARV) medicines among HIV-positive pregnant women in Africa is roughly 80%, which higher than many regions of the world, although in high-burden countries, such as Angola, Chad and Nigeria, less than half of pregnant or breastfeeding women living with HIV are receive ARV medicines [5].

In 2013 there were an estimated 793,700 people living with HIV including 200,300 children in Ethiopia. There were approximately 45,200 AIDS related deaths in 2013 and about 898,400 AIDS orphans in the same year. HIV adult prevalence is estimated at 1.5% in 2011. However, prevalence varies according to age, sex, gender and geographical location. The 2016 Ethiopian Demographic and Health Survey (EDHS) shows that 62% of pregnant women in the country had at least one ANC visit [6,7].

Few published studies are available on PMTCT services' provision in Ethiopia and even fewer examine client satisfaction with PMTCT services. Therefore, this study aims to contribute to science by assessing client satisfaction with PMTCT services provision at public hospitals of Hadiya Zone, southern Ethiopia.

The study was an institution-based cross-sectional study conducted at three public hospitals in Hadiya Zone, approximately 200 kilometers southwest of Ethiopia's capital city, Addis Ababa. The study used quantitative data collection method from March 1 to April 10, 2017.

All public hospitals providing PMTCT services in Hadiya Zone, including Shone, Homecho, and Nigist Elleni Mohammed Memorial Teaching Hospitals, were included in our study. Sample size was determined using single population proportion formula at a 95% confidence level, 80% power of the test and 5% margin of error, where p, the proportion of clients satisfied with PMTCT services, was assumed to be 50%. Considering 10% of non-response rate, the final sample size was 423.

Sample was allocated proportionally to selected hospitals based on average ANC attendance in the three-months preceding the study period. All sampled pregnant women who met inclusion criteria at ANC clinics were interviewed by diploma-level nurses using a structured questionnaire adapted from UNAIDS and Family Health International (FHI) [8,9]. The questionnaire was prepared in English, translated to Hadiyisa, and backtranslated to English separately by two individuals to ensure consistency. Nurse data collectors were supervised by two BSc supervisors. All data collectors were selected from outside of study area to minimize bias. Incomplete and unclear questionnaires were returned to interviewers to be completed.

Data was entered, cleaned and analyzed using SPSS 20 and was cleaned by running frequencies, cross-tabulation and sorting cases. Bivariate and multivariate logistic regression analyses were used to determine the association of independent variables with the dependent variable. Variables with p < 0.25 in bivariate analysis were entered into a multivariate logistic regression model. Odds ratio with 95% confidence were computed to identify the presence and strength of associations, and statistical significance was declared if p < 0.05 was found. Final model was checked using the Hosmer-Lemeshow goodness of fit test. Cofounders, interaction and multi-collinearity were checked to minimize bias.

Study protocol was approved by the Institutional Research Review Board of Jimma University's, Institute of Health Science and Community Services Ethical Review Committee. Permission was obtained from Hadiya Zone Health Department and participating hospitals. Informed verbal consent was obtained from participants prior to enrollment in the study. Participation in the study was voluntary and participants were informed of the right to withdraw from the study. Data collection was conducted confidentially, and data was de-identified, de-linked and stored in a secure location.

A total of 423 women were interviewed, giving a response rate of 100%. Age of respondents ranged from 16 to 43 with a mean age of 27.24 (± 5.67) years. Only seventy-nine (18.7%) women were unable to read and write. Three hundred nineteen (75.4%) lived in urban areas and 219 (51.8%) were housewives, followed by government employee 67 (15.8%). Three-fourths (75.4%) belonged to the Hadiya ethnic group and 413 (97.6%) were married (Table 1).

Socio-demographic characteristics of respondents, client satisfaction with PMTCT services in public hospitals of Hadiya zone, South Ethiopia, 2017. https://www.clinmedjournals.org/articles/ijdrt/ijdrt-5-116-table1.html

Most (79.7%) women knew about the availability of PMTCT services before coming to ANC and most (234, 69.4%) derived this information from health workers or health extension workers (65, 19.3%). Three hundred nineteen (75.4%), women waited less than 30 minutes to see a provider. Mean duration of counseling session was 17.37 minutes. The same counselor provided pre- and post-test counseling for 337(79.9%) women. Fifty-one (12.1%) women expressed that a language barrier was present (Table 2).

Waiting time, duration, information source and perceived benefit of counseling session; client satisfaction with PMTCT services in public hospitals of Hadiya zone south Ethiopia, 2017. https://www.clinmedjournals.org/articles/ijdrt/ijdrt-5-116-table2.html

The majority of women were satisfied with PMTCT services. Most (82.7%) women were "satisfied" or "very satisfied" with the comfort of the waiting room. Women were similarly satisfied with the counseling room and privacy during counseling, wait time and duration of the counseling session (Table 3).

Client satisfaction with the comfort and privacy of counseling room, and adequacy of counseling session; client satisfaction with PMTCT services in public hospitals of Hadiya zone, south Ethiopia 2017. https://www.clinmedjournals.org/articles/ijdrt/ijdrt-5-116-table3.html

Most women were also satisfied with the counselors themselves, believing them to be respectful, trustworthy, and competent. Three hundred seventy-one (87.7%) women were "satisfied" or "very satisfied" with the service (Table 4).

Client satisfaction by counselor's characteristics and availability of services, client satisfaction with PMTCT services in public hospitals of Hadiya zone south Ethiopia, 2017. https://www.clinmedjournals.org/articles/ijdrt/ijdrt-5-116-table4.html

Women who waited less than 30 minutes to see a provider had odds 4.6 times higher [AOR = 4.65, 95% CI = (2.18, 9.89) of being satisfied as compared to those that waited >= 30minutes [AOR = 4.65, 95% CI = (2.18, 9.89), p-value < 0.00]. Women counseled for more than 15 minutes had odds 3.7 times more likely to be satisfied than women counseled for < 15 minutes (AOR = 3.7, 95% CI; 1.65, 8.54). Women who were not counseled by the same ANC counselor before and after HIV test were considerably less likely to be satisfied as compared to women whose counseling given by same counselor (AOR = 0.19, 95% CI; 0.09, 0.41) (Table 5).

Table 5: Multivariable logistic regression analysis of variables predicting satisfaction of PMTCT clients in public hospitals of Hadiya zone, south Ethiopia 2017. View Table 5

Overall satisfaction with PMTCT service was 89.8%, which is similar to Kafa Zone [6] and Dessie City Administration and higher than studies in Adama [Ethiopia], Nigeria and Tanzania (range 40% - 75%) [7,10,11]. Almost 80% of women were satisfied with the privacy of counseling rooms, which is similar to a study in Addis Ababa [12] and slightly higher than a study in Tanzania [11].

Not being counseled by the same ANC counselor pre- and post-test was a significant predictor of client satisfaction, which is consistent with the study in Adama [7]. It is recommended that the same person offer pre- and post-test counseling [7]. These findings might be related to clients' concerns regarding issues of confidentiality. [Extended counseling sessions were also tied to patient satisfaction in our study. The odds of a woman being satisfied were 3.7 times higher among women whose counseling sessions lasted more than 15 minutes, a finding supported by the study in Addis Ababa [12-14]. Discussing for extended periods may decrease women's fears about a positive test result. Lastly, women who waited less than 30 minutes to see counselor had higher odds of being to be satisfied, which is consistent with a study in Zimbabwe [15-17]. Decreasing wait time might encourage service utilization.

Our study has several strengths, including employing a validated and standardized questionnaire that was tested and revised. Our study also used newly implemented Federal Ministry of Health (FMOH) guidelines on PMTCT to avoid measurement bias. Since respondents were interviewed in the hospital setting, they may have given responses biased in favor of the providers/healthcare facility; however, interviews were conducted in a separate room by non-staff members to minimize bias.

The level of satisfaction with the PMTCT service provision was very high compared to other studies. Predictors of the clients� satisfaction level on PMTCT services provision were counseling given by same counselor before and after HIV test, waiting time to see counselor, counseling time.

In general, in all public hospitals of Hadiya zone health care provider should improve provider-client communication and devising ways of increasing clients� satisfaction with PMTCT services particularly in respecting the clients and developing Trustworthiness. Since current waiting time of clients to see the counselor is encouraging, providers should maintain such working culture in this regard. All hospitals must give attention to transmit information about PMTCT services through mass media.

Our gratitude goes to supervisors, data collectors, study respondents and Hadiya Zone Health Department for facilitating the study.

Bahailu Balcha: Had made substantial contributions to conception and design, acquisition of data, analysis and interpretation of data, and Desta Erkalo: Had revised the paper critically for important intellectual content starting from proposal development to manuscript preparation. Tilahun Beyene: Involved in interpretation and manuscript preparation. All authors read and approved the final manuscript.

The authors declare that they have no competing interests.

We would like to thank Jimma University's, Institute of Health for funding this research.

References FMOH/Ethiopia (2016) National Comprehensive PMTCT Training Participant's Manual. WHO (2014) HIV Reporting: Global Update on the Health Sector Response to HIV 1-168. https://www.who.int/hiv/pub/progressreports/update2014/en/ UNAIDS (2012) Regional Fact Sheet. (2011) FHAPCO/FMOH: Guideline for Prevention of Mother to Child Transmission, Ethiopia, 1-51. Anthonia A (2010) Assessing and Assuring Quality of Health Care in Africa. African Journal of Medical Sciences 3: 31-36. Bayou NB, Tsehay YE (2012) Quality of PMTCT Services in Gebretsadiq Shawo Memorial Hospital, Kafa Zone, Southwest Ethiopia: A Descriptive Study. Open Access Library Journal 1499. Asefa A, Mitike G (2014) Prevention of mother-to-child transmission (PMTCT) of HIV services in Adama town, Ethiopia: clients' satisfaction and challenges experienced by service providers. BMC Pregnancy Childbirth 14: 57.http://www.ncbi.nlm.nih.gov/pubmed/24484774 UNAIDS. Tools for evaluating HIV voluntary counseling. Geneva, Switzerland; 2000.http://data.unaids.org/publications/irc-pub02/jc685-toolseval_en.pdf FHI and Elizabeth Glaser Pediatric AIDS Foundation (2003) Baseline Assessment Tools for Prevention of Mother to Child Transimission (PMTCT) of HIV 1-92. https://www.aidsdatahub.org/baseline-assessment-tools-preventing-mother-to-child-transmission-pmtct-of-hiv-fhi-and-elizabeth-glaser-pediatric-aids-foundation-2003 FHAPCO (2014) Country progress report on the HIV response. Addis Ababa, Ethiopia 1-51.https://www.unaids.org/sites/default/files/country/documents/ETH_narrative_report_2014.pdf Lyatuu MB, Msamanga GI, Kalinga AK (2008) Clients' Satisfaction with Services for Prevention of Mother-To-Child Transmission of HIV in Dodoma Rural District. East Afr J Public Health 5: 174-179.https://www.ncbi.nlm.nih.gov/pubmed/19374320 Ismail H, Ali A (2008) Pregnant women's satisfaction and comprehension level of information given during HIV Counseling and Testing for PMTCT in public health facilities in Addis Ababa.https://www.ajol.info/index.php/ejhd/article/view/74388 Ashipa T, Ofili AN, Ighedosa SU (2013) Assessment of Clients' Satisfaction with the PMTCT Counselling Service In Benin City, Edo State, Nigeria. Journal of Medicine and Biomedical Research 12: 150-165. https://www.ajol.info/index.php/jmbr/article/view/104636 CDC (2006) Testing and Counseling for Prevention of Mother-to-Child Transmission of HIV (TC for PMTCT). Centers for Disease Control and Prevention, Reference Guide. Atlanta: Atlanta: Center for Disease Control. Mutede BR, Tachiwenyika E, Musarandega R, Khabo B, Mhangara M, et al. (2014) What factors are critical in improving client satisfaction with PMTCT services in Zimbabwe.https://b.3cdn.net/glaser/7ac56e629d805de3b4_qjm6i68bc.pdf Abaynew Y (2016) Quality of Prevention of Mother to Child Transmission (PMTCT) Services in Dessie Referral Hospital, Dessie City Administration, Ethiopia: Client Perspective. Neonat Pediatr Med 3:1.https://www.omicsonline.org/open-access/quality-of-prevention-of-mother-to-child-transmission-pmtct-servicesin-dessie-referral-hospital-dessie-city-administration-ethiopi-2572-4983-1000123.php?aid=87947 EDHS (2016) Central Statistical Agency (CSA) [Ethiopia] and ICF. 2016. Ethiopia Demographic and Health Survey 2016. Addis Ababa, Ethiopia, and Rockville, Maryland, USA: CSA and ICF.https://dhsprogram.com/pubs/pdf/FR328/FR328.pdf