The Role Of Maternal, Psychosocial And Social-Cultural Factors In Hiv-Exposed Infants’ Service Uptake; Nakuru County Refferal Hospital, Kenya

ABSTRACT 

In 2015, approximately 1.8 in million children under 15 years of age were living with HIV with an estimated 150,000 newly infected mainly through Mother-to-Child Transmission while 110,000 died of HIV/AIDS related causes. In East and Southern Africa region, approximately one million children were living with HIV with 56,000 newly infected and 47,000 due to AIDS-related illnesses in the same year. Although Early Infant Diagnosis (EID) and immunization services for HIV-Exposed infants are readily available and provided free of charge in public health facilities, only 35% of HIVExposed infants received EID before the age of 6 weeks in Kenya in 2012. Nakuru County is one of the 20 high prevalence HIV burden counties in Kenya which stands at 5.6% among mothers attending antenatal care clinics. The study was carried out in Nakuru County Referral Hospital; a high-volume level five government facility accounting for the highest prevalence of HIV among women attending PMTCT clinic at 5% in 2013 and 11% in 2014. The objective of the study was to assess the relationship between maternal determinants, Psycho-social and social-cultural factors which determine HIV-Exposed Infant’s service uptake. Due to stigma and discrimination related to HIV infection, negative attitudes and beliefs on HIV infection and lack of HIV status disclosure, uptake of HIV-Exposed infants’ services is likely to be compromised. This calls for informed strategies to motivate HIV infected mothers to embrace timely HEI services uptake. Study design was cross-sectional descriptive study of mother/baby pairs enrolled in PMTCT care in Nakuru County and Referral Hospital. Systematic sampling method was used to select respondent and a total of 329 mother/baby pairs were recruited for the study. Data was collected using both quantitative and qualitative approaches where an interviewer administered questionnaires and key informant interviews were used as the data collection tools. Cleaned data was analyzed using SPSS software version 20. Descriptive statistics were used to describe the continuous variables while chi square tests assessed associations between categorical variables. Hypothesis testing was done using chi-square test. All the results were considered at a significance level of 0.05. The study findings indicated that maternal factors including marital status and timeliness of uptake of immunization services had significant statistical association (X 2 =7.67, df=1, P=0.001). Psycho-social factors showed significant association with timeliness in immunization (X 2 =8.87, df= 1, P=0.03) and timeliness in uptake of Early Infant Diagnosis (EID) as (X2 =28.9, df=1, P˂0.001). Further findings on the respondents who had disclosed their HIV status to their male partners showed significant statistical association (X 2 =6.88, P=0.009). The study concluded that maternal characteristics, psychosocial and social-cultural factors influenced timely HIV Exposed Infants’ service uptake and recommended for promotion of PMTCT psychosocial support groups among all HIV positive women and inclusion of mentor mothers as champions in demand creation, campaigns and interpersonal communication to improve the timely uptake of early infant diagnosis (EID) and immunization services.