Factors Influencing Utilization of Antenatal Care and Prevention of Mother-to-Child Transmission of Human Immunodeficiency Virus Services Among Nomadic Women

Presentation at the Global Maternal Newborn Health Conference, October 21, 2015

Background: Nomads constitute a hard-to-reach population. Effective Prevention of Mother-to-Child Transmission (PMTCT) of Human Immuno-deficiency Virus (HIV) is dependent on closing gaps in geographical coverage and improving utilization of Antenatal Care (ANC) services. This study was conducted to identify factors influencing nomads’ access to ANC and PMTCT.

Methods: We conducted a cross-sectional study among nomadic women of reproductive age, Traditional Birth Attendants (TBAs), and health facility personnel using interviewer-administered semi-structured questionnaires. Nomads‘ knowledge, attitude and practices regarding ANC, HIV and MTCT, TBAs’ HIV knowledge and safe delivery practices, and health facility availability of services were assessed. Geographical coordinates were used in mapping distance between residence and health facilities. Odds ratios (OR) and 95% confidence intervals were calculated.

Results: Of 375 women interviewed, 236 (63%) were aware of HIV although 364 (97%) had poor knowledge of HIV and MTCT; Only 16 (4%) delivered at a health facility despite 92 (25%) attending ANC. Of 290 women who delivered at home, 249 (86%) had cultural reasons. Less than 1% were screened for HIV. All five health facilities assessed provided ANC and 3 (60%) provided PMTCT services. Nomads with primary education were more likely to have good knowledge (OR = 42.4; CI95% 9.6-200) and to attend ANC (OR= 8.0; 95%CI 1.1-161.6). All ten (100%) TBAs had poor knowledge of HIV and its prevention and did not use gloves or sterilize blades. Most settlements were within a five kilometer radius around health facilities.

Conclusion: Nomads under-utilized ANC and PMTCT services due to cultural factors, low educational level and poor knowledge of HIV. Sensitizing and educating nomads on HIV and its prevention, is important to encourage them to utilize available services.