Knowledge, attitudes and practices regarding hivaids prevention among pregnant women attending antenatal care at the setthathirath hospital in vientiane capital, lao people’s democratic republic

MINISTRY OF HEALTH UNIVERSITY OF HEALTH SCIENCES, FACULTY OF PUBLIC HEALTH and MINISTRY OF EDUCATION AND TRAINING - MINISTRY OF HEALTH HANOI UNIVERSITY OF PUBLIC HEALTH H P PHOUNGEUN PHONGXAY U Knowledge, attitudes and practices regarding HIV/AIDS prevention among pregnant women attending antenatal care at the Setthathirath Hospital in Vientiane Capital, Lao People’s Democratic Republic H MASTER THESIS MASTER OF PUBLIC HEALTH CODE: 8720701 Hanoi, 2019 MINISTRY OF HEALTH UNIVERSITY OF HEALTH SCIENCES, FACULTY OF PUBLIC HEALTH and MINISTRY OF EDUCATION AND TRAINING - MINISTRY OF HEALTH HANOI UNIVERSITY OF PUBLIC HEALTH PHOUNGEUN PHONGXAY H P Knowledge, attitudes and practices regarding HIV/AIDS prevention among pregnant women attending antenatal care at the Setthathirath Hospital in Vientiane Capital, Lao People’s Democratic Republic U H MASTER THESIS MASTER OF PUBLIC HEALTH CODE: 8720701 Dr Somphou Sayasone, Ph.D Dr Duong Minh Duc, Ph.D Hanoi, 2019 i ACKNOWLEDGEMENTS This work has been a long journey with a lot of support and input from lecturers, tutors, friends and my family members No journey is undertaken alone This master‟s thesis would not have been successful without them Thus, I owe my utmost gratitude to all the individuals who participated in making this study and who supported me during the study process First of all, I would like to thank very sincerely the Ministry of Health, University of Health Sciences and Faculty of Public Health in Laos, the Hanoi University of Public Health in Vietnam, and the LEARN project for granting me the H P scholarship and opportunity to participate in this Master of Public Health course I would like to thank my supervisors, Dr Duong Minh Duc, Ph.D (Hanoi University of Public Health) and Dr Somphou Sayasone, Ph.D (Lao Tropical and Public Health Institute) for their invaluable support, guidance and patience Without their encouragement, I would not have continued my study and come to the end of U this journey I present my deepest thanks to the honorable teachers, staff, coordinators and organizations that advised and helped me to conduct this thesis study Their H kindness will always be in my cherished memories I would also like to offer my warmest thanks to the leaders, doctors and nurses of the Setthathirath Hospital in Vientiane Capital for giving me permission to collect data in their hospital and for their encouragement during the data collection period I also sincerely thank all patients who willingly participated in my study Finally, I would like to thank my classmates and my family, particularly my parents and my brothers and sisters, for supporting me spiritually and for their unconditional love, patience and encouragement throughout my study This accomplishment would not have been possible without them Thank you very much PHOUNGEUN PHONGXAY ii LIST OF CONTENTS ACKNOWLEDGEMENTS .i ABBREVIATIONS vi LIST OF TABLES vii LIST OF FIGURES vii ABSTRACT viii Introduction Research Objectives Chapter 1: Review of Literature H P 1.1 Definitions 1.1.1 HIV 1.1.2 HIV/AIDS prevention from mother to child 1.1.3 Prevention of mother to child transmission 1.2 Global burden of HIV infection U 1.3 Situation of HIV infection in the Lao PDR 1.4 HIV infection among women 1.5 Transmission of HIV from mother to infant H 1.6 Prevention of Mother-to-Child Transmission (PMTCT) 10 1.7 Knowledge regarding HIV/AIDS prevention of pregnant women 11 1.8 Attitudes regarding HIV/AIDS prevention of pregnant women 14 1.9 Practices regarding HIV/AIDS prevention of pregnant women…………… 15 1.10 Conceptual framework 18 Chapter 2: Subject and Methodology 19 2.1 Subject 19 2.1.1 Inclusion criteria 19 2.1.2 Exclusion criteria 19 2.2 Setting and duration 19 2.3 Study design 19 iii 2.4 Sample size 20 2.5 Sampling method 20 2.6 Data collection 21 2.7 Variables 21 2.7.1 Key variables 21 2.7.1.1 Independent variables 21 2.7.1.2 Dependent variables 21 2.8 Definition(s)/Concept(s), measures and assessment 22 2.8.1 Definition(s)/concept(s) 22 2.8.1.1 Demographic characteristics 22 H P 2.8.1.2 Knowledge 22 2.8.1.3 Attitudes 22 2.8.1.4 Practices 22 2.8.1.5 Maternity 22 2.8.1.6 Pregnant women 23 U 2.8.2 Measures and assessment 23 2.8.2.1 Knowledge regarding HIV/AIDS prevention among pregnant women 23 H 2.8.2.2 Attitudes regarding HIV/AIDS prevention among pregnant women 24 2.8.2.3 Practices regarding HIV/AIDS prevention among pregnant women 24 2.8.2.4 Socio-demographic characteristics among pregnant women 24 2.8.2.5 Psychological factors among pregnant women 24 2.8.2.6 Reproductive history of pregnant women 24 2.9 Data quality and analysis 25 2.10 Ethical issues 25 2.11 Limitations and bias and how to minimize these biases 26 Chapter 3: Results 27 iv 3.1 Socio-demographic factors .28 3.2 Psychological factors 29 3.3 Reproductive health history 30 3.4 Knowledge regarding HIV/AIDS prevention among pregnant women 31 3.5 Attitudes regarding HIV/AIDS prevention among pregnant women 35 3.6 Practices regarding HIV/AIDS prevention among pregnant women 39 Chapter 4: Discussion 43 4.1 Demographic characteristics 43 4.2 Reproductive health history 44 4.3 Knowledge regarding HIV/AIDS prevention among pregnant women 44 H P 4.4 Attitudes regarding HIV prevention among pregnant women 46 4.5 Practices regarding HIV/AIDS prevention among pregnant women 48 Conclusions 50 Recommendations 51 REFERENCES 52 U LIST OF ANNEXES 58 Annex 1: Pregnant woman consent form 58 Annex 2: Key variables factors 60 H Annex 1: Key individual factors 61 Annex 2: Research questionnaire presented to the pregnant women 65 Annex 3: Research questionnaire presented to the pregnant women 64 - Questionnaire form section 1: Socio-demographic data of pregnant women 64 - Questionnaire form section 2: Psychological factors of pregnant women 66 - Questionnaire form section 3: Reproductive history of pregnant women attending ANC service 67 - Questionnaire form section 4: Knowledge of pregnant women regarding HIV/AIDS prevention 68 - Questionnaire form section 5: Attitudes of pregnant women regarding HIV/AIDS prevention 72 - Questionnaire form section 6: Practices of pregnant women regarding v HIV/AIDS prevention among pregnant women attending ANC 73 Annex 4: Ethical Approval 75 Annex 5: List of research team members 76 Annex 6: Curriculum Vitae of Researcher 77 Annex 7: Thesis comments 80 Annex 8: Minutes of Explanation 90 H P H U vi ABBREVIATIONS AIDS …………………Acquired Immunity Deficiency Syndrome AMR …………………Ambulatory Medical Record ART ………………….Anti-Retroviral Treatment GARP…………………Global AIDS Response Progress HCWs ……………… Healthcare Workers H P HIV.………………….Human Immunodeficiency Virus JICA…………………Japan International Cooperation Agency KAP Knowledge, Attitudes and Practices PMTCT .Prevention of Mother-to-Cchild Transmission of HIV U MTCT .Mother-to-Child Transmission SPSS Statistical Package for Social Sciences H STIs Sexually Transmitted Infections TPB Theory of Planned Behaviour UNAIDS United Nations Programme on HIV/AIDS WHO World Health Organization ANC Antenatal Care PLHIV People living with HIV VTC Voluntary testing and counseling vii LIST OF TABLES Table 3.1: Socio-demographic characteristics of study respondents………… 27 Table 3.2: Psychological perceptions among study respondents of HIV Infection……………………………………………………………………… 29 Table 3.3: Reproductive health history of study respondents ……………… 30 Table 3.4.1: Knowledge of pregnant women regarding HIV/AIDS prevention.31 Table 3.4.2: Multiple logistic regression association between knowledge and influencing factors…………………………………………………………… 33 Table 3.5.1: Attitudes of pregnant women regarding HIV/AIDS prevention H P …….35 Table 3.5.2: Multiple logistic regression association between attitudes and influencing factors …………………………………………………………… 37 Table 3.6.1: Practices among pregnant women regarding HIV/AIDS prevention 39 U Table 3.6.2: Multiple logistic regression association between practices and influencing factors…………………………………………………………… 40 H LIST OF FIGURES Figure 1: Conceptual framework………………………………………………18 viii ABSTRACT Introduction: In Laos it is estimated that there are 12,000 people living with HIV and 570 new infections yearly The number of HIV positive pregnant women during 2015-2018 was 423 cases, but among children aged 0-4 years during 2010-2018, there were 7,410 recorded as HIV positive New HIV infections amounted to 1,016 cases, and the total number of deaths was 779 HIV positive children Objectives: This study is to assess the knowledge, attitudes and practices regarding HIV/AIDS prevention and to identify the associated factors among pregnant women attending antenatal care at the Setthathirath Hospital in Vientiane Capital, Lao PDR, in 2019 H P Methods: This study applied a cross-sectional design The target population was pregnant women attending antenatal care (ANC) in 2019 The calculated sample was 215 mothers using simple random sampling All were interviewed by use of a self-administered questionnaire Independent variables (socio-demographic, psychological symptoms and reproductive history) were tested for association with the dependent variables (knowledge, attitudes and practices regarding HIV/AIDS prevention) The statistical significance was a P-value of ≤ 0.05 U Results: Out of the 215 respondents, more than half had a poor knowledge regarding HIV/AIDS prevention and more than half of the respondents (53.0%) had a negative attitude towards HIV/AIDS prevention Only 17.2% had a highly positive attitude towards HIV/AIDS prevention Similarly, more than half of the respondents (55.8%) had poor practices, while less than a quarter of the respondents (23.7%) had good practices regarding HIV/AIDS prevention There was no association between the socio-demographic variables with the knowledge, attitudes, and practices towards HIV/AIDS prevention among mothers attending the ANC services (p > 0.05) H Conclusion: The knowledge, attitudes and practices towards HIV/AIDS prevention amongst pregnant women were poor There was a lot of misunderstanding amongst pregnant women regarding HIV/AIDS prevention We have not found any sociodemographic factors with significant association with their knowledge, attitudes and practices regarding HIV/AIDS prevention Keywords: HIV/AIDS prevention, pregnant women, knowledge, attitudes, practices, Setthathirath Hospital, Vientiane, Lao PDR 79  Work Experience (please start with most recent position) Month/Year Month/Year commenced completed Employer Job Title and Roles and Responsibilities 2013 2014 The Department of Communicable Disease Control, Ministry of Health Academic staff prevention and control disease 1999 2012 The Department of Inspection, Ministry of public health Academic Staff of inspection of state division 1990 1999 Mittaphab Hospital Pharmacy Staff  Other Experience (e.g member of a committee, volunteer work, work-related experience etc.) Month/Year Month/Year commenced completed H P Organization 05/2009 06/2009 University of Health Sciences 11/2009 11/2009 25 th SEA Games, LAOS Vientiane 2009 7/2009 9/2009 National Emerging Infectious Diseases Coordination Office (NEIDCO) Roles and Responsibilities Chief of unit, Community Development Site Nurse Assistant Procurement and Purchase of Project U  Language Skills: Language Speaking Reading Writing English Good Good Good Thailand Good Good Fair Lao (Native language)  Certification I, Undersigned, certify that to the best of my knowledge and belief, this bio-data correctly describes my qualification, my experience and myself I understand that any miss-statement described herein may lead to my disqualification or dismissal, if employed H Date: 10 February, 2020 Signature: Phoungeun PHONGXAY 80 Annex 7: Thesis comments HANOI UNIVERSITY OF PUBLIC HEALTH THESIS COMMENT FORM OF MASTER PROGRAM (For reviewer of thesis defence committee – Master Program) Thesis topic: KNOWLEDGE, ATTTITUTE AND PRACTICE HIV PREVENTION AMONG PREGNANT WOMEN ATTENDING ANTENATAL CARE AT THE SETTHATHIRATH HOSPITAT IN VIENTIANE CAPITAL, LAO PDR H P Thesis code: page) (Written on the right corner of thesis cover U June 17th, 2019 General comments: - Revision after the first round of review: not significant revisions, just write “revised” but in fact not revised - Template of thesis - References: too many ref (more than 120 in 20 pages), some are not relevant H Thesis topic has correct orientation and specialized codes (Master of public health applied science orientation/ Master of public health applied research orientation) Yes Thesis topic: Research summary: 81 What does the author mean: “no statistical significance” is presented in the results, but “some factors significant difference”? This is not clear, even it makes reader confuse Introduction: Too much information of HIV epidemiological information, but little information about KAP of HIV prevention among pregnant women presented in the Introduction More information about KAP and its related factors of HIV prevention among pregnant women and information supporting that KAP of HIV prevention among pregnant women is a problem need to be studied (problem statement) H P Research Objectives: Specific objectives are clear, but no need to have general objective Literature review: Comments: (structure and content of literature review are coherent with objectives and research topic, use updated reference and citation correctly, and other comments (if any) : ……………… U H Literature should be revised base on the following suggestions: RESTRUCTURE - Key concepts, definitions: concepts, definitions will be used in the current study should be included - KAP: what are current KAP on HIV prevention among women? Relevant references should be quoted to provide evidences in each specific issue (K, A and P) - Associated factors section should be added or presented clearly It is not clear about factors related to KAP of HIV prevention among pregnant women This should be improved to provide bases for development of the conceptual framework Subjects and research methods: Section 2.8.2 Measurement: bases (references, e.g WHO, UNFPA…) of measurement and assessment of KAP should be provided 82 For example: correct answer gets 1; wrong answer get 0; how about “don‟t know/not sure”? For attitude: divided in three groups (low, moderate and high” are not appropriate And what is 80% - high level of attitude… Research results: Comments: (i) Research results are suitable with objectives, orientation and specialized codes; (ii) Research result is presented clearly and followed by objectives; (iii) Using data analysis appropriately and ensuring confidence of these methods; and other comments (if any): ……….………………………………………………………… H P - No need to number the Introduction section in the Result chapter - Tables should be separated and renumbered following the guidelines of the HUPH (e.g starting with Table 3.1; Table 3.2, etc.) - Titles of sections/tables should be shortened (no need “pregnant women attending… N=125” - No summary for table 10-12 More detail summary and explanation of key findings in Tables 10, 11 and 12 should be provided No need to puts all variables in multivariate analysis MEANING of analysis???? U Discussion: template should be revised - H No need to number the Introduction section in the Discussion chapter Starting with o 4.1 Demographics… o 4.2 Knowledge… o 4.3 Attitude o 4.4 Practice… o … - Sections 4.2.1 (demographic info.) and 4.2.2 (RH history) should be integrated in other sections of discussion, because reproductive health history is of related factor groups - For all discussion sections: too much result is repeated More references should be used to compare, discuss and explain of the findings - Discussions on related factors are not clear This section should be improved 83 10 Conclusion: not based on results, must be revised following revised results - Conclusions must be clear and concise, providing conclusions (not summary study results) with evidence - Conclusion must be meet the two study objectives, answer two research questions (look back the research questions, p.3) 11 Recommendations - Rewrite accordingly to revised conclusion section - Recommendation must be based on the study results and provide clear and specific information about: what, who, how and when… H P 12 FINAL CONCLUSION: [ x ] Approval with major revisions Need to reapproval of a member of the thesis evaluation committee - U English should be edited H Reviewer (Sign and full name) Assoc Prof Ha Van Nhu 84 HANOI UNIVERSITY OF PUBLIC HEALTH THESIS COMMENT FORM OF MASTER PROGRAM (For reviewer of thesis defence committee – Master Program) Thesis topic: “Knowledge, attitudes and practices regarding HIV/AIDS prevention among pregnant women attending antenatal care at the Setthathirath Hospital in Vientiane Capital, Lao People’s Democratic Republic” Thesis code: 8720701 (Written on the right corner of thesis cover page) H P …………, Date Month… year 2019 13 Thesis topic has correct orientation and specialized codes (Master of public health applied science orientation/ Master of public health applied research orientation) U YES………………………………………………………………………………… ……… ……………………………………………………………………………… 14 Thesis topic: Comments Good………………………………………………………………………………… H ……………………………………………………………………………………… Which part need to be edited, (if any): ……………………………………………….……………………………… ………………………………………………………………………………… ………… Research summary: Comments The problem is only quantified, which does not automatically justify Knowledge on prevention study (is the root of the problem knowledge??) The results are not clear this is partly English/and partly giving pieces of info that are not directly useful For example you state: using sharp materials with HIV positive person? What is meant, and why not discuss other ways of 85 transmitting which seem more related to pregnant women (having sex/MTCT), sharp object are mostly relevant for Intravenous drug users !!! After reading the intro, please add MTCT in the abstract as well …………………………………………………………………………… ………………………………………………………………………………… Which part need to be edited, (if any): Pleases add a part that makes clear the problem may be with lack of knowledge/incidence increasing, etc… and please also make clear why this target group is of interest ……………………………………………… ………………………………………………………………………………… ………………………………………………………………………………… H P 15 Introduction: Comments: The focus is unclear Pregnant women? MTCT? Or just knowledge The target group „pregnant women‟ is a bit odd Unless we focus on MTCT This is unclear Or provide reasons why you ask pregnant women… and no other groups Because this can also be a reason: that you want to question sexually active women: and therefore you sampled at ANC ………………………………………………………………………………… U H Which part need to be edited, (if any): Provide more evidence that it is important to focus on pregnant women For example, make clear how much MTCT is there in Laos? Or provide reasons why you ask pregnant women… and no other groups Because this can also be a reason: that you want to question sexually active women: and therefore you sampled at ANC ………………………………………………………… ……………………………………………………………………………………… Research Objectives: Comments fine: See below on pregnant women …………………………………………………………………………… ……………………………………………………………………………………… Which part need to be edited, (if any): 86 I advise to make the study focus on sexually active women An make clear in the methods that you sampled thought ANC as these women are sexually active (a limitations is off course that it has a focus on women who are already health-seeking)……………………………………………………… ……………………………………………………………………………………… ……………………………………………………………………………………… Literature review: Comments: (structure and content of literature review are coherent with objectives and research topic, use updated reference and citation correctly, and other comments (if any): The literature review is fragmented and not always relevant It focuses too much on context and broad concepts, with references to literature that is not always relevant (e.g reference to the situation in Norway) H P The latter part on HIV in Laos is much better Though the relations between KAP and MTCT is not made very clear Nor what can be done with the evidence ………………………………………………………………………………… ………………………………………………………………………………… ………………………………………………………………………………… U Which part need to be edited, (if any): (Would make the start briefer) H And thereafter make more clear how KAP and MTCT is related, and how insight in KPA can help in improving prevention …………………………………………………………………… ………………………………………………………………………………… ………………………………………………………………………………… 16 Subjects and research methods: Comments: (i) Subjects are suitable to objectives; (ii) Sample size and sample selection are appropriate and feasible; (iii) Variables/contents are suitable to objectives, orientation and specialized codes; (iv) Data collection is clear, feasible and appropriate with research content; (v) Data analysis and research ethic are written clearly and appropriately; (vi) Other comments (if any): - It covers most aspects: though it is written down in bullets and it is not a structured story (but this is probably the format) 87 - Why you make this division: as than you will always have the most in the middle? Even if everyone scores high or low - High level = > Mean ± Standard Deviation - Moderate level = Mean ± Standard Deviation - Low level = < > Mean ¬ Standard Deviation  This needs to be discussed with your supervisor Why did you choose for creating three levels: why not continuous, or two or levels I - miss: on what questionnaire are the questions based: how sure are we that this is a valid measurement tool? Which part need to be edited, (if any): - Add on what Questionnaire this is based, and/or how it is made adapted for your study - Please write more in an article form (not needed) - Discuss the division of low/medium high with your supervisor H P Research results: Comments: (i) Research results are suitable with objectives, orientation and specialized codes; (ii) Research result is presented clearly and followed by objectives; (iii) Using data analysis appropriately and ensuring confidence of these methods; and other comments (if any): - The English makes it sometimes hard to understand whether the author make statements intentionally: Majority of the respondents, 101 (47.0%), did not know that HIV can be transmitted by insect bite  insect bites can‟t transmit HIV? So how I need to interpreted this  CHANGE - The part on attitude is unclear: what is meant with HIGH, please elaborate here - For the regressions: I am not sure whether the choice of high/medium/low is sufficient, and therefore I am not sure whether you are using the right outcome variable: can you make it continuous? Is it normally distributed? Please discuss with your supervisor U H Which part need to be edited, (if any): see above ……………………………………………………………………………………… ……………………………………………………… ……………………………… …………………………………………………………… 17 Discussion: Comments: (i) Structure/Content of this part are suitable to objective and research results; (ii) Reference citation is correct: 88 - The discussion lacks interpretation of findings? What can we with the data??? - The discussion should be aligned when choices related pregnant women are made …………………………………………………………………………………… …………………………………………………………………………………… Which part need to be edited, (if any): ……………………………………………………………………………………… ……………………………………………………… ……………………………… …………………………………………………………… ………………………… Conclusion: Comments: (The main research result are given in this part and suitable to objectives) Fine: but lacks what we can/should with findings/evidence …………………………………………………………………………………… … ……………………………………………………………………………… …………………………………………………………………………………… H P Which part need to be edited, (if any): ……………………………………………… ……………………………… ………………………………………………………………………………… …………… Recommendations U H Comments: The recommendation is given appropriately and based on research results: ……… ……………………………………………………………………………… ……………………………………………………………………………………… Which part need to be edited, (if any): ……………………………………………………………………………………… ……………………………………………………… ……………………………… 18 FINAL CONCLUSION: (NEED TO BE CLEARLY STATE): [ ] Approval [ ] Approval with some conditions [ ] Reject I have read the report with interest, this is very important Congratulations I approve with minor conditions: 1- Make the link between target group and findings more clear (see also above) a Why you focus on pregnant women 89 b The questionnaire is not geared towards MTCT, but more general c The literature also has a more general focus d I would make pregnant women a choice in sampling (as these are sexually active) rather than making it part of the aim 2- Make clear what the basis was of the questionnaire and how it was adapted 3- Discuss you‟re your supervisor whether the choice of outcome variable (high/medium/low is smart 4- Be clear about the relation between insect bites and getting HIV 5- Align the discussion with new set-up of the study ………………………………………………………………………………… ………………………………………………………………………………… H P (Notes: Please not WRITE your name because this is a hidden comment round) H U Reviewer (Sign and full name) Dr Dirk Essink 90 Annex 8: Minutes of Explanation MINISTRY OF HEALTH HANOI UNIVERSITY OF PUBLIC HEALTH FORM MINUTES OF EXPLANATION AFTER THESIS/PROPOSAL DEFENCE Full name: ……Ms Phoungeun PHONGXAY………………………………………… Thesis title: H P “Knowledge, attitudes and practices regarding HIV/AIDS prevention among pregnant women attending antenatal care at the Setthathirath Hospital in Vientiane Capital, Lao People’s Democratic Republic” TT Student’s explanations detail Comments (List all comments followed by outline/ dissertation/thesis/thematic structure) Thesis topic ………………… Abstract ……………………… U Orientation and specialized codes …………… (Clearly state how, which part, page that student edits if students disagree, reasons should be indicated H ……………………… ……………………… Introduction Need to look back general objective - I added more in the introduction and developed the question and cut some points to be appropriate - Revised the research questions according to topic of study Objectives ……………………… ………………………… 91 Review of Literature/Theoretical framework • Read the instruction first for how to write the literature in general - I have revised and follow with the instruction •Associated factor need to matching with conceptual frame work - I added more determinants of K/P on HIV prevention which linked to conceptual framework used in this study • Need to revise all indicate of DV and IV knowledge attitude and practice - For the conceptual framework, I revised according to objectives of study Objects and research methods • 8.2 assessments was not clear enough, Mean, under Mean and over the Mean how to measure and analysis • Max and score, 10 questions with Likertscale 1-5: and how calculate and sum score? - I have revised - I did measure knowledge; how to measure practices, attitudes by questionnaire will be used as an instrument for data collection by selfadminister the target population H P - I added the define of independent and dependent variables - Max and score, 10 questions with Likertscale 1-5: I have calculate by mean score on STATA programmed - I got ethical approval for this study U Study results • No explanation and significant and no model regarding to the model H • Don‟t know any meaning of analysis • Regression between attitude and factor influencing the HIV prevention • DV and IV need to be clear in the result • Associated factor DV or IV need to be clear for analysis • Multiple linear analysis: high mean=high knowledge… - High mean=positive attitude… • Univariate and multiple analyses need to be clear • Which variable need to include in the multiple analyses for each outcome variable • Multivariate clear more in the result • General=>outcome variable by subtitle I did revise it and revised an analyzed of the results presented by research objectives and conceptual framework followed by the old comment until now 92 • Understanding the logical thing on the study what outcome or DV need to be add in the model • All the table for DV put in the model and match with conceptual framework • Put the result in the content and table Discuss Template and structure should be revised 10 I have revised Conclusions • Please clear in factor associated I have revised • High, low and poor categorize • Need to conclude each like if three should be conclude by categorize 11 Please follow from conclusions 12 I have revised References U Too many but some reference did not use in this thesis, so cut and choose the real one with content suitable 13 H P Recommendations Questionnaire H • Put more question into mother to child prevention You should arrange variable to correct parts such as Knowledge, Attitude and practices I have revised For the questionnaire, I revised and developed variable to correct parts such as Knowledge, Attitude and practices • Questionnaires for attitudes should not only question Yes or No • Look back the question about the attitude what include and maternal factor like yes, no question 14 Other comments • Why focus on practice on the pregnant women and PMCT • How about the children or mother • Introduction and discussion need to be clear I have revised 93 Notes: - Use line to separate each Comments and explanations Comments and equivalent explanations stay at the same row - Explanations should be written by following thesis structure (if any) Students not mention the examiners‟ name Day 17 February year 2020 Student (Sign and full name) H P Phoungeun PHONGXAY 1st supervisor 2nd supervisor Supporting lecture (if any) (Sign and full name) (Sign and full name) (Sign and full name) Dr Somphou SAYASONE Dr Duong Minh Duc U H Examiners’ comments (if any): Prof Vanphanum SYCHAREUN ………………………………………………………………………………………… …… ………………………………………………………………………………………… …… Day 10 February year 2020 On behalf of the committee (Sign and full name) Assoc Prof Nguyen Thanh Huong