Volume 8, Issue 7, July – 2023 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

Factors Affecting the Utilization of Prevention of

Mother-to-Child Transmission of
Hiv Among Antenatal Clinic Attendees
In Federal Medical Centre, Yola
Dr. Solomon Joseph Chiegil1* Mercy Umeh, Orji2
Doctor of public Health, Global Healthplus Public Initiative, Global Healthplus Public Initiative, Nigeria
Nigeria

Joseph Emmanuel Chiegil3 Stephen Maisamari B.4

Jhpiego-Johns Hopkins Affiliate; Ministry of Health, College of Nursing Science, Jalingo, Taraba State
Jalingo, Taraba State

Simon Abafalous5 Joseph Mohammed Dahmonyi6

College of Nursing Science, Jalingo, Taraba State College of Nursing Science, Jalingo, Taraba State

Dahiru Ahmed Dan’azumi7 Egeonu Stephen Ugoeze8

College of Nursing Science, Jalingo, Taraba State College of Nursing Science, Jalingo, Taraba State

Corresponding Author: Dr Chiegil, Solomon Joseph*

Abstract:-
Utilization of PMTCT services on 28-points scale,
=10.7 (0.11) ± 1.10. However, the respondents’
 Background:
achievement of utilization prevalence rate was 38%
An important strategy in HIV prevention is the
away from the minimum adherence rate of 95%. From
Prevention of Mother- to-Child transmission. This study
Regression analysis, predisposing factors accounted for
investigates the factors affecting the utilization of
6.5% of utilization (r = 0.251; R2 = 0.065; P-Value 0.00);
Mother-to-Child Transmission of HIV among ANC
Reinforcing factors, 4.0% (r= 0.20; R2=0.040; P-value =
Clinic attendees in Federal Medical Center, Yola.
0.00) and Enabling factors, 2.5% (r= 0.151; R2=0.025; P-
value= 0.000).
 Methodology:
Descriptive survey design with validated
 Conclusion:
interviewer administered questionnaires was used to
Predisposing, reinforcing and enabling factors
gather Information from 96 participants. Ethical
appear to be significant predictors to the utilization of
permission was sought for, from Taraba State Ministry
PMTCT services. It is therefore, recommended that the
of Health, and informed consent was obtained from
trio should be put into consideration when implementing
participants. Data analysis was done using IBM SPSS
PMTCT programs and services.
version 21 and descriptive and inferential statistics
presented. Questionnaire was tested for validity and
Keywords:- Demography, Factors, Mother, Enabling,
reliability with Cronbach Alpha 0.705 computed.
Utilization, Transmission
 Results:
I. BACKGROUND TO THE STUDY
Respondents mean age was 41.89 ±7.41, Majority
were married (81.3%), Civil servants (51%) of Islamic
The greatest 21st century challenge to human kind is
faith (60.4%).they were mostly of secondary educational
the epidemic of Acquired Immune Deficiency Syndrome
level (53.1%) with 1-5 children (66.7%). Predisposing
(AIDs) (Waymack, Sundareshan, 2023), the causative
factors were tested on 18-points scale and reported organism being the Human Immune Deficiency Virus
=13.7 (0.09) ± 0.85, Reinforcing factors on 32-points (HIV), discovered in 1981 (Greene, 2007). Over 55% of the
people living with HIV are women of reproductive age who
scale, = 15.0 (0.17) ± 1.71, Enabling factors on 32-
carry pregnancy with prevalence rate of 7.2% for pregnant
points scale, =26.9 (0.22) ± 2.13 and Self-reported women (Ozim, Mahendran, Amalan, & Puthussery, 2023).

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Volume 8, Issue 7, July – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Ozim, et al (2023) noted that because Women are among Antenatal Clinic Attendees in FMC, Yola. The
vulnerable, HIV infections in their reproductive age increase specific objectives of the study include to:
perinatal HIV epidemic. It was further reported that about
39 million people globally live with HIV, out of which 2.58  Determine the predisposing factors responsible for the
million are children 0-19, and 1.8 million are from sub- utilization of PMTCT of HIV services amongst pregnant
Saharan Africa. Worldwide, over 270,000 children become women in FMC, Yola.
infected (UNICEF, 2023).  Ascertain the reinforcing factors responsible for the
utilization of PMTCT of HIV services among pregnant
In Nigeria, about 69,400 children became infected with women in FMC, Yola.
HIV through mother-to-child transmission at the rate of  Determine the enabling factors responsible for the
9.7% of HIV exposed infants (Itiola, Goga, & utilization of PMTCT of HIV services among pregnant
Ramokolo, 2019). This has led to a rise in the total number women in FMC, Yola.
of children living with HIV in the country to an  Evaluate the extent of utilization of PMTCT of HIV
unprecedented 440,000 (UNICEF, 2020). Kassa (2018) services among pregnant women in FMC, Yola.
reported that virtually all HIV infection in children occurs
following mother to child transmission during the ante natal, II. METHODOLOGY
intra-natal, delivery, and post natal periods. With effective
interventions, such as use of anti – retroviral drugs and  Research Design
formula feeding, the risk of mother to child transmission has The research design used in this study was descriptive
been shown to reduce by 5% (CDC, 2023). Primary survey
prevention activities such as (preventing new infections,
prevention of new pregnancies in women that are infected  Population
with HIV) and secondary prevention practices like The population for the study was all the pregnant
(reducing mother to child transmission of HIV infected),are women in Federal Medical Centre, Yola.
the three approaches in reducing mother to child
transmission (MTCT) promoted by the world health  Description of Study Area
organization (WHO), (USAID, 2022 & World Health Federal Medical Center, Yola is a 330-bed multi-
Organization, 2009). specialist hospital located along Lamido Zubairu Way,
Yola-Town on GPS coordinates, latitude: 9.2084, longitude:
New approaches in preventing MTCT to less than 2% 12.4815, Adamawa state - north eastern part of Nigeria. It
includes use of combined anti – retroviral prophylaxis, covers a total land mass of 39.59 hectares. FMC, Yola was
elective caesarean section, and by avoiding prolonged established following an agreement between the Federal
breastfeeding or mixed feeding (UNICEF, 2018). An Ministry of Health and the then Adamawa State
estimated 66% of new HIV infections among children in Government to take over the then Yola Specialist Hospital
2015 and 63% of HIV related deaths occurred in West and Yola in 1998 before relocating to its present permanent site
Central Africa (WHO, 2021). Although the region has seen in 2006. The hospital is a tertiary healthcare center
a 31% reduction in new child (sometimes referred to as established to service people from Adamawa, parts of
pediatric) HIV infections between 2010 and 2015 (USAID, Taraba, Gombe and Borno states in addition to those coming
2022), East and Southern Africa has achieved the largest from the neighboring republic of Cameroun. Within the
decline in MTCT anywhere in the world, falling from 18% limits of available resources, the facility has been able to
of infants born to mothers living with HIV in 2010 to 6% in provide high standard of healthcare to its teeming clients;
2015—a threefold decrease (John-Stewart, Peeling, Levin, provided with state-of-the-art equipment in the theatres,
et al., 2017). The Northern part of Africa and the Midle East laboratories, radio-diagnosis, Special Care Baby Unit
progresses least among the regions of Africa, as nearly one (SCBU), obstetrics and gynecology unit, Dialysis Unit etc.,
third of women living with HIV passed the virus on to their which are intended to provide patient-friendly and
children in 2015 (UNAIDS Global AIDS update, 2022). conducive working environment for its staff.
Responsible socio-economic factors as reported in the
findings of Jumare (2019), including a stock-out of ARVs  Sample Size Determination/ Sampling Technique
and test kits, inadequate health human resources, transport Multi-stage sampling method was adopted. First, a
cost, distance, clinic cost for PMTCT and antenatal care as simple random sampling led to a selection of Yola South
well as the high cost of formula feeding. Another study LGA and FMC, Yola respectively, followed by systematic
identified such factors as knowledge of sero status in random sampling with a selection of every fifth pregnant
pregnancy, home deliveries, inadequate partner support, sub woman LWHA on the PMTCT register.
optimal adherence, late commencement of ARV
prophylaxis, practice of mixed breast feeding and inability Sample size was determined using a sample size
to take septrine prophylaxis computation. According to Taro Yamani, he illustrates a
(Hussen R, Zenebe WA, Mamo TT, et al., 2022). formula mathematically as:

The aim of this study was to identify the Factors n= N/ (1+N (e) 2)
responsible for the Utilization of PMTCT of HIV services Where:
n = Sample size

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Volume 8, Issue 7, July – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
N = Total population = 100 administration. The instrument for this study was also
e = Limit of tolerate error (0.05) scrutinized by the researcher’s supervisor who made
necessary corrections. A measurement scale was develop to
Substituting this formula, ensure accuracy of the data collected using constructs from a
suitable model, the precede model. This model unveiled the
variables for designing the instrument.

Reliability was ensured by a pilot-test and by test retest

Therefore, n = 80 of the developed instrument to ensure that consistency was
maintained in the measurement of what was intended to
The sample size for the study was 80 pregnant women measure. The questionnaire scales were sufficiently reliable
living with HIV, who attended clinic from January to May, (Cronbach Alpha 0.793), although it was noted that some
2020. However, to cater for losses and incompleteness, scales could be improved.
about 15% was added=
 Procedure for Data Collection
15/80 x 100 = 18.75 + 80= 99 (100 was therefore, Two research assistants were trained on how to
considered for sample size). administer the instrument for data collection. The health
facility was accessed through the management of FMC,
Bias: Sampling was systematically done from the Yola to seek permission for the conduct of the study. The
sapling frame so that each participant had equal chances of respondents were met at the ANC/PTMCT clinic. The
being selected. There was a also a Careful framing of questionnaires were administered to all the respondents
research questions. available at clinic for a period of one (1) week duration.

 Variables  Inclusion Criteria was all pregnant women LWHAs and

Both Primary and secondary dependent variables, the accessible at the time of this study while Exclusion
Utilization of PMTCT services were tested, including the criteria included all pregnant women who were not
independent and moderating variables, obtained from the present or accessible at the time of this study and who
constructs of the precede model. Demographic declined study at any stage of the study.
characteristics, predisposing, reinforcing, enabling and
behavior practice of the utilization of PMTCT services were  Measures
all measured. Questionnaire enabled data collection tool was
structured on demographics, including Age, Sex, Marital
 Null Hypothesis Testing status, Religion, Education, Occupation and the constructs
Study tested all Null Hypotheses to verify relationships of the Precede Model. Multiple-item summative scales were
among/ between variables. computed from these items to be measured. A scale of
measurement for each of the constructs of the precede model
 Data Collection Methods and Instrument for the Study was developed and the mean scores of responses converted
A validated interviewer administered questionnaire to percentage of the maximum scores on scale and rated in
was designed which consisted of five main sections of quartiles. An example of this computation is being
socio-demographic characteristics, predisposing, illustrated below: a mean score of 13.8 for a variable on
reinforcing, enabling and behavior practice of the utilization
of PMTCT services maximum scale of 14 was computed as X

= 98.6%. After the computation, low scores were

In section A: Demographic information with seven considered for percentages ≤ 25%; ≥25% and ≤ 49% as
items measuring the age, marital status, etc. Section B: below average scores and ≥ 50% of the maximum score
Assessed a nine items constructs of the predisposing factor based on the scale as average scores. Scores ≥ 75% were
with yes or no response pattern. The third section was the seen as high (good) scores.
measurement of construct of reinforcing factors (8 items)
with response patterns strongly agreed, agreed, disagreed
and strongly disagreed. The fourth section measured  Data Management and Statistical Analysis
enabling factors with eight items and response pattern of Validated interviewer administered questionnaire was
strongly agreed to strongly disagree. The fifth section used for this study to collect information from participants.
consisted of seven items measuring the utilization of For better understanding of the questionnaire items and and
PMTCT services. Response pattern were none of the Time, for accurate response, a total of two (2) research assistants
Some of the Time, Most of the Time and All of the Time. received training to be equipped with skills for data
collection covering aspects of the study procedures: the
 Data Validity and Reliability objectives of the study; research ethics and conducts;
Thorough literature review was done to identify the participants’ rights, confidentiality, informed consent and
variables that constitute the questionnaire, followed by identification of prospective respondents. Collation of the
necessary adjustment to the instrument before the final data collected was completed and analyzed with the use of

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Volume 8, Issue 7, July – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
statistical software, Statistical Packages for Social Sciences carry out the research. The researcher introduced herself by
(SPSS) version 21, so that an estimation of measures of presenting a copy of the letter of introduction obtained from
central tendency and dispersion were done (Descriptive the HOD nursing department to the management of the
statistics and analytic/inferential statistics). health facility and then to the Chief Nursing Officer in-
charge of antenatal clinic. The research tittle was introduced
 Validity and Reliability to the respondents and instructions given on how the
The instrument for this study was validated by questionnaires should be completed. The researcher
examining the contents, constructs, and items followed by reassured the participants that all information must be only
necessary corrections to ensure face validity. Literature used for academic purpose and client’s names were omitted
contents related to the problem under review were also in order to maintain confidentiality and privacy.
scrutinized and a scale of measurement developed to ensure
accuracy of the data to be collected. Constructs from a The consent of the respondents was adequately gained
suitable model, the precede model was used which unveiled by giving them adequate information to enable them to
the variables used in designing this instrument. To ensure express their feelings.
reliability, pre-testing and test, retest of the developed
instrument was done on similar population. This was to III. RESULTS
ensure the consistency of the measurement.
 Demographic Characteristics of Respondents
This was followed by a modification of the A total of 100 eligible participants were considered in
questionnaires, elimination of technical terms and this study, who responded to the questionnaires with a return
reformulation of some items in clearer and every day rate of 96%. Their ages ranged between 18 years to 50 years
vocabularies. Questionnaire were interpreted into local with a mean score of 41.98; standard deviation = 7.413. The
languages and the questionnaire scales sufficiently reliable self-employed represented a majority (47.9%) of
(Cronbach Alpha 0.705), although it was noted that some respondents, most of whom were married (81.3%) and of
scales could be improved. Islamic faith (60.4%). The academic statuses of the majority
of the respondents were of secondary educational level
 Ethical Issues (53.1%). Most of them were Civil servants (51%) with 1-5
Ethical permission was sought for, from the children (66.7%).
management of FMC, Yola, who granted the permission to

Table 1 Frequency Distribution of Demographic Characteristics of Respondents in this Study

Variables ***(N = 96)
N (%)
Occupation
Unemployed 21 21.9
Self-employed 46 47.9
Civil Servant 29 30.2
Marital Status
Single 7 7.3
Married 78 81.3
Separated 4 4.2
Widow 7 7.3
Religion
Christian 37 38.5
Islam 58 60.4
Traditional Belief 1 1.0
Education
Non-formal 4 4.2
Primary 8 8.3
Secondary 51 53.1
Tertiary 33 34.4
No. of Children
None 7 7.3
1-5 64 66.7
More than 5 25 26.0
Husband Occupation
Civil Servant 49 51.0
Self employed 40 41.7
Public figure 7 7.3
*** Respondents in this study

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 Predisposing Factors in the Utilization of PMTCT level of enabling factors in the utilization of PMTCT
Services services). Comparing Enabling factors, tertiary educational
In this study, the predisposing factors necessary for the attainments scored highest ( = 27.7 (0.2) ± 0.6) and non-
utilization of PMTCT services was measured as 9 items on
18-points scale to ask about some personal level factors like formal education, lowest ( = 25.5 (0.3) ± 2.0).
the knowledge of some PMTCT related information
contributing to adherence. Results showed that respondents  Utilization of PMTCT Services
(95.8% ) have some knowledge that Mothers on ARVs can This section consisted of 8 items Self-Reported
still continue to breast feed their babies according to choice adherence measured on 32-point scale. It enquired how
of feeding method, HIV viral load can significantly be often respondents did certain activities that contributed to
suppressed by adherence to ART (99.6%), ART adherence their Utilization of PMTCT services. In this study, (100%)
protects mothers from developing opportunistic infections of the respondents reported not forgetting to take their
(OIs) (91.7%, and culture does not discriminate HIV recommended ART medications. About 100% do not stop
patients (19.8%). drugs because they experience side effects, 95% do not miss
refill appointments, 93.7% reported not missing scheduled
Predisposing factors in the utilization of PMTCT PMTCT clinic appointments and 99% do not forget carrying
services on maximum score of 18-points scale reported a their medications along when they travel.
mean score of 13.7 (0.09) ± 0.85 being 76% of the
maximum score (a high level of Predisposing factors in the  Self-reported utilization of PMTCT services with
utilization of PMTCT services). Even though all the groups maximum score of 28-points reported a mean score of
scored high levels for predisposing factors, Holders of 10.7 (0.11) ± 1.10 being 38% of the maximum score
(meaning that there was a low level of utilization of
tertiary education scored the highest ( = 13.9 (0.2) ± 0.5)
PMTCT services). However, from this study,
and lowest ( = 12.7 (0.1) ± 0.7) for non-formal education respondents achieved PMTCT services utilization
prevalence rate of 38% away from the minimum
 Reinforcing Factors in the Utilization of PMTCT adherence rate of 95%. Summary of Descriptive
Services statistics for analysis of variables is shown in Table 4.7.
In this study, reinforcing factors in the utilization of Utilization of PMTCT services however, scored highest
PMTCT services was considered on 32-points scale. for non-formal education ( = 11.0 (0.2) ± 1.5) and
Respondents reported whether they were supported by
immediate people around them such as family, Health care lowest for primary educational attainments ( = 10.6
providers, spouse, etc, in the course of their treatment. (0.1) ± 0.2). These scores were followed by nurses who
About 99% of respondents reported receiving consistent measured their degrees in other fields other than nursing
support from family, Privacy from nurses and care givers (0.5) ±1.8. This means that graduate nurses
(54.2%), Incentives for adherence and appointment keeping has better preparation for nursing roles than the diploma
(21.8%), Assistance from support groups (24%), and nurses and nurses who are degree holders in other allied
Supports from religious group (0%). fields.

 Reinforcing Factors in the Utilization of PMTCT

Services on maximum score of 32-points scale reported a
mean score of 15.0 (0.17) ± 1.71 being 47% of the
maximum score (an intermediate level of Reinforcing
factors in the utilization of PMTCT services). Even
though all the groups scored high levels, Reinforcing
factors scored highest for tertiary education ( = 15.9
(0.4) ± 0.9) and lowest ( = 14.0 (0.2) ± 1.6) for non-
formal education.

 Enabling factors in the utilization of PMTCT Services

Enabling factors in the utilization of PMTCT services
was measured in this section in terms of self-reported
environmental factors that favor the utilization of PMTCT
services. For this section, 32% of the respondents reported
that distance to PMTCT clinic was not far, cost of drugs and
services are not high (100%), waiting time to get attention is
not long (21.9%), hospitable staff are skilled and
professional (99%), Friendly and non-discriminatory
(22.9%) and Clean and welcoming environment (100%).
Enabling factors in the utilization of PMTCT services on
maximum score of 32-points scale reported a mean score of
26.9 (0.22) ± 2.13 being 84% of the maximum score (high

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 Summary of Descriptive Statistics for Respondents in this Study

Table 2 Summary of Descriptive Statistics for Respondents in this Study

Variable Scale of measure Mean SE SD

Predisposing 18 13.7 0.09 0.85

Reinforcing 32 15.0 0.17 1.71
Enabling 32 26.9 0.22 2.13
Utilization 28 10.7 0.11 1.10
SE: Standard Error of Mean; SD: Standard deviation

Table 3 Mean Scores Comparisons for Knowledge, Attitude, Behavioral skills and Self-Reported practice of Universal
Precaution according to type of Educational Attainments in Nursing in this Study
Variables Max. Non-formal Primary (N=8) Secondary Tertiary P-
Score (N=4) (N=215) value
(SE) ± SD (SE) ± SD (SE) ± SD (SE) ± SD
Predisposing 18 12.7 (0.1) 0.7 13.5 (0.1) 0.8 13.7 (0.3) 1.0 13.9 (0.2) 0.5 0.001
Reinforcing 32 14.0 (0.2) 1.6 14.8 (1.2) 1.7 15.7 (0.6) 1.9 15.9 (0.4) 0.9 0.213
Enabling 32 25.5 (0.3) 2.0 26.9 (0.2) 2.1 26.7 (0.9) 2.6 27.7 (0.2) 0.6 0.029
Utilization 21 11.0 (0.2) 1.5 10.6 (0.1) 0.2 10.3 (0.6) 0.7 10.8 (0.4) 0.8 0.016
SRA: Self-Reported Adherence; SE: Standard Error of Mean; SD: Standard Deviation

 Summary of Outcome of Regression Analysis for Path Analysis (N=96)

Table 4 Summary of Outcome of Regression Analysis for Path Analysis (N=96)

Variables Utilization of PMTCT P-Value
R R2
Predisposing factors 0.25 0.065 0.000
Reinforcing factors 0.20 0.040 0.000
Enabling factors 0.15 0.025 0.000

 Hypotheses Testing Utilization of PMTCT services in this study, hence, we fail

Study had three null Hypotheses which were subjected to accept the Null hypothesis.
to tests to determine which of the predictor variables
produced higher changes on the outcome variable of Ho: 3. There will be no significant relationship between
Utilization of PMTCT services. Regression analysis at 0.05 Enabling factors in PMTCT Utilization and the Utilization
level of significance was done with decision rule that if P≤ of PMTCT services among participants in this study.
0.05, then the Null Hypotheses will fail to be accepted in Study showed a statistically significant relation between
favor of alternative hypotheses and if P≥ 0.05, then the Null Enabling factors and the Utilization of PMTCT services
Hypotheses will fail to be rejected. with coefficient of r= 0.015 and R2= 0.025 with P-value of
0.000. This showed that there is a relationship between
Ho: 1. There will be no significant relationship between enabling factors and the Utilization of PMTCT services in
predisposing factors and utilization of PMTCT services this study. We therefore, fail to accept the null hypothesis.
among participants in this study.
Results yielded a positive significant relation with IV. DISCUSSION, CONCLUSION AND
correlation coefficient analysis of r = 0.250 and R2 = 0.065) RECOMMENDATIONS
with P- Value of <0.000. This is a significant relationship
between predisposing factor and Utilization of PMTCT  The Demographic Characteristics of Respondents in this
services in this study. Hence, we fail to accept the Null Study
hypothesis. The results of this study indicates a varied ages
representation, ranging from ages of 18 – 50, being those
Ho: 2. There will be no significant relationship between with ages of accountability, and holding responsibilities for
Reinforcing factors and Utilization of PMTCT services selves and for other dependents. 81.3% of the participants
among participants in this study. were married with 1-5 children (67%). Majority of the
From results, a positive statistically significant relation respondents (53.1%) had only a secondary school education,
exists between reinforcing factors and the Utilization of a reason likely to affect their understanding of PMTCT. This
PMTCT services with correlation coefficient of (r= 0.201 agreed with the point raised by Fabiyi, & Obaniyi & Olukosi
and R2= 0.040), P-value of <0.000. This showed that strong & Oyawoye (2015), that one’s level of education affects his
relationship exists between reinforcing factors and the or her informed decision making. The study area is

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ISSN No:-2456-2165
predominantly dominated by the Islamic faith (60.4%) even The utilization of PMTCT services in the study
though other religious faith too exists. area recorded low scores, though respondents claim not
forgetting to take their drugs, not stopping Drugs even when
A good number of respondents (95.8%) were aware side effects occur, not missing refill appointment and not
that mothers on ART can still breastfeed their children, missing PMTCT schedules. The study has contradicted the
99.6% that adherence to ART can suppress HIV viral load report of Mabachi, Brown, Sandbulte, Wexler, Goggin,
and 91.7% believes that ART adherence builds immunity Maloba, & Finocchario-Kessler (2020), that there is increase
that protects the mother from opportunistic infections. coverage in the utilization of PMTCT in the country.
However, most cultures within the study area still However the Mustapha, Musiime, Bakeera-Kitaka,
discriminate HIV patients with only 19.8% that do not Rujumba, & Nabukeera-Barungi, (2018) agrees that
discriminate them. Women in the study area are not fully utilization of PMTCT services was still very low, though
represented in all PMTCT related decisions and at such only this was better among the pregnant women living with HIV.
a negligible percentage has free access to ANC and HCT.
The findings are similar to what Zegeye, Ahinkorah,  Lessons Learnt/ Contribution of Study
Ameyaw, et al (2022) reported, that most women are not In this study, evidence demonstrates that for optimal
involved in PMTCT decision making due to cultural and adherence to the behavioral practice of exclusive
religious beliefs held in those communities. Study reported breastfeeding, adherence to ART while breastfeeding will
high level of predisposing factors in the utilization of go a long way to reduce the viral load of the disease and also
PMTCT services which contradicts the findings of Deressa, provides protection to both the mother and child. It is worth
Seme, Asefa, Teshome, & Enqusellassie (2014) and mentioning too that keeping schedules for ANC, Refill and
Chalachew Genet Akal, Dessie Tegegne Afework (2018) other appointments are roadmaps to living a healthier life
concluding that predisposing factors involved in the that cannot be neglected on the part of the patient. And
utilization of PMTCT services such as knowledge of furthermore both predisposing and reinforcing factors play a
mothers on MTCT of HIV was high. vital role in the utilization of PMTCT services and therefore
must be appreciated in the different phases of PMTCT
Reinforcing factors in the utilization of PMTCT uptake.
services included receiving consistent support from family
(99%), incentives for adherence and appointment keeping  Conclusion
with health care providers (21.8%), and assistance from The problem of access to ANC and PMTCT services is
support groups (24%). This was also reported by the what this study tried to address. It found that when Health
Mabachi, Brown, Sandbulte, Wexler, Goggin, Maloba, & education and counseling components are inculcated in
Finocchario-Kessler (2020) who reportet that an every PMTCT program there will be an improvement in
improvement in social support for the mother improved the predisposing, reinforcing and enabling factors to PMTCT
uptake of PMTCT service. Others included, close watch services. It is therefore, recommended that health workers
from health care providers (82.3%), privacy from Nurses should pass health information across to the clients,
and care givers (54.2%), which were in line with the work of adequately accompanied by motivational components to
Nassali (2009), that health care workers and care givers inspire behavioral practice of adherence, remove barriers
plays important roles in PMTCT services. There was and then optimze adherence. An application of the precede
reported, an intermediate level of reinforcing factors in the Model in PMTCT programs can produce immeasurable
utilization of PMTCT services which is consistent with the behavioral change.
findings of Kassa (2018) who stressed the need for social
and organizational supports, though he did not measure its  Recommendation
levels in his study. Many recommendations are drawn from the results of
this study and are as follow
Enabling factors in PMTCT services Utilization
had high scores in this study as 32% agreed that their  Health workers should improve their counseling and
distance is not far from the PMTCT clinic, 100% says drugs educational skills.
are cheap (99%), hospital staff are skilled (100%),  Government and/ or proprietors should motivational
environment is clean and welcoming (21.9%) and waiting their staff to further motivate the behavior practice of
clinic time is not long. On same note, Akal, & Afework adherence to health information.
(2018) noted that most health care centers were located in  Health care providers should build a trusting relationship
urban areas making it difficult for rural dwellers to gain with community members.
access. The study also agreed with WHO (2008) where  Health care leaders and stakeholders, Ministry of Health
having skilled professionals and a friendly environment can should ensure regular supervision of health institutions
improve access to PMTCT in our health centers. Contrarily, and collaboration with the community to ensure
a report by Chalachew Genet Akal, Dessie Tegegne adherence to breast feeding information
Afework (2018), noted a contrary result, showing low levels  There should be collaborative resources identification
of enabling factors in terms of lack of materials and and mobilization for exclusive breast feeding and
equipment for PMTCT services, hot temperature of the area, adherence to PMTCT purposes between the government
language barrier, and low number of PMTCT providers. and non-governmental organizations; Community based
organizations and faith-based organizations.

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 PMTCT centers or clinics should be located at accessible [7]. Jumare, F. (2019). Factors influencing utilization and
sites in the community adherence to Prevention of Mother to Child
 Long waiting time/hours should be avoided in all Transmission of HIV/AIDS services in Rivers State,
PMTCT centers or clinics Nigeria. (). ,Faculty of Humanities ,Department of
Social Development. Retrieved
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Employer and philanthropists did not provide financial [8]. John-Stewart G, Peeling RW, Levin C, et al. (2017).
aid of any sort. Prevention of Mother-to-Child Transmission
of HIV and Syphilis. In: Holmes KK, Bertozzi S,
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with nursing in Nigeria, most importantly, the sample data International Bank for Reconstruction and
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ACKNOWLEDGMENTS https://www.ncbi.nlm.nih.gov/books/NBK525182/ doi:
10.1596/978-1-4648-0524 0_ch6
We use this medium to acknowledge and thank all the [9]. Kassa, G.M. (2018). Mother-to-child transmission of
authors for their contributions towards actualization of this HIV infection and its associated factors in Ethiopia: a
project. systematic review and meta-analysis. BMC Infect
Dis 18, 216 (2018). https://doi.org/10.1186/s12879-
 Funding: 018-3126-5
This research did not receive any grant/funding [10]. Mabachi, N. M., Brown, M., Sandbulte, M., Wexler,
C., Goggin, K., Maloba, M., & Finocchario-
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