Assessing health workers knowledge, practices, and perceptions of PMTCT services using modified obstetric care as a tracer condition in the Lindi region of Tanzania

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

XI 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.