1,720,990 research outputs found
Barriers to condom use in serodiscordant couples where one partner was on ART at the UZ Clinical Research Centre, Harare, Zimbabwe
Get PDFMagister Public Health - MPHThe HIV prevalence rate in Zimbabwe has been estimated at 15% (15 years old and above), which is one of the highest in the world, and HIV/AIDS remains a significant public health problem. The focus of HIV prevention strategies has been on heterosexual transmission since this is the primary driver of the HIV epidemic in Zimbabwe. Heterosexual serodiscordant couples represent an important subpopulation for HIV prevention but are not well studied in Zimbabwe. In Harare almost all serodiscordant couples participating in the HPTN 052 study reported correct and consistent condom use. However, rates of STIs and pregnancies showed that couples in the study continued to have unprotected sex, in-spite of intensive couples’ counselling, quarterly follow up visits and provision of condoms. The aim of this qualitative study was to explore barriers to condom use by these serodiscordant couples in which one partner was on ART in Harare, Zimbabwe. It used a two stage qualitative approach with semi-structured interviews being the primary method of data collection. These interviews were conducted on a sample of five study staff, 15 serodiscordant couples and individuals enrolled in the HPTN 052 study in Harare, Zimbabwe after consent was obtained. Thematic analysis was used to analyse data collected.The study findings showed that partners were in a fairly large age range (30 to 50+ years) with males being slightly older than females. Seven males and five females were HIV positive. Couples had a wide variation in the length of their relationships, from one month to over 15 years as a couple. The study findings also showed that individuals in serodiscordant relationships understood serodiscordance. Problems unique to these couples were identified and broadly categorized as dealing with an HIV positive result, accepting serodiscordance, and difficulty of disclosing serodiscordance to family. Couples also showed understanding of the importance of condom use in a discordant relationship. The most common reason for using condoms was to prevent transmission of HIV to the uninfected partner. The main barriers to condom use were the strong desire to have children, male partner reluctance to use condoms and the influence of the negative partner in determining condom use. Based on these findings, a nuanced approach to prevention strategies, such as condom use and couples counselling and testing, is required. The aim should be to increase understanding of serodiscordance, risk and condom use at all sessions or contacts with couples
Use of continuous quality improvement to improve prevention of mother to child transmission (pmtct) programme performance in Amathole district municipality of Eastern Cape province, South Africa
No full textPhilosophiae Doctor - PhDGlobally, new Human Immunodeficiency Virus (HIV) infections in children reduced by 54% due to implementation of Prevention of Mother to Child Transmission (PMTCT) of HIV since the peak in 1996, increase in Antiretroviral treatment (ART) coverage among children and increase in the proportion of pregnant women receiving ART.
In South Africa, significant progress has been made regarding PMTCT programme geared towards the virtual elimination of new HIV infections in children, which has contributed to 40% reduction of new HIV infection in children
The effects of the devolution of HIV treatment programmes from external to local non-governmental organisations: A mixed-methods study in Kano, Northern Nigeria
Get PDFPhilosophiae Doctor - PhDThe devolution of health programmes from external to local non-governmental organisations (NGOs) is a relatively new phenomenon in sub-Saharan Africa. The special characteristics of the devolution of complex programmes pose both managerial and employee challenges, which previous change management research has not adequately addressed. Furthermore, earlier research has mainly viewed organisations as isolated and independent entities, whereas programmes that aim at large-scale interventions, such as the President’s Emergency Plan for AIDS Relief (PEPFAR) projects, are embedded in their organisational context. Ineffective implementation of the PEPFAR antiretroviral therapy (ART) devolution process is a potential threat to programme sustainability in Nigeria
The effects of the devolution of HIV treatment programmes from external to local non-governmental organisations: A mixed-methods study in Kano, Northern Nigeria
No full textPhilosophiae Doctor - PhDThe devolution of health programmes from external to local non-governmental organisations (NGOs) is a relatively new phenomenon in sub-Saharan Africa. The special characteristics of the devolution of complex programmes pose both managerial and employee challenges, which previous change management research has not adequately addressed. Furthermore, earlier research has mainly viewed organisations as isolated and independent entities, whereas programmes that aim at large-scale interventions, such as the President’s Emergency Plan for AIDS Relief (PEPFAR) projects, are embedded in their organisational context. Ineffective implementation of the PEPFAR antiretroviral therapy (ART) devolution process is a potential threat to programme sustainability in Nigeria
Exploring the factors that contribute to poor utilization of primary health care services: a study of two primary health care clinics in Nasarawa State, Nigeria
Get PDFMagister Public Health - MPHIntroduction: Nigeria operates a three tiered health care delivery system with a large percentage of health care delivery vested at the primary care level. There has been over the years a continued effort by the government to decentralize health care service thereby increasing the range of services provided at the primary care level. Despite all these efforts there is still low utilization of primary health care services. This study therefore seeks to explore the factors that may be responsible for poor utilization of primary health service in Nasarawa State, Nigeria using two primary health clinics in Lafia local government area as case studies. Methodology: The study was carried out using the qualitative research methodology primarily using two data collection methods, the focus group discussions and individual interviews. A total of sixty participants were sampled, these consisted of ten members of staff, twenty non facility users and thirty facility users. Thirty individual interviews were conducted and four focus group
discussions held with staff and facility users at the two clinics. Facility users were randomly selected as they attended the clinic on the data collection days and were invited to participate in the study. Every second patient attending the clinic was selected for the focus group discussion and every third person for the interviews. The staff participants were randomly selected based on their availability while non-facility users were selected using snowballing. Data was analyzed using thematic analysis method. Findings: Two major themes emerged following data analysis; these were perception and experiences of facility users and barriers to utilization of health services. Users had a good perception of the services they received and are reasonably satisfied but certain deficiencies in the health care systems compromised the quality of service. Several factors were however hindering the utilization of these services and these include mainly institutional factors such as lack of infrastructure, equipment and staffing constraints; household factors such as cost of service and responsibility of decision making and other factors such as stigmatization and beliefs. Conclusion: Facility users of these clinics seem to have an overall good impression of services at the clinics; however there are certain fundamental deficiencies that need to be urgently addressed to improve the care provided at these clinics as these constitute barriers to utilization. These deficiencies such as the absence of electricity and water, lack of basic work equipment and inappropriate staff composition need to be addressed by the local government health department to ensure utilization and improved quality of service
Experiences of early antiretroviral therapy (art) initiation among people living with HIV in Livingstone district in Zambia
Get PDFMagister Public Health - MPHBeing healthy (‘feeling fine’) and health deterioration (‘getting sick’) were key health concerns among PLHIV prior to ART initiation. PLHIV often referred living with HIV as ‘being sick’ and experiencing poor health when already infected with HIV as ‘very sick’ and this perception about sickness and wellness partly determined the need and value placed on accessing HIV services. Motivations for starting treatment included needing to maintain or regain health, encouragement from HCWs, relatives and friends and believing in the effectiveness of ART to improve health. Prevention of HIV transmission to others was not cited to influence uptake. The majority of PLHIV reported stringent adherence to ART; even a half-hour delay in taking treatment was sometimes defined by participants as ‘non-adherence’. Initial reminders for taking ART (setting alarm, placing pills where visible) fell away as daily medication became routine. However, daily uptake of treatment had its own psychosocial and economic consequences which PLHIV had to navigate. With few exceptions, when taking the first line regimen, most PLHIV experienced both temporal (hallucinations, vomiting) and long-term (dizziness and irregular heartbeat) side-effects attributed to ART, which although not considered life threatening, could undermine ART adherence. HIV status disclosure was both limited and selective (mainly to spouses, close relatives, friends and co-workers) and deemed as promoting adherence to treatment and access to HIV services. HIV/AIDS stigma persisted even among relatively healthy PLHIV due to links with ‘promiscuity’, hampering disclosure and access to HIV services. Competing demands on participants’ time, especially livelihood activities, also disrupted accessing services. Good relationships between HCWs and PLHIV promoted access to services
Understanding the perceptions of women who experienced any delay in accessing appropriate health care services during childbirth in Otjiwarongo district hospital, Namibia
Get PDFMaster of Public Health - MPHAccess to appropriate health care service during childbirth is a great challenge to many women in
Africa and Namibia is no exception. More than 70% of women in Otjozondjupa region experienced
some form of delay during childbirth, and while maternal mortality continued to rise over the years
in Namibia it is currently at about 265/100 000, which is too high for a middle-income country.
Hence, this study aimed to get a deeper understanding of the perceptions of women who
experienced any of the three delays in accessing appropriate health care during childbirth in
Otjiwarongo hospital
Complex systems thinking to improve health policy implementation in a resource-limited setting: The case of integration of palliative care into the health system in Zimbabwe
No full textRecent research in public health has found that whilst complex systems thinking and implementation research have considerable overlap, they are rarely used in combination, especially for the implementation of health interventions or policies. This deficiency is demonstrated in Zimbabwe where the current approach to implementing health policy is unidimensional and linear, with a cause-effect type of thinking. This approach is limited as it does not consider context or the complexity inherent in the health system. This doctoral study offers a significant and original contribution to knowledge via the improvement of the knowledge, theory, methodology and practice of health policy implementation in a resource-limited setting. This study sought to examine how a more comprehensive approach, complex systems thinking, could be applied to evaluate and improve the process of implementing health policy in a resource-limited setting. The study aim was to monitor and evaluate the policy implementation process of integrating palliative care into the health system at public health facilities in Zimbabwe using the Parirenyatwa Group of Hospitals (PGH) as a case
Factors influencing male partner involvement in the mother-to-child transmission of HIVplus (MTCT-plus) programme in Gobabis district, Namibia: a qualitative study
Get PDFMagister Public Health - MPHBackground: Although great strides have been made in reducing mother-to-child transmission of HIV (MTCT) in Namibia, the universal target of less than 5% by 2015 has not yet been achieved. In an effort to scale-up services in the programme, a comprehensive family centred approach which broadens HIV prevention activities and considers HIV as a family disease was instituted. However its success has been affected by low male partner participation in the programme. Study aim: To investigate factors influencing male partner involvement in MTCT-plus programme in Gobabis District, Omaheke Region, Namibia. Study design and data collection: This was a cross sectional descriptive study that wasconducted using a qualitative research methodology. Data was generated through focus group discussions (FGDs) and in-depth interviews. Four same sex FGDs were conducted with men and pregnant women. The study participants were HIV positive pregnant women and HIV positive women in their postnatal period purposefully selected from the PMTCT clients. A few male participants were partners of the female participants and other men conveniently sampled from the community. Seven in-depth interviews were conducted to gather information from key informants who were programme managers and midwives. Thematic analysis was used for the data analysis. Results: Men were generally knowledgeable and appreciated the importance of participating in the MTCT-plus programme but the majority of them did not participate. They cited several barriers to actively supporting their partners. Men‘s participation in the MTCT-plus programme was affected by lack of trust in the health workers and cultural practices that shift the role of taking care of their partners to the biological parents. The other barriers included HIV related stigma, unfriendly environment at the antenatal care clinics, time and work related constraints, having many sexual partners and gender and power imbalances in relationships that affect patterns of communication on HIV related matters. Discussion: Participation in the MTCT-plus programme is well supported by men. However, few men put this into practice because of complexities surrounding their specific role in women reproductive health issues, as well as cultural practices and health facilities organizational structures that preclude men from participation in the MTCT-plus programme. Given the positive attitude by men towards participation in this programme, creating a male friendly space within the MTCT-plus programme and empowering men to participate in them should be prioritized for the programme to achieve its goals
Evaluation of the quality of counselling for prevention of mother to child transmission of HIV offered to pregnant women in the copperbelt province of Zambia
Get PDFMagister Public Health - MPHBackground: One study on estimating rates of mother to child transmission of HIV (MTCT) in program settings in Zambia showed significant reduction in the MTCT rate with some specific prevention of mother to child transmission of HIV (PMTCT) interventions. Prolonged breastfeeding and mixed feeding practices by HIV positive mothers increased the MTCT rate by more than double by the time the infant reached 6 to12 months of age. Although the study did not assess the quality of PMTCT counselling in antenatal care settings, literature shows that poor quality of counselling on PMTCT reduces the effectiveness of PMTCT interventions. Study aim: To evaluate the quality of PMTCT counselling offered to pregnant women attending antenatal care (ANC) services in four public health facilities in Kitwe, Copperbelt province of Zambia. Study design and data collection: This was a cross sectional descriptive study. Data was generated using qualitative research methods including document analysis and individual interviews with 22 participants using non-participant observations, client exit interviews and focus group discussions (FGDs) to collect data. The study participants were ANC attendees and PMTCT providers. Two FGDs were conducted with a total of 98 counselling observations done and 16 ANC client exit interviews. Client exit interviews were done immediately after the mothers had undergone PMTCT counselling. Results: Content for group health education (GHE) varied across the facilities. Individual pre-test, post-test and follow up counselling sessions were very short and lacked depth. A total of 41 (83.7%) pre-test observations took between 1 and 5 minutes to be conducted. In addition, several key topics including major modes of HIV transmission, MTCT and the "window period" were omitted. The counsellors' interpersonal skills were generally good but they did not consistently summarize the main issues. The 16 mothers interviewed had limited knowledge of PMTCT with only one client knowing all the MTCT modes correctly. Discussion: Quality of PMTCT counselling did not meet expectations. With a lot of key topics omitted, outcomes of PMTCT interventions may not be as good as expected. Facilities are faced with serious staff shortages and limitations with space. The few members of staff available are overworked and are not able to provide quality PMTCT
counselling. Conclusion: While the PMTCT uptake was good and clients felt satisfied, the quality of PMTCT counselling is compromised. There is need to improve it and ensure optimal effectiveness of PMTCT services
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