Luận văn 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

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 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 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 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 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 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 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 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 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 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 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 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 2.8.2 Measures and assessment 23 2.8.2.1 Knowledge regarding HIV/AIDS prevention among pregnant women 23 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 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 LIST OF ANNEXES 58 Annex 1: Pregnant woman consent form 58 Annex 2: Key variables factors 60 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 vi ABBREVIATIONS AIDS …………………Acquired Immunity Deficiency Syndrome AMR …………………Ambulatory Medical Record ART ………………….Anti-Retroviral Treatment GARP…………………Global AIDS Response Progress HCWs ……………… Healthcare Workers HIV.………………….Human Immunodeficiency Virus JICA…………………Japan International Cooperation Agency KAP Knowledge, Attitudes and Practices PMTCT .Prevention of Mother-to-Cchild Transmission of HIV MTCT .Mother-to-Child Transmission SPSS Statistical Package for Social Sciences 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 …….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 Table 3.6.2: Multiple logistic regression association between practices and influencing factors…………………………………………………………… 40 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 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 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) 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