The timing of first antenatal care visit and factors associated with access to care among antenatal care attendees at Chitungwiza municipal clinics, Zimbabwe

Magister Public Health - MPHBackground and Rationale: Antenatal care (ANC) is vital for accessing prevention of mother to child transmission (PMTCT) services. The timing of the first ANC visit is critical for HIV infected pregnant women to access antiretroviral (ARV) prophylaxis as recommended. In addition pregnant women access other interventions like syphilis screening and treatment, provision of ferrous iron supplements, malaria prevention and treatment, health education, identification and management of risk factors. There is however paucity of information on factors associated with the timing and adequate use of ANC services in Chitungwiza Township, Zimbabwe. Aim: This study aimed to determine the factors associated with early access to and adequate use of ANC services among women attending ANC in the four polyclinics in Chitungwiza Township.Method:The study included a retrospective record review of women who registered for ANC in 2010 and a cross sectional study of pregnant women attending ANC clinic for the first time during the current pregnancy during the survey period. Data on gestation age at first ANC visit, number of ANC visits, age, gravidity, parity, tetanus, iron sulphate, rhesus results, HIV test result, WHO clinical stage, CD4 count, cotrimoxazole, PMTCT option accepted, date of initiation of AZT or ART; partner HIV test results; and infant feeding adherence done was abstracted into an MS Excel spreadsheet from the 2010 ANC registers in the four primary health care clinics. Every fourth record was captured. Exit interviews were also conducted on all women attending ANC for the first time during the current pregnancy using a structured questionnaire. Questions on socio-economic status, pregnancy history, reasons for seeking ANC, knowledge and belief about ANC services and their perception of the service received were asked. The outcome variables were gestation age at first ANC visit and the number of ANC visits. The spreadsheet was imported into Epi Info 7.0.9.7 and STATA 11 for analysis. The questionnaires were captured into an Epi Info 7 database exported to STATA 11 for analysis. A sample of 1,236 of first ANC visit records were abstracted from the 2010 ANC registers in the four primary care clinics and 80 women coming for ANC were interviewed in three clinics. The prevalence of pregnant women attending ANC for the first time at gestation age less or equal to 14 weeks and the prevalence of women with less than 4 ANC visits were computed. Pearson Chi-square tests were used to determine the strength of the relationships between the dependent variable (gestation age at the time of the first visit) and independent variables of age, marital status, level of education, parity, gravidity. All statistical tests were performed at 5% significance level and estimates were calculated at 95% confidence interval. Multiple logistic regression analysis was used to investigate the association between the outcome and the independent variables. Model interpretation was done using odds ratios (OR). Levels of knowledge and perception about ANC services as well as service content during the visit were also summarized. Results: Less than 1% of the women who attended ANC in 2010 came for 1st visit at week 14 or less, while of the women interviewed, 2.5% came at similar gestation age. Thirty-nine percent of women attending ANC in 2010 had at least four visits. Lower parity and tetanus immunization were significantly associated with early ANC initiation, while tetanus immunization and syphilis screening were associated with the number of visits.Among the interviewed women (n=80), 72.1% believed that a pregnant women should start ANC at 14 weeks or earlier. Most women (61.7%) cited having no money for booking as the reason for not coming earlier. Need for husband or partners permission, procrastination and not having any health problems with previous pregnancies were also a barrier to access. Uptake of HIV testing was very high at 94.7% of the women. However partner testing was very low at 2.1%. Knowledge of the appropriate time of the first ANC visit was somewhat high but not universal. Conclusions and Recommendations: Timely and adequate uptake of ANC services is very low in Chitungwiza Township. The user-fees appeared to be a major barrier to accessing ANC timely. While correct knowledge about when to go for ANC and the health problems women face during pregnancy and childbirth is prevalent,other factors like the need for permission from spouse or partner and procrastination were barriers to seeking service. Abolishing maternity fees should be seriously considered in order to increase access to timely ANC services. Sustainable means of financing services without reducing quality should be sought. There was variable uptake of various interventions in the ANC package due in part to supplies stock outs. There is need for strengthening the procurement and distribution systems so as to ensure continuous supplies at service delivery level

How Aids Changed Everything - MDG 6: 15 Years, 15 Lessons Of Hope From The Aids Response

The AIDS targets of Millennium Development Goal (MDG) 6 -- halting and reversing the spread of HIV -- have been achieved and exceeded, according to this report. Released in Addis Ababa, Ethiopia, on the sidelines of the Third International Conference on Financing for Development, the report demonstrates that the response to HIV has been one of the smartest investments in global health and development, generating measurable results for people and economies. It also shows that the world is on track to meet the investment target of US$22 billion for the AIDS response by 2015 and that concerted action over the next five years can end the AIDS epidemic by 2030.The report celebrates the milestone achievement of 15 million people on antiretroviral treatment -- an accomplishment deemed impossible when the MDGs were established 15 years ago. It also looks at the incredible impact the AIDS response has had on people's lives and livelihoods, on families, communities and economies, as well as the remarkable influence the AIDS response has had on many of the other MDGs. The report includes specific lessons to take forward into the SDGs, as well as the urgent need to front-load investments and streamline programs for a five-year sprint to set the world on an irreversible path to end the AIDS epidemic by 2030

Using mathematical and economic epidemiology tools for modelling HIV infection in serodiscordant couples.

Master of Science in Mathematics.We investigate the appropriate strategies that reduce the HIV transmission rate amongst the serodiscordant married couples. In particular, we formulate two discrete sub-models, the formation of married serodiscordant couples through marriage of single individuals and the formation of married serodiscordant couples through infection of HIV concordant negative married couples. We incorporate a constant treatment rate and solve these sub-models analytically. Our results showed that the formation of married serodiscordant couples through marriage of single individuals sub-model has no disease free equilibrium point because the serodiscordant couples are always present in the population. We computed the invasion reproductive number and showed that the endemic equilibrium point is stable when the invasion reproduction number is greater than one. In the formation of serodiscordant couples through infection of HIV concordant negative married couples, our results revealed that there exist a disease free equilibrium point and the endemic equilibrium point. We use the fixed point theory to determine the existence of the endemic equilibrium. We showed that when the basic reproduction number is less than unity, then it will be possible to control the HIV epidemic in serodiscordant couples otherwise the infection will persist. Sensitivity analysis revealed that for the disease to be controllable, intervention strategies must target to increase the treatment rate to reduce the HIV transmission rate. We then formulated the main model combining the dynamics of the two sub-models and incorporate treatment rate as the price-dependent demand function. We use the main model to explore the effects of treatment under eight different intervention strategic scenarios. Our results showed that out of the eight strategies only six were capable of reducing the HIV transmission rate amongst the serodiscordant married couples. The most effective intervention strategy was to treat directly the serodiscordant married couples. This strategy is expected to be cost efficient and could be implemented in poor resource setting

O conflito ético entre proibicionismo e redução de danos : análise e contribuições bioéticas

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Bioética, 2017.Esta dissertação propõe uma reflexão crítica acerca do fenômeno moral das drogas, a partir do conflito ético entre Proibicionismo e Redução de Danos. Foi realizada pesquisa bibliográfica e análise documental com objetivo de sistematizar criticamente os principais marcos históricos da moral sobre drogas, fundamentada em dois discursos proeminentes: o proibir e o cuidar. Apresentou-se também um ensaio da trajetória da Saúde Pública e da Justiça brasileiras na construção de políticas públicas sobre drogas. Buscou-se também apresentar as fundamentações teóricas filosóficas dos polos do conflito, aproximando o Proibicionismo à Ética Deontológica e a Redução de Danos à Ética Utilitarista. Considerando o caráter propositivo das Bioéticas Críticas latino-americanas, o estudo se propôs a orientar à tomada de decisão de gestores de políticas públicas sobre drogas, a partir de três princípios da Declaração Universal sobre Bioética e Direitos Humanos: autonomia e responsabilidade individual; responsabilidade social e de saúde; não discriminação e não estigmatização. Constatou-se três orientações fundamentais para tomada de decisões em políticas sobre drogas no Brasil: 1) a autonomia e a responsabilidade individual sobre o uso de drogas devem ser compreendidas a partir das condições de vulnerabilidades; 2) a ação de proteção do Estado deve se pautar numa perspectiva intersetorial de garantia de direitos; 3) o debate sobre drogas deve priorizar a discussão sobre racismo, discriminação de gênero e raça e demais marcadores sociais envolvidos.This dissertation proposes a critical reflection on the moral phenomenon of drugs, starting from the ethical conflict between Prohibitionism and Harm Reduction. A bibliographical research and documentary analysis was carried out with the objective of critically systematizing the main historical milestones of drug morality, based on two prominent discourses: the Prohibition and the Care. An essay on the trajectory of Brazilian Public Health and Justice in the construction of public policies on drugs was also presented. It was also analysed the philosophical theoretical foundations of the two parts of the conflict, approaching Prohibitionism to Deontological Ethics and Harm Reduction to Utilitarian Ethics. Considering the propositional nature of the Latin American Critical Bioethics, the study proposed to guide the decision-making managers of public policies on drugs, based on three principles of the Universal Declaration on Bioethics and Human Rights: autonomy and individual responsibility; Social and Health Responsibility; Discrimination and no Stigmatization. Three fundamental guidelines for decision-making in drug policies in Brazil were found: 1) autonomy and individual responsibility for drug use should be understood from the conditions of vulnerability; 2) the State protection action must be based on an intersectoral perspective of guarantee of rights; 3) the drug debate should prioritize the discussion on racism, racial discrimination and other social markers involved