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Kumwenda M, Singogo E, Nyondo-Mipando AL. Using the RE-AIM Framework to Evaluate Implementation of Male Involvement Strategies to Optimize the PMTCT Program in Malawi: A Mixed-Methods Study. Am J Mens Health 2023; 17:15579883231192320. [PMID: 37606316 PMCID: PMC10467183 DOI: 10.1177/15579883231192320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 07/08/2023] [Accepted: 07/17/2023] [Indexed: 08/23/2023] Open
Abstract
Involvement of male partners has been shown to be key for the prevention of mother-to-child HIV transmission (PMTCT). Despite the recorded success, uptake and implementation of strategies to involve men in PMTCT continues to be low in Malawi. In this study, we used the Reach Effectiveness Adoption Implementation and Maintenance (RE-AIM) implementation science framework to explore the implementation of male involvement (MI) strategies in Lilongwe, Malawi. We used a cross-sectional mixed-methods complementary-concurrent design from September to October 2020 in two health facilities. Qualitatively, we used a phenomenological approach and conducted seven focus group discussions (FGDs), three with women and four with men. We further conducted four key informant interviews (KIIs) among health care workers. Quantitatively, we conducted a cross-sectional study comprising 138 men presenting at an antenatal clinic (ANC). We used univariate analysis in Stata for the quantitative data, whereas a manual thematic analysis was applied to the qualitative data. Implementation and adoption of the strategies was high among health providers and there were indications of maintenance of the strategies. Provider's attitude, coordinated service provision, integrated training and service provision, information provision, and baby's HIV outcomes were driving factors in implementing the MI strategies. These factors have contributed to the sustained implementation of the strategies over time. In contrast, financial and time constraints, inadequate human resources, and male-friendly spaces impede the implementation of MI strategies. Improving MI will require a systems approach considering health system and individual-level factors for both providers and consumers.
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Affiliation(s)
- Mphatso Kumwenda
- Department of Health Systems and Policy, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Alinane Linda Nyondo-Mipando
- Department of Health Systems and Policy, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
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Okelo K, Onyango S, Murdock D, Cordingley K, Munsongo K, Nyamor G, Kitsao-Wekulo P. Parent and implementer attitudes on gender-equal caregiving in theory and practice: perspectives on the impact of a community-led parenting empowerment program in rural Kenya and Zambia. BMC Psychol 2022; 10:162. [PMID: 35761318 PMCID: PMC9238051 DOI: 10.1186/s40359-022-00866-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 06/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fathers are often perceived to be mainly responsible for the provision of the family's economic needs. However, past studies have demonstrated that fathers' involvement in parenting has great significance for the child's holistic growth and development. Few studies have investigated fathers' roles in the nurturing care of young children, particularly responsive care and stimulation, in sub-Saharan Africa. The study reported here was carried out as part of a larger study that sought to evaluate the effectiveness of the Moments That Matter (MTM) program in improving the nurturing care of young children in rural communities in Zambia and Kenya. The MTM program uses a parenting empowerment approach to promote bonding and interactions between caregivers and their children within the home, focusing on responsive care, early learning, and security and safety so that children reach their full developmental potential. Trained volunteers facilitated monthly primary caregiver support and learning groups and ECD home visits. Fathers were encouraged to participate in the home visits and to attend some of the group meetings on specific topics. The study reported in this paper aimed to establish the impact of the parenting empowerment program in promoting more gender-equal attitudes and practices on parenting among fathers (who were not the primary caregivers). METHODS Qualitative data were collected at three time points (pre-intervention before the implementation began; mid-intervention after 6 months of implementation; and post-intervention, after 24 months). We conducted focused group discussions with primary caregivers (n = 72) and fathers (n = 24) with children below 3 years. In-depth interviews were conducted with ECD Promoters (n = 43) and faith leaders (= 20). We also conducted key informant interviews with the MTM program implementers (n = 8) and government officials (n = 5) involved in the program implementation. We employed thematic analysis to analyse the qualitative data. RESULTS The findings showed that the MTM program resulted in improved gender-equal parenting attitudes and practices among mothers/other primary caregivers and fathers. Study participants reported that most fathers spent more time playing and interacting with their children and were more involved in household chores due to their participation in the MTM program. CONCLUSION The study findings provide evidence for policy formulation and a guide for implementation of policies that can influence changes in perceived gender roles in parenting.
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Affiliation(s)
- Kenneth Okelo
- African Population and Health Research Center, Nairobi, Kenya.
| | - Silas Onyango
- African Population and Health Research Center, Nairobi, Kenya
| | | | | | - Kelvin Munsongo
- Zambia Anglican Council Outreach Programmes (ZACOP), Lusaka, Zambia
| | - George Nyamor
- Anglican Church of Kenya Development Services-Nyanza (ADS-Nyanza), Kisumu, Kenya
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Ngangue P, Fleurantin M, Adekpedjou R, Philibert L, Gagnon MP. Involvement of Male Partners of Pregnant Women in the Prevention of Mother-to-Child Transmission (PMTCT) of HIV in Haiti: A Mixed-Methods Study. Am J Mens Health 2021; 15:15579883211006003. [PMID: 33874810 PMCID: PMC8060766 DOI: 10.1177/15579883211006003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
This mixed-methods study aimed to determine the level of male involvement in the
prevention of mother-to-child transmission (PMTCT) services in Haiti and
identify barriers and associated factors. From May to June 2018, a questionnaire
was used to measure the level of male involvement. Semistructured interviews
with pregnant women were also conducted. Multivariate linear regression and
qualitative content analyses were performed to explore factors associated and
barriers to male partners’ involvement in PMTCT services. One hundred and two
pregnant women living with HIV completed the questionnaire. About 47% of male
partners had a high level of involvement. Specifically, 90% financially
supported their spouse, and 82% knew her appointment date at the antenatal
clinic (ANC). Only 25% of male partners accompanied their spouse to the ANC, and
19% routinely used a condom during sexual intercourse. Factors associated with
male involvement in PMTCT were being married and sharing HIV status with the
male partner. Male partners with a positive HIV status were more likely to be
involved in PMTCT. Qualitative findings revealed that barriers to male
involvement included the conflict between opening hours of the ANC and the male
partner’s schedule, waiting time at the ANC, and the perception of antenatal
care as being women’s business. Overall male partners’ involvement in PMTCT
services is moderate. Gender relations, sociocultural beliefs, and care
organization are likely to hinder this involvement. Developing and implementing
contextually and culturally accepted strategies for male partners of pregnant
women could contribute to strengthening their involvement in the PMTCT
program.
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Affiliation(s)
- Patrice Ngangue
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | | | | | - Leonel Philibert
- Faculté des Sciences Infirmières, Université Laval, Québec, QC, Canada
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Jones DL, Rodriguez VJ, Soni Parrish M, Kyoung Lee T, Weiss SM, Ramlagan S, Peltzer K. Maternal and infant antiretroviral therapy adherence among women living with HIV in rural South Africa: a cluster randomised trial of the role of male partner participation on adherence and PMTCT uptake. SAHARA J 2021; 18:17-25. [PMID: 33641621 PMCID: PMC7919911 DOI: 10.1080/17290376.2020.1863854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
‘Mother-to-child transmission of HIV’ can occur during the period of pregnancy, childbirth, or breastfeeding. ‘Prevention of mother-to-child transmission of HIV’ (PMTCT) in Mpumalanga Province, South Africa, is especially vital as the prevalence of HIV is 28.2% in women aged 15–49. PMTCT interventions resulted in a drop of MTCT rates in Mpumalanga from ∼2% in 2015 to 1.3% in 2016. This randomised controlled trial in Mpumalanga examined the potential impact of a lay healthcare worker administered intervention, ‘Protect Your Family’, on maternal and infant adherence, and to assess the relative influence of male partner involvement on infant and maternal adherence. This cluster randomised controlled trial used a two-phase and two-condition (experimental or control) study design where participants (n = 1399) did assessments both during pregnancy and post-postpartum. Only women participated in Phase 1, and both female and male partners participated in Phase 2. Results indicated that male involvement was associated with self-reported maternal or infant antiretroviral therapy (ART) adherence, but the intervention was not associated with ART adherence. Self-reported adherence was associated with depression, age, and partner HIV status. The study results provide support for the involvement of men in the antenatal clinic setting during pregnancy. Results also support further research on the meaning and assessment of male involvement and clarification of the constructs underlying the concept in the sub-Saharan African context. Outcomes provide support for male involvement and treatment of depression as adjuncts to improve uptake of both maternal and infant medication as part of the PMTCT protocol.
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Affiliation(s)
- Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Violeta J Rodriguez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Psychology, University of Georgia, Athens, GA, USA
| | - Manasi Soni Parrish
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tae Kyoung Lee
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Stephen M Weiss
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Shandir Ramlagan
- HIV/AIDS/STIs and TB (HAST) Research Programme, Human Sciences Research Council, Pretoria, South Africa
| | - Karl Peltzer
- Department for Management of Science and Technology Development, Ton Duc Thang University, Ho Chi Minh City, Vietnam.,Faculty of Pharmacy, Ton Duc Thang University, Ho Chi Minh City, Vietnam
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Retention in HIV Care Among HIV-Seropositive Pregnant and Postpartum Women in Uganda: Results of a Randomized Controlled Trial. AIDS Behav 2020; 24:3164-3175. [PMID: 32314120 DOI: 10.1007/s10461-020-02875-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We tested an intervention that aimed to increase retention in antiretroviral therapy (ART) among HIV-positive pregnant and postpartum women, a population shown to be vulnerable to poor ART outcomes. 133 pregnant women initiating ART at 2 hospitals in Uganda used real time-enabled wireless pill monitors (WPM) for 1 month, and were then randomized to receive text message reminders (triggered by late dose-taking) and data-informed counseling through 3 months postpartum or standard care. We assessed "full retention" (proportion attending all monthly clinic visits and delivering at a study facility; "visit retention" (proportion of clinic visits attended); and "postpartum retention" (proportion retained at 3 months postpartum). Intention-to-treat and per protocol analyses found that retention was relatively low and similar between groups, with no significant differences. Retention declined significantly post-delivery. The intervention was unsuccessful in this population, which experiences suboptimal ART retention and is in urgent need of effective interventions.
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Clark J, Sweet L, Nyoni S, Ward PR. Improving male involvement in antenatal care in low and middle-income countries to prevent mother to child transmission of HIV: A realist review. PLoS One 2020; 15:e0240087. [PMID: 33057353 PMCID: PMC7561142 DOI: 10.1371/journal.pone.0240087] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/21/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Childhood Human Immunodeficiency Virus (HIV) infection occurs almost exclusively via mother to child transmission (MTCT) during pregnancy, birth, or through breastfeeding. Recent studies have shown that male involvement (MI) in antenatal care (ANC) and HIV testing, including couples voluntary counselling and testing (CVCT), increases the likelihood that women will adhere to prevention advice and comply with HIV treatment if required during their pregnancy; hence reducing the rates of MTCT of HIV. This realist review investigates how, why, when, and for whom MI in ANC works best to provide contextual advice on how MI in ANC can be best used for prevention of mother to child transmission (PMTCT) of HIV. METHODS A realist review of existing evidence was conducted. Realist review seeks to explain how and why an intervention works, or does not work, in a given context. This was completed through the five stages of realist synthesis; Eliciting the program theory, search strategy, study selection criteria, data extraction, and data analysis and synthesis. Findings are presented as context-mechanism-outcome (CMO) configurations outlining the mechanisms that work in given contexts to give an outcome. RESULTS Three CMO configurations were developed. These describe that 1) Couples in monogamous relationships have higher levels of trust, commitment and security leading to increased uptake of PMTCT programs together; 2) ANC spaces that make 'male friendly' adaptions promote normalisation of MI in PMTCT and are more welcoming, leading to increased willingness of male partners to participate in ANC; and 3) couples and communities with higher health literacy encourage increased informed decision making, ownership, and responsibility and thus increased participation in PMTCT of HIV. CONCLUSIONS The CMOs developed in this review give contextual advice on how one might improve ANC services to increase MI and help reduce MTCT of HIV. We propose that MI in ANC works best where couples are monogamous and trusting, where ANC spaces actively promote being a 'male friendly space' and where there are high levels of community education programs around MTCT.
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Affiliation(s)
- Jacinta Clark
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Linda Sweet
- School of Nursing and Midwifery, Deakin University and Western Health Partnership, Burwood, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Simangaliso Nyoni
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Paul R. Ward
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Adane HA, Assefa N, Mengistie B, Demis A. Male involvement in prevention of mother to child transmission of human immunodeficiency virus and associated factors in Enebsiesarmider District, north West Ethiopia, 2018: a cross-sectional study. BMC Pregnancy Childbirth 2020; 20:144. [PMID: 32138700 PMCID: PMC7059659 DOI: 10.1186/s12884-020-2837-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 02/25/2020] [Indexed: 05/30/2023] Open
Abstract
Background Globally, male involvement has been identified as a priority target area to be strengthened in the prevention of mother to child transmission (PMTCT) of HIV. However, there are limited studies on husband involvement in the prevention of mother to child transmission of HIV in Ethiopia. Therefore, this study aimed to assess male involvement in the prevention of mother to child transmission of HIV and associated factors among males whose wives gave birth in the last six months before the survey in Enebsiesarmider district, Northwest Ethiopia. Methods A Community-based cross-sectional study was employed to assess male involvement in the prevention of mother to child transmission of human immunodeficiency virus and associated factors in Enebsiesarmider District, Northwest Ethiopia. The study was conducted from February 10–30, 2018. A total of 525 participants were involved in the study. A stratified cluster sampling method was used to recruit study participants. Data were collected using a structured interviewer-administered questionnaire. Data were entered using the epi Data software and exported to SPPS for analysis. Descriptive statistics including mean, a proportion were used to describe study variables. Multivariable logistic regression was employed to describe variables with the outcome variable. Result Overall male involvement in PMTCT was found to be 26.1% [95%CI, 22.1–29.5]. Respondents who have attended secondary education and above were more likely get involved in PMTCT than who have no formal education [AOR 2.45, 95%CI, 1.47–4.11], Respondents who have good knowledge on PMTCT [AOR 2.57, 95%CI, 1.58–4.18], good knowledge on ANC [AOR 2.10, 95%CI, 1.28–3.44], low cultural barriers [AOR 2.20, 95%CI, 1.34–3.63] low health system barriers [AOR 2.40, 95%CI, 1.37–4.20] were variables that significantly increase male involvement in PMTCT practices. Conclusion Male involvement in PMTCT was found to be low in the study area. Therefore, the district health office in collaboration with local health care providers shall design strategies for enhancing male involvement through creating a husband’s knowledge regarding the merit of prevention of mother to child transmission through the provision of adequate information for all male partners at ANC clinic is recommended.
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Affiliation(s)
- Haimanot Abebe Adane
- Department of Public Health, College of Health Sciences and Medicine, Wolkite University, Wolkite, Ethiopia.
| | - Nega Assefa
- Department of Public Health, College of Health Sciences and Medicine, Haramaya University, Harar, Ethiopia
| | - Bizatu Mengistie
- Department of Public Health, College of Health Sciences and Medicine, Haramaya University, Harar, Ethiopia
| | - Asmamaw Demis
- Department of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
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Ayalew M, Gebrie M, Geja E, Beyene B. Determinants of Male Partner Involvement Towards Prevention of Mother to Child Transmission Service Utilization Among Pregnant Women Who Attended Focused Antenatal Care in Southern Ethiopia. HIV AIDS (Auckl) 2020; 12:87-95. [PMID: 32210635 PMCID: PMC7069496 DOI: 10.2147/hiv.s233786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/14/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Male partner involvement is an important and crucial determinant of prevention of mother to child transmission (PMTCT) of HIV. It creates an opportunity to reverse the transmission of HIV during pregnancy, labor, and breastfeeding. Thus, involving male partners during HIV screening of pregnant mothers at ANC is the key to fight against MTCT of HIV. OBJECTIVE This study was designed to assess the magnitude and factors associated with male partner's involvement on PMTCT service utilization among pregnant women who attended focused antenatal care (FANC) in Southern Ethiopia. METHODS An institutional-based cross-sectional study was conducted among 420 randomly selected pregnant women who enrolled in PMTCT service at ANC clinics. Pre-tested and structured self-administered questionnaires were used to collect the data. Multiple logistic regression analysis was used to determine the presence of statistically significant associations between the outcome variable and the independent variables with a p-value less than 0.05. RESULTS A total of 409 pregnant women who had ANC follow-up have participated in this study. The majority 160 (39.1%) of the participants were in the age group of 25-29 years. The magnitude of male involvement in PMTCT service was 129 (29.8%). Number of ANC visits (3rd visit (AOR=2.36, CI=1.09, 5.10), 4th visit (AOR=3.49, CI=1.65, 7.38), birthplace interest (AOR=3.01, CI=1.16, 7.84), awareness about partner monthly income (AOR=2.17, CI=1.15, 4.11), source of family saving scheme (partner (AOR=2.99, CI=1.39, 6.43), self (AOR=8.59, CI=3.92, 18.82), both (AOR=5.13, CI=2.21, 11.92), maternal perception about the importance of consulting partner before HIV testing (AOR=9.30, CI=2.65, 32.64), and kinds of partner support (psychological (AOR=0.08, CI=0.02, 0.29), financial (AOR=0.33, CI=0.17, 0.68) were found to be significantly associated with male involvement in PMTCT. CONCLUSION This study found out that male partner involvement in PMTCT is low. Therefore, improving male partner involvement in PMTCT is recommended for improving maternal FANC service utilization and adherence with notification of their partner and provision of psychological and financial support.
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Affiliation(s)
- Mohammed Ayalew
- School of Nursing, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Melese Gebrie
- School of Nursing, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Ephrem Geja
- School of Nursing, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Bereket Beyene
- School of Nursing, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Kabanga E, Chibwae A, Basinda N, Morona D. Prevalence of male partners involvement in antenatal care visits - in Kyela district, Mbeya. BMC Pregnancy Childbirth 2019; 19:321. [PMID: 31477058 PMCID: PMC6720074 DOI: 10.1186/s12884-019-2475-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 08/26/2019] [Indexed: 11/27/2022] Open
Abstract
Background In most countries in the world, promotion of maternal and child health is perceived as women’s role and men do not feel that they are responsible and see no reason to accompany their partners to Antenatal Care (ANC) clinics [Vermeulen, E., et al., BMC Pregnancy Childbirth 16:66, 2016]. Male involvement in Reproductive, Maternal, Neonates and Child and Adolescent Health (RMNCAH) programs in Tanzania is low. In Prevention of Mother to Child Transmission (PMTCT) program, the data shows only 30% attend couple counseling and only 8% for HIV counseling with their partners. There is limited data on prevalence of male involvement in ANC visits in Kyela. The purpose of this study was to determine prevalence of male involvement in ANC services and assess factors influencing male partners’ involvement in ANC visits in Kyela district in Mbeya. The findings from this study will serve as a baseline in efforts to increase male involvement in ANC care in Kyela. Methods Hospital based cross-sectional study was undertaken in Kyela district, Mbeya from October 2017 to November 2017. Data was collected using structured questionnaire and analyzed using SPSS version 20. Factors with P values of < 0.05 in univariate logistic regression were included in a multivariable logistic regression model to determine predictor variables that are independently associated with the outcome. Significant difference was defined as a P- value less than 0.05 and Odds Ratio (OR) that did not include 1.0. Results About 174 pregnant women who were visiting the ANC in their second to fourth visits or higher. About, 56.9% (99) attended with their male partners and 51% (52) of these reported to be accompanied by male partners to ANC because the women had requested their partners to accompany them. Attendance of male partners to ANC was significantly associated with male partner awareness of ANC visiting dates OR 24.1, 95% CI 6.8, 86.5, and P < 0.0001. Conclusion Prevalence of male attendance to the ANC in Kyela district is not adequate as fearing of HIV testing seemed to decrease male attendance to ANC services. So, there is high need to improve ANC health services with a focus on male friendly services. Electronic supplementary material The online version of this article (10.1186/s12884-019-2475-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elizabeth Kabanga
- Catholic University of Health and Allied Sciences-Bugando, P.O Box 1464, Mwanza, Tanzania
| | - Alfred Chibwae
- Catholic University of Health and Allied Sciences-Bugando, P.O Box 1464, Mwanza, Tanzania.
| | - Namanya Basinda
- School of public health, Catholic University of Health and Allied Sciences P. O BOX 1464, Mwanza, Tanzania
| | - Domenica Morona
- School of public health, Catholic University of Health and Allied Sciences P. O BOX 1464, Mwanza, Tanzania
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Nkhoma N, Nyondo-Mipando LA, Makanjee C, Myburgh ND, Nyasulu PS. "What Will I Be Doing There Among So Many Women?": Perceptions on Male Support in Prevention of Mother to Child Services in Lilongwe, Malawi. Glob Pediatr Health 2019; 6:2333794X19865442. [PMID: 31384631 PMCID: PMC6661781 DOI: 10.1177/2333794x19865442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 05/15/2019] [Accepted: 06/28/2019] [Indexed: 11/29/2022] Open
Abstract
Participation of males in the prevention of mother-to-child transmission (PMTCT)
programs remains a challenge despite the implementation of guidelines. The study
aimed at exploring male involvement in the PMTCT program at a primary health
facility in Lilongwe, Malawi. Focus group discussions and in-depth individual
interviews were used to collect data from health care workers, men, and women
who were attending PMTCT services. Snowball sampling was used to recruit
participants who were purposively identified. Alcohol consumption, pressure from
work places, stigma, role conflict, denial or nondisclosure of HIV status among
women, and lack of awareness were among factors found to hinder male
participation in PMTCT services. Therefore, to have an effective PMTCT program,
male involvement is needed as this could positively influence the delivery of
interventions including antiretroviral treatment among HIV-infected pregnant
women. As such, health education awareness campaigns emphasizing the value of
men in PMTCT services should be reinforced.
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Affiliation(s)
- Nicola Nkhoma
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Chandra Makanjee
- Department of Medical Radiation Sciences, School of Clinical Sciences, Faculty of Health, University of Canberra, Australia
| | - Nellie Dominica Myburgh
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Peter Suwirakwenda Nyasulu
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Takah NF, Malisheni M, Aminde L. Male Partner Involvement in the Utilization of Hospital Delivery Services by Pregnant Women Living with HIV in Sub Saharan Africa: A Systematic Review and Meta-analysis. Matern Child Health J 2019; 23:711-721. [PMID: 30600506 DOI: 10.1007/s10995-018-2676-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective The level of male partner involvement in hospital delivery by pregnant women living with HIV in sub Saharan Africa (SSA) is low. We conducted a systematic review and meta-analysis to identify the approaches that are used in improving male partner involvement and their impact on the utilization of hospital delivery services by pregnant women living with HIV in SSA. Methods Ovid Medline, Embase, PsycINFO, Cochrane library, ClinicalTrials.gov, Web of Science and Current Controlled Trials were searched. Only studies carried out in SSA that reported an approach used in involving male partners and the impact on the uptake of hospital delivery services irrespective of the language and date of publication were included. Odds ratios were extracted or calculated from studies and combined in a meta-analysis using the statistical package Stata version 11.0. A forest plot was used to show the impact of various male involvement approaches. A funnel plot was used to report publication bias. Results From an initial 2316 non-duplicate articles, 08 articles were included in the systematic review and meta-analysis. The overall pooled OR was 1.56 (95% CI 1.45-1.68). After stratification, the odds ratios were: 1.51 (95% CI 1.38-1.65), 1.58 (95% CI 1.38-1.80), 3.47 (95% CI 2.16-5.58) for complex community interventions without community health workers (CHWs), complex community interventions with community health workers, and verbal encouragement respectively. The overall I-square was 91.0% but after stratification into the three different approaches, the I-squared within the complex community intervention without CHWs group was 0.0%. Conclusions for Practice Complex community interventions and verbal encouragement increase the utilization of hospital delivery services by pregnant women living with HIV in SSA. The overall heterogeneity was high but very low for studies that used complex community interventions without CHWs. More well conducted studies (including randomized controlled trials) are needed in future to add to the quality of evidence.
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Affiliation(s)
- Noah F Takah
- Department of Health Policy, International Diagnostics Centre Africa, Addis Ababa, Ethiopia. .,Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK.
| | - Moffat Malisheni
- Department of Health Policy, International Diagnostics Centre Africa, Addis Ababa, Ethiopia
| | - Leopold Aminde
- Department of Health Policy, International Diagnostics Centre Africa, Addis Ababa, Ethiopia.,Department of Clinical Epidemiology, School of Public Health, University of Queensland, Brisbane, Australia
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Thindwa D, Landes M, van Lettow M, Kanyemba A, Nkhoma E, Phiri H, Kalua T, van Oosterhout JJ, Kim EJ, Barr BAT. Pregnancy intention and contraceptive use among HIV-positive Malawian women at 4-26 weeks post-partum: A nested cross-sectional study. PLoS One 2019; 14:e0215947. [PMID: 31013338 PMCID: PMC6478345 DOI: 10.1371/journal.pone.0215947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 04/12/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Avoiding unintended pregnancies through family planning is a WHO strategy for preventing mother to child transmission of HIV (PMTCT) and maternal morbidity/mortality. We investigated factors associated with unintended index pregnancy, unmet contraceptive need, future pregnancy intention and current contraceptive use among Malawian women living with HIV in the Option B+ era. METHODS Women who tested HIV positive at 4-26 weeks postpartum were enrolled into a cross-sectional study at high-volume Under-5 clinics. Structured baseline interviews included questions on socio-demographics, HIV knowledge, partner's HIV status/disclosure, ART use, pregnancy intention and contraceptive use. Logistic regression was used to determine factors associated with outcomes. RESULTS We enrolled 578 HIV-positive women between May 2015-May 2016; median maternal age was 28 years (y) (interquartile-range [IQR]: 23-32), median parity was 3 deliveries (IQR: 2-4) and median infant age was 7 weeks (IQR: 6-12). Overall, 41.8% women reported unintended index pregnancy, of whom 35.0% reported unmet contraceptive need and 65.0% contraceptive failure. In multivariable analysis, unintended index pregnancy was higher in ≥35y vs. 14-24y (adjusted Odds Ratio [aOR]: 2.1, 95% Confidence Interval [95%CI]: 1.0-4.2) and in women with parity ≥3 vs. primiparous (aOR: 2.9, 95%CI: 1.5-5.6). Unmet contraceptive need at conception was higher in 14-24y vs. ≥35y (aOR: 4.2, 95%CI: 1.8-9.9), primiparous vs. ≥3 (aOR: 8.3, 95%CI: 1.8-39.5), and women with a partner of unknown HIV-status (aOR: 2.2, 95%CI: 1.2-4.0). Current contraceptive use was associated with being on ART in previous pregnancy (aOR: 2.5, 95%CI: 1.5-3.9). CONCLUSIONS High prevalence of unintended index pregnancy and unmet contraceptive need among HIV-positive women highlight the need for improved access to contraceptives. To help achieve reproductive goals and elimination of MTCT of HIV, integration of family planning into HIV care should be strengthened to ensure women have timely access to a wide range of family planning methods with low failure risk.
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Affiliation(s)
- Deus Thindwa
- Management Sciences for Health, Lilongwe, Malawi
- * E-mail:
| | - Megan Landes
- Dignitas International, Zomba, Malawi
- Department of Family and Community Medicine, University of Toronto, Ontario, Canada
| | - Monique van Lettow
- Dignitas International, Zomba, Malawi
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | | | | | - Happy Phiri
- Management Sciences for Health, Lilongwe, Malawi
| | | | - Joep J. van Oosterhout
- Dignitas International, Zomba, Malawi
- Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Evelyn J. Kim
- Centers for Disease Control and Prevention, Lilongwe, Malawi
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Gbadamosi SO, Itanyi IU, Menson WNA, Olawepo JO, Bruno T, Ogidi AG, Patel DV, Oko JO, Onoka CA, Ezeanolue EE. Targeted HIV testing for male partners of HIV-positive pregnant women in a high prevalence setting in Nigeria. PLoS One 2019; 14:e0211022. [PMID: 30699160 PMCID: PMC6353157 DOI: 10.1371/journal.pone.0211022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 01/07/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Partner HIV testing during pregnancy has remained abysmally low in sub-Saharan Africa, particularly in Nigeria. Males rarely attend antenatal clinics with their female partners, limiting the few opportunities available to offer them HIV testing. In this study, we evaluated the scale-up of the Healthy Beginning Initiative (HBI), a community-driven evidenced-based intervention to increase HIV testing among pregnant women and their male partners. Our objectives were to determine the: (1) male partner participation rate; (2) prevalence of HIV among male partners of pregnant women; (3) factors associated with HIV positivity among male partners of HIV-positive pregnant women. METHODS We reviewed program data of expectant parents enrolled in HBI in Benue State, north-central Nigeria. During HBI, trained lay health workers provided educational and counseling sessions, and offered free onsite integrated testing for HIV, hepatitis B virus and sickle cell genotype to pregnant women and their male partners who participated in incentivized, church-organized baby showers. Each participant completed an interviewer-administered questionnaire on demographics, lifestyle habits, and HIV testing history. Chi-square test was used to compare the characteristics of HIV-positive and HIV-negative male partners. Simple and multivariable logistic regression models were used to determine the association between participants' characteristics and HIV positivity among male partners of HIV-positive women. RESULTS Male partner participation rate was 57% (5264/9231). Overall HIV prevalence was 6.1% (891/14495) with significantly higher rates in women (7.4%, 681/9231) compared to men (4.0%, 210/5264). Among the 681 HIV-positive women, 289 male partners received HIV testing; 37.7% (109/289) were found to be HIV-positive. In multivariate analysis, older age (adjusted odds ratio [aOR]: 2.45, 95% confidence interval [CI]: 1.27-4.72 for age 30-39 years vs. <30 years; aOR: 2.39, CI: 1.18-4.82 for age ≥40 years vs. <30 years) and self-reported daily alcohol intake (vs. never (aOR: 0.35, CI: 0.13-0.96)) were associated with HIV positivity in male partners of HIV-positive women. CONCLUSION The community-based congregational approach is a potential strategy to increase male partner HIV testing towards achieving the UNAIDS goal of 90% HIV screening. Targeting male partners of HIV-positive women for screening may provide a higher yield of HIV diagnosis and the opportunity to engage known positives in care in this population.
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Affiliation(s)
- Semiu Olatunde Gbadamosi
- Florida International University Robert Stempel College of Public Health & Social Work, Miami, FL, United States of America
| | - Ijeoma Uchenna Itanyi
- Department of Community Medicine, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | | | - John Olajide Olawepo
- School of Community Health Sciences, University of Nevada-Las Vegas, Las Vegas, NV, United States of America
| | - Tamara Bruno
- Independent Researcher, Las Vegas, NV, United States of America
| | - Amaka Grace Ogidi
- Research Resource Center, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Dina V. Patel
- HealthySunrise Foundation, Las Vegas, NV, United States of America
| | | | - Chima Ariel Onoka
- Department of Community Medicine, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Echezona Edozie Ezeanolue
- HealthySunrise Foundation, Las Vegas, NV, United States of America
- Department of Pediatrics and Child Health, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
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