Assessment of knowledge of and adherence to the recommended intrapartum obstetric guidelines for PMTCT of HIV by health workers at Mbagathi District Hospital, Nairobi.

Abstract

Introduction: In Kenya, 37,000-42,000 infants are infected with HIV yearly due to mother-to-child transmission (MTCT). Even though intra-partum obstetric guidelines for PMTCT of have been developed and ratified by the Ministry of Health (MoH) to lower the incidence of MTCT, there is paucity of data on the knowledge of and the adherence to these recommended protocols by health care workers in Nairobi County. Objective: To determine the level of knowledge of healthcare workers on the recommended intrapartum guidelines for PMTCT and the level of adherence to the recommended guidelines when tending to HIV positive patients at Mbagathi District Hospital, Nairobi Methodology: A cross-sectional study was done at Mbagathi District Hospital. Observation of deliveries by 110 healthcare workers was done by trained research assistants, a structured questionnaire used to collect data, and Focus Group Discussions (FDGs) used for informant interviews. Quantitative data was analysed using SPSS version 17. Descriptive statistics were computed and visualised in tables and charts and the Chi square test used to test the relationship between the dependent and independent variables. Qualitative data was transcribed verbatim, coded into discrete lines of text, and the NVIVO statistics software used for data analysis. Results: One hundred and ten (110) health care workers were interviewed. A majority (50.9%) were aged between 25 and 34 years. Females (65.5%) were more than males (34.5%). Around while 67.3% had attained tertiary level education while university graduates constituted 32.7% of the population. In terms of qualification, most respondents (39.1 %) were nurses. Clinical officers (CO) were 25.5% of the population while trainee nurses were 17.9% .At the time of the study, most health workers interviewed (58.2%) had spent less than one year in the labour ward. Only 41.8% had training on PMTCT, 87.3% of which were knowledgeable on the recommended intrapartum obstetric methods for PMTCT. Sex (p=0.05) and qualification (p=0.97) of respondents did not influence the awareness of intrapartum methods significantly. PMTCT training, however, influenced awareness of the recommended intra partum obstetric methods, with trained heath workers being 11 times more aware of the recommended protocols than those with no training (OR=11 (95%CI=2.3-52), p<0.01). Respondents with university level of education were also aware of the recommended intrapartum protocols for PMTCT than those with tertiary level education (OR=17 (95%CI=1.0-302), p=0.00). Only 38.15% practiced nine or more (≤75%) of the recommended 12 PMTCT protocols by the MoH during delivery. While practice of standard protocols such as such as minimising vaginal examinations (87.3%), discouraging prolonged labour (87.3%), and immediate cord clamping were almost universal, only 34.5%, 29.1%, and 27.3% of healthcare workers cleansed neonates, cleansed vaginas with antiseptics after membrane rupture, and presented women with the option of elective caesarean section (CS) before onset of labour respectively. Females (81%) adhered to the recommended guidelines for PMTCT more than males (19%) (OR=3.4 (95%CI=1.4 to 8.3), p=0.01. Workers with PMTCT training (57.1%) also adhered to the recommended intra partum guidelines for PMTCT of HIV 1 than those with no training (42.9%) (OR=2.8 (95%CI=1.3- 6.2), p=0.01). Conclusion: Knowledge of intrapartum obstetric methods of PMTCT was high (87.3%) among the healthcare in the labour ward of Mbagathi District Hospital. Unfortunately, adherence to the recommended protocols was poor (38.18%) and variable by gender, PMTCT training, and experience of healthcare workers. Workload, staff shortages, patient xiv complications, and lack of adequate resources were identified as key reasons for poor adherence to PMTCT protocols.