Abstract:
Assessing health workers knowledlge, practices, and perceptions of PMTCT services using
modified obstetric care as a tracer condition in the Lindi Region of Tanzania.
Background. Modified obstetric care (MOC) is the combination of selected obstetric practices
designed to minimize chances of transmitting HIV from mother to her neon ate. In some areas
PMTCT has reduced vertical transmission to less than 4%. However in Tanzania a high
proportion of exposed neonates (13%) still seroconvert to HIV. This situation led to initiation of
this study whose main objectives were to determine the health workers knowledge, practices, and
perceptions of PMTCT services using modified obstetric care as a tracer condition. Results of
this study would provide data for improvement ofPMTCT services.
Materials and methods. This was a cross sectional study in which data were collected using
structured questionnaire and focused group discussion. The sample size was 72, however the
study included 90 of all 96 health care workers trained on PMTCT and working in all 7 hospitals
ofLindi region.
Results. Levels of health workers general knowledge on MOC were found to be moderate
(64.4%) and low (34.4%). Factors found to influence level of general knowledge were being a
diploma holder, (AOR = 3.5, 95% Cl = 1.327 -9.282, p - value 0.00,) and being trained staff
(AOR = 4.00, 95% Cl = 1.396 -12.9, 4 P - value 0.0).
Those who had knowledge that minimizing vaginal examination' is a part of modified obstetric
care was 71 %. (n = 64). Knowledge level being influenced by being a diploma holder (AOR =
3.45,95% Cl =1.327 -9.282) and being trained on PMTCT by MoHSW (AOR = 3.17,95% Cl =
1.22 -8.43). Avoiding ARM" as MOC strategy was known by 85.6%. (n = 77). Level of
knowledge was being influenced by being a trained health worker, (p - value =0.00, AOR 18.29,
Cl =4.85 - 77.65). Avoiding routinely suction was known by 91.1% of the respondents.
Knowledge being influenced by being diploma holder, (p - value = 0.00, AOR 3.38, 95% Cl =
1.39 - 8.45), trained health staff (p- value = 0.01, AOR = 4.17, Cl = 1.4 - 12.9) and being placed
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in the labour ward, (p - value =0.04, AOR = 2.67, Cl =1.007 -7.24).The rest of the MOC
interventions were not known.
More than 90% of the health care workers perceived the known intervention as useful. Failure to
implement the recommended interventions was reported to be due to patients complications.
Conclusion. A large proportion of study population had low to moderate knowledge about the
modified obstetric care. This may be the reason for poor PMTCT performance. It is
recommended that PMTCT be amended to include all modified obstetric care procedures for its
improvement.
