Male involvement in PMTCT and associated factors among men whom their wives had ANC visit 12 months prior to the study in Gondar town, North west Ethiopia, December, 2014

Male involvement in PMTCT and associated factors among men whom their wives had ANC visit 12 months prior to the study in Gondar town, North west Ethiopia, December, 2014

Abdella Amano^1,&, Abdulbasit Musa²

 

¹School of Public and Environmental Health, College of Medicine and health sciences, Hawassa University, Ethiopia, ²Department of Midwifery, College of Health and Medical sciences, Haramaya University, Ethiopia

 

 

^&Corresponding author
Abdella Amano, School of Public and Environmental Health, College of Medicine and health sciences, Hawassa University, Ethiopia

 

 

 

 

Human Immunue Deficiency Virus (HIV) is transmitted from an HIV-infected mother to her child during pregnancy, labor, delivery or breastfeeding is known as mother-to-child transmission (MTCT) and preventing HIV transmission in pregnant women and their children often referred to as prevention of mother-to-child transmission (PMTCT) [1, 2]. These PMTCT become a crucial intervention in the global fight against this epidemic [2]. To prevent the transmission of HIV from mother to baby, the World Health Organization (WHO) promotes a comprehensive approach, which include preventing HIV transmission from a woman living with HIV to her infant [3, 4]. An estimated 430,000 children were newly infected with HIV in 2008, over 90% of them through mother-to-child transmission (MTCT). Without treatment, about half of these infected children will die before their second birthday [5]. MTCT is the primary cause of all HIV infections in children under fifteen years of age [6]. Without intervention, the risk of MTCT ranges from 20% to 45%. With specific interventions in non-breastfeeding populations, the risk of MTCT can be reduced to less than 2%, and to 5% or less in breastfeeding populations [7, 8]. Globally, male involvement has been recognized as a priority focus area to be strengthened in PMTCT [8] but testing male partners for HIV in the context of preventing mother-to-child transmission remains a challenge in most low- and middle-income countries. In 2008, 57 countries documented the number of male partners of pregnant women attending antenatal care who received an HIV test. The proportion of pregnant women attending antenatal care whose male partners were tested for HIV was 5% in 2008 versus 2% in 2007 [9].

 

Studies have shown that the utilization of PMTCT services by the pregnant women is influenced both by factors related to the health system such as accessibility of VCT services, and by individual factors such as fear of disclosure of HIV results, lack of male partner support, fear of domestic violence, abandonment and stigmatization [2,5,10]. Couple VCT was shown to have greater benefits than accompanying the female partner for individual VCT [11]. Unfortunately, few men accompany their partners to antenatal clinics and even fewer participate in couple counseling when it is available [12,13]. There is evidence that lack of partner support is associated with poor uptake of antiretroviral medication and the inability to modify infant feeding practices [7,14]. Sexual abstinence and condom use have also been shown to be more common among postpartum women who reveal HIV-positive results to partners [15,16]. These associations between partner involvement and uptake of interventions underscore the importance of involving the male partner in HIV-1 prevention efforts initiated in the antenatal setting [17]. Low rates of HIV testing among women in antenatal setting have several implications for PMTCT programmes as the optimal uptake and adherence to such programmes is difficult for women whose partners are either unaware or not supportive of their participation. So, to improve utilization of HIV testing among women in ANC, assessing magnitude of male involvement in PMTCT and associated factors will have important implications to address the perspective issues.

 

 

A community based cross-sectional study was conducted in Gondar town from December 1- 20, 2014. Gondar town is found in North Gondar zone of Amhara regional state and is located 750 km Northwest of Addis Ababa. According to the 2007 Ethiopian census report, Gondar has a total population of 206, 987 and adolescents aged 15-19 years are estimated to be (25,128) 12% of the total population. Administratively, the town is divided into 12 administrative areas. The health system in the town is represented by one referral hospital, eight health centers and two governmental youth center. In addition, there are five higher clinics, one hospital, twenty two medium clinics; nineteen lower clinic owned by private sectors and two NGO clinics. The study populations were men whose wives had ANC follow up in the last 12 months prior to study period in the selected clusters. Cluster sampling technique was used to select the study units. By taking admistrative area as cluster, 4 out of 12 admistrative areas were selected. Then, all eligible men in the selected administrative area were included in the study. The sample size was determined by using a single population proportion formula considering the following assumptions: Magnitude of male involvement in PMTCT 50% (p= 0.5) as there was no previous study, 5% level of significance (a = 0.05), 5% marginal error (d= 0.05). The final sample size was adjusted by using design effect of 2 and 5% non-response. Finally the sample size determined was 808. Data was collected by face to face interview using a structured and pre-tested questionnaire. Ten diploma nurses were used to collect data. Three Midwives from University of Gondar teaching Hospital were assigned to supervise the data collection process. Training was given for both data collectors and supervisors. The level of male involvement in PMTCT programme was measured using six questions adapted from similar study conducted in Uganda (17). The questions were modified to local context and include: whether the man attends antenatal care with his partner, whether the man knows the partner's antenatal appointment, whether the man discusses antenatal interventions with his Partner, whether the man supports his partner's antenatal visits financially, whether the man has sought permission to use a condom during the current pregnancy and whether the man tested for HIV with his partner. The involvement score for each respondent range from 0 = no involvement to 6 = involved in all 6 activities. A total score of 4-6 was considered as a 'high' male involvement score and 0-3 as 'low' male involvement. Data entry was done by using EPI Info 2002 and exported to SPSS version 20.0 soft ware package for analysis. The presence of association between independent and dependent variables was assessed using odds ratio with 95% confidence interval by applying logistic regression model. Ethical clearance was obtained from College of Medicine and Health Sciences ethical review committee, University of Gondar. Formal letter of cooperation was written for North Gondar Zone Health Department and Gondar woreda Health Office. After informing the objective of the study, consent was obtained voluntarily from each study subject.

 

 

Socio demographic characteristics

 

A total of 802 male whom their wives had ANC follow up in the last 12 months were interviewed; out of these 641(79.9%) were Orthodox religion followers. The mean age of the respondents was 33.17 years with SD of 7.25 years. The majority, 701(87.4%) of the husbands were married. Five hundred thirteen (64.0%) of the husbands were attended secondary and post secondary education. Among the respondents 572(71.3%) of the husbands were self employer. Concerning wives educational status, 475(59.2%) attended secondary and post secondary education (Table 1).

 

Level of male involvement in PMTCT programmed

 

The level of male involvement in PMTCT was assessed using six variables shown in Table 2. Only 219 (27.3%) of the 802 men had attended ANC with their partners. One in three (33.9%) of the husbands knows ANC appointment of their wives. The majority of respondents 554(69.1%) had not asked their partners whether they could use condoms during sexual intercourse with them. Only 176(21.9%) of husbands had tested for HIV with their wives. Only one in five (20.9%) of the husbands had high male involvement index in PMTCT (Table 2).

 

Factors associated with Male Involvement in PMTCT Programme

 

As depicted in the bivariate models, male involvement in PMTCT was associated significantly with age of the husband, husband occupation, educational status of the husband, having heard about PMTCT and marital status. From the variables found to be significant in the bivariate analysis; educational status of husbands, husband occupation, having heard about PMTCT and marital status were found to be significantly associated with male involvement in PMTCT in multiple logistic regression analysis. Men who heard about PMTCT were 1.7 times morelikely to have high involvement index in PMTCT as compared to those who didn’t hear. Those who attended secondary and post secondary education were 3.6 times more likely have high involvement index in PMTCT than those who cannot read and write. Those who are married and in union were about 4.3 times more likely to have high involvement index than those who were widowed or separated. Men whose occupation was government employee were about 2 times more likely to be involved in PMTCT as compared to self employer (Table 3).

 

 

The study results revealed that only one in four men (20.9%) had high PMTCTC involvement index in the study area. This finding is similar with study report from Mekele town health facilities, Ethiopian in which 20% of men had high PMTCTC involvement index [17] . The finding is higher than study conducted in Nairobi antenatal clinic, Kenya in which only 15% of male involved in VCT with their wives [11]. But this finding is lower when compared with the study from eastern Uganda 26% and Addis Ababa, Ethiopia 28.1% [16,18]. The difference between our findings and other studies might be due to the difference of socio-economical and accessibility and availability of health care. In this study we have found a number of factors associated with male participation in the PMTCT programme. They include having had information about PMTCT, Husband education, occupational status of the husband and marital status. Those men's who had prior information about PMTCT about 1.7 times more likely to have high PMTCT involvement index as compared to those who had no information. This finding is in line with the study finding of Mbeya Region, Tanzania in which lack of information about PMTCT hinders male involvement in PMTCT [19]. Similarly study conducted in Addis Ababa revealed that those men's who had knowledge on PMTCT were more likely to have high PMTCT involvement index [18]. The possible explanation for this might be having information about PMTCT will help the partners to know the benefit of PMTCT programme for themselves as well as their new born thereby increase their involvement. Men's who attended secondary education and above were more like to have high PMTCT involvement index than those who were unable to read and write. This finding is in agreement with other study conducted in Uganda [16] and Zambia [20] where level of men's education had significant association with involvement in PMTCT. These might be due to the fact that educated men's had better awareness about the benefits of preventive health care including PMTCT. They might also have higher receptivity to new health related information. This study also revealed that men's whose occupation was government employee were about 2 times more likely to involve in PMTCT as compared to self employer. This finding is similar with the study finding of Addis Ababa [18] where government employer were more likely to involve in PMTCT than private employer. Study conducted in Uganda [16] also showed occupation of the husband had significant association with male involvement in PMTCT. The possible explanation for this might be that those government employers were more educated and had more awareness about health related issues than private employers like daily laborer. Those men's who are married and in union were about 4 times more likely to have high involvement index than those who were widowed or separated. These finding is comparable with study conducted in northern Tanzania where partners living together were more likely involved in PMTCT [21]. These might be due the fact that partners who live together had a penchant to discuss about health and related issue that can increase men's involvement in PMTCT.

 

 

In conclusion, this study revealed that the proportion of men who had high PMTCT involvement index in the study area was low. Having had information about PMTCT, Secondary and post secondary education, being government employer and living in union with partner were factors significantly associated with male involvement in PMTCT. Improving male involvement by creating husband’s awareness regarding benefit of PMTCT through provision of balanced information for all male partners is recommended.

 

 

The authors declare no competing interests.

 

 

AA wrote the proposal, participated in data collection, analyzed the data and drafted the paper. AM approved the proposal with some revisions, participated in data analysis and revised subsequent drafts of the paper. All authors read and approved the final manuscript.

 

 

We are very grateful to the University of Gondar for approval of ethical clearance, technical and financial support of this study. Then, we would like to thank all men who participated in this study for their commitment in responding to our interviews. Finally, we are also grateful to the North Gondar zone health department and Gondar woreda health offices for their assistance and permission to undertake the research.

 

 

Table 1: socio-demographic characteristics of the study participants, Gondar Town North West Ethiopia, December, 2014

Table 2: level of male involvement in PMTCT programme Gondar Town, Gondar, North West Ethiopia, December, 2014

Table 3: bivariate and multivariate analysis of factors associated with Male involvement in PMTCT among men whose wives had ANC follow up in the last 12 months in Gondar town, December -2014, Gondar, North West Ethiopia

 

 

1. WHO. PMTCT strategic vision 2010-20: preventing mother-to-child transmission of HIV to reach the UNGASS and Millennium Development Goals. Geneva, Switzerland. February 2010. Google Scholar


2. WHO. HIV/AIDS, Gender and the Prevention of Mother-to-Child Transmission (PMTCT). Switherland: 2007. Google Scholar


3. WHO, UNICEF. Guidance on global scale-up of the prevention of mother to child transmission of HIV: towards universal access for women, infants and young children and eliminating HIV and AIDS among children. Switzerland: 2007. Google Scholar


4. WHO. Towards Universal Access, Scaling up priority HIV/AIDS interventions in the health sector, 2009 Progress Report. Switherland: 2009. Google Scholar


5. Antelman G, Fawzi MCS, Kaaya S, Mbwamboc J, Msamangad GI, Huntere DJ et al. Predictors of HIV-1 serostatus disclosure: a prospective study among HIV-infected pregnant women in Dares Salaam, Tanzania. AIDS. 2001; 15(14):1865-74. PubMed | Google Scholar


6. Maman S, Mbwambo J, Hogan NM, P Kilonzo G, Sweat M. Women's barriers to HIV-1 testing and disclosure: Challenges for HIV-1 voluntary counseling and testing. AIDS Care. 2001; 13(5):595-603. PubMed | Google Scholar


7. Kiarie JN, Kreissa JK, Richardsonb BA, John-Stewarta GC. Compliance with antiretroviral regimens to prevent perinatal HIV-1 transmission in Kenya. AIDS care. 2003;17 (1):65-71. PubMed | Google Scholar


8. Katz1 DA, Kiarie JN, John-Stewart GC, Richardson BA, John FN, Farquhar C. Male Perspectives on Incorporating Men into Antenatal HIV Counseling and Testing. PLoS ONE. 2009;4(11):e7602. PubMed | Google Scholar


9. Baiden F, Remes P, Baiden R, Williams J, Hodgson A, Boelaert M, et al. Voluntary counseling and HIV testing for pregnant women in the Kassena-Nankana district of northern Ghana: Is couple counseling the way forward? AIDS Care. 2005;15(5):648-57. Google Scholar


10. Bajunirwe F, Muzoora M. Barriers to the implementation of programs for the prevention of mother-to-child transmission of HIV: A cross-sectional survey in rural and urban Uganda. AIDS Research and Therapy. 2005;2(10):1-7. PubMed | Google Scholar


11. Farquhar C, Kiarie JN, Richardson BA et al. Antenatal couple counseling increases uptake of interventions to prevent HIV-1 transmission. J Acquir Immune Defic Syndr. 2004;37(5):1620-6. PubMed | Google Scholar


12. Homsy J, Kalamya JN, Obonyo J et al. Routine intrapartum HIV counseling and testing for prevention of mother-to-child transmission of HIV in a rural Ugandan hospital. J Acquir Immune Defic Syndr. 2006;42(2):149-54. PubMed | Google Scholar


13. Farquhar C, Mbori-Ngacha, Bosire RK, Nduati RW, Kreiss JK, John GC. Partner notification by HIV-1 seropositive pregnant women: association with infant feeding decisions. AIDS. 2001;15(6):815-7. PubMed | Google Scholar


14. Nebie Y, Meda N, Leroy V et al. Sexual and reproductive life of women informed of their HIV seropositivity: a prospective cohort study in Burkina Faso. J Acquir Immune Defic Syndr. 2001;28(4):367-72.. PubMed | Google Scholar


15. UNAIDS: 2006 Report on the global AIDS epidemic. Geneva: UNAIDS; 2006. Google Scholar


16. Robert Byamugisha, James K Tumwine, Nulu Semiyaga, Tylleskär T. Determinants of male involvement in the prevention of mother-to-child transmission of HIV programme in Eastern Uganda: a cross-sectional survey. Reproductive Health.2010;7(12). PubMed | Google Scholar


17. Fisaha Haile, Brhan Y. Male partner involvements in PMTCT: a cross sectional study, Mekelle, Northern Ethiopia. BMC Pregnancy and Childbirth. 2014; 14(65). PubMed | Google Scholar


18. Yohannes Abuhay, Lakew Abebe, Fentahun N. Male involvement in prevention of mother to child transmission of HIV and associated factors among males in Addis Ababa, Ethiopia. American Journal of Health Research. 2014; 2(6): 338-343. PubMed | Google Scholar


19. Stefanie Theuring, Paulina Mbezi, Hebel Luvanda, Brigitte Jordan-Harder, Andrea Kunz, Harms G. Male Involvement in PMTCT Services in Mbeya Region, Tanzania. AIDS Behav. 2009; 13: S92-S102. PubMed | Google Scholar


20. Matongo L, Hang’andu, Nzala SH, Malebe T. Exploring determinants of male involvement in PMTCT programs in Chibombo district of central province of Zambia. Asian Journal of Multidisciplinary Studies. 2014;2(12). PubMed | Google Scholar


21. Msuya SE, Mbizvo EM, Hussain A, Uriyo J, Sam NE, Stray-Pedersen B. Low male partner participation in antenatal HIV counseling and testing in northern Tanzania: implications for preventive programs. AIDS Care. July 2008; 20(6):700-709. PubMed | Google Scholar