KNOWLEDGE AND ATTITUDE ON PREVENTION OF MOTHER TO CHILD TRANSMISSION OF HIV AMONG WOMEN ATTENDING ANTENATAL CARE IN MADAKIYA PHC

TOPIC IS SUITABLE FOR:
1-Department of Nursing Science
2-Department of Public Health
3-Department of Community Health
4-Department of Health Education

TOPIC: KNOWLEDGE AND ATTITUDE ON PREVENTION OF MOTHER TO CHILD TRANSMISSION OF HIV AMONG WOMEN ATTENDING ANTENATAL CARE IN MADAKIYA PHC

TABLE OF CONTENT
Abstract
CHAPTER ONE: INTRODUCTION
1.1 Background of the Study
1.2 Statement of the Problem
1.3 Objectives of the Study
1.4 Research Questions
1.5 Hypotheses
1.6 Significance of the Study
1.7 Scope of the Study
1.8 Operational Definition of Terms
CHAPTER TWO: LITERATURE REVIEW
2.1 Conceptual Review
2.2 Theoretical Framework
2.3 Empirical Review
2.4 Research Gaps
CHAPTER THREE: METHODOLOGY    
3.1 Research Design    
3.2 Research Setting         
3.3 Target population                                  
3.4 Sample size 
3.5 Sampling technique    
3.6 Instruments for data collection     
3.7 Validity and Reliability of Instrument
3.8. Pilot Study    
CHAPTER FOUR: DATA PRESENTATION AND ANALYSIS
4.0 Introduction
4.1 Demographic Analysis 
4.2 Analysis of the level of knowledge of prevention of mother to child transmission of HIV among women attending ANC in Madakiya PHC
4.3 Analysis of the attitudes of women towards prevention of mother to child transmission of HIV in Madakiya PHC
4.4 Analysis of the preventive measures of mother to child transmission of HIV practiced among women attending ANC in Madakiya PHC
CHAPTER FIVE: DISCUSSION OF FINDINGS
5.1 Key findings    
5.2 Implications of findings to nursing                            
5.3 Limitations of the study                            
5.4 Summary of the study                                      
5.5 Conclusion                                    
5.6 Recommendations                                 
5.7 Suggestions for further studies 
References
Appendix

ABSTRACT
This study assessed the knowledge and attitude on prevention of mother to child transmission of HIV among women attending Antenatal Care in Madakiya PHC. The study aimed to assess the level of knowledge of prevention of mother to child transmission of HIV among women attending ANC, assess the attitudes of women towards prevention of mother to child transmission of HIV, evaluate the preventive measures of mother to child transmission of HIV practiced among women attending ANC, and to identify the factors influencing the attitude and practice of preventive measures of mother to child transmission of HIV women attending ANC in Madakiya PHC. Descriptive research design was adopted to have a better understanding of respondents' knowledge, attitudes and practices. Study population consisted of 240 women coming to ANC in Madakiya PHC from which sample size of 150 was calculated using Taro Yamane's formula. Participants were selected using a multi-stage sampling technique of stratified and convenience sampling. Data were collected using a structured questionnaire which covered demographic details, knowledge on PMTCT, attitude towards prevention and actual practices and factors affecting adherence to PMTCT. Data were analyzed using descriptive statistics such as frequency counts, percentages, mean and standard deviation. The results showed that the respondents had moderate knowledge of PMTCT with mean scores ranging from 2.8 to 3.1, slightly low attitudes with mean scores from 2.8 to 3.0 and moderate, slightly low preventive practices with mean scores of 2.8 to 3.0. The positive determinants of adherence, health education, partner and family support, counseling, and peer influence, had high mean scores ranging between 3.4 and 3.6, which means that there was strong support for appropriate PMTCT practices. Based on the findings, it was recommended that health authorities should enhance PMTCT education programs, health workers should offer continuous counseling and guidance, families and communities should help with adherence, and policy makers should improve access to regular follow-up ANC services for effective PMTCT. 
Keywords: knowledge, attitude, prevention, mother to child transmission, HIV,women. 

CHAPTER ONE
INTRODUCTION (Preview)
1.1 Background of the Study
Mother-to-child transmission (MTCT) of HIV is still one of the main avenues of HIV infection in children around the world and contributes a large proportion of paediatric new cases each year. In the world, close to 1.3 million women living with HIV have a child annually, and without appropriate interventions, the risk of transmission during pregnancy, delivery, labour or breastfeeding is 15-45% (Terefe et al., 2024; Yeshaneh et al., 2023). The prevention of mother-to-child transmission (PMTCT) has thus become a pillar of global HIV response and integrated approaches to PMTCT, including routine antenatal HIV testing, antiretroviral therapy (ART) initiation and promotion of safe infant feeding practises, have proven to be extremely effective. As Dhillon et al. (2023) point out, women's awareness directly leads to service use as they know the routes of transmission and preventive measures, which is why maternal awareness is important in ensuring that the progress towards achieving elimination of paediatric HIV infection is maintained.
Over the last two decades, there has been a significant decrease in MTCT rates as a result of intervention worldwide, especially in high-income countries where PMTCT coverage is above 90%. However, in sub-Saharan Africa, where HIV prevalence among women of reproductive age is the highest, the lack of knowledge, attitude, and access to services is still a major barrier to progress (Tamir et al., 2024; Zegeye et al., 2020). For example, Olakunde et al. (2019) posit that in spite of policy progress in Nigeria, PMTCT work is undermined by systemic barriers including lack of health system resources and sociocultural barriers. To support this stance, Udeji et al. (2024) highlight a lack of knowledge and misconception of HIV transmission and prevention among pregnant women, which continues to fuel their vulnerabilities. Thus, enhancement of women's understanding of PMTCT interventions during antenatal care (ANC) is acknowledged as one of the key determinants of effective prevention outcomes.
Equally important to the provision of PMTCT services, however, is the attitude towards the services which is a critical factor for uptake and adherence. While knowledge is the intellectual base, positive attitudes influence women's willingness to test for HIV, to disclose their status and to adhere to treatment protocols (Ngadaya et al., 2021; Saka et al., 2021). For example, Ezenkiri (2020) found that expectant mothers who viewed HIV testing as routine, as well as a good thing to do, were more likely to follow the recommendations related to prevention, whereas negative perceptions informed by the stigma dissuaded the participation. Similarly, Dirisu et al (2020) suggested that at the community level, stigma and individuals' fears of discrimination have an impact not only on women's attitudes but also on overall utilisation of ANC services. This dynamic interaction between knowledge and attitude reflects the complexity of the nature of influencing maternal health-seeking behaviour in culturally sensitive settings.
Within Nigeria, PMTCT has been incorporated into national HIV response programmes but it is not consistently being adopted by pregnant women. Spatial variations in the level of knowledge were described by Olopha et al. (2021), where women in the rural communities are a lot of times reported as having a lower level of awareness compared to those in the urban areas and this reiterates the inequality in service utilisation. According to Udoh and Ushie (2019), the use of opt-out strategy for antenatal HIV testing in Nigeria has meant that the coverage of antenatal HIV testing has improved nationally, however, the uptake of antenatal HIV testing varies significantly depending on women's perception of confidentiality and trust in healthcare providers. These results are consistent with the argument of Joseph and Yalma (2024) that women's willingness to access PMTCT services is not only determined by clinical indication but also by the perceived benefits and social support structures that the women have. Thus, contextual factors are very important in influencing knowledge and attitude towards prevention.
Furthermore, women's actual preventive behaviours like taking HIV tests, following antiretroviral therapy and safe infant feeding practises are closely tied to their knowledge and attitudes (Yeshaneh et al., 2023; Sabu et al., 2019). For example, Tura (2019) has shown that women who had detailed knowledge about the transmission and prevention of HIV were more likely to implement and maintain preventive practises during and after pregnancy. To further support this claim, Zegeye et al. (2020) contend that adherence is more often improved if women perceive PMTCT services as accessible and useful. However, according to Danladi et al. (2020), frequent practise is often discouraged for various reasons such as fear of reaction from the spouse, lack of finances to travel to health facilities because of its travel distance from their present home. This affirms the importance of the integration of knowledge, attitude and practise in the holistic framework of PMTCT.
Adding to this complexity are structural and contextual determinants such as health system readiness, community norms and socioeconomic status. Olakunde et al. (2022) demonstrate the inequities that are apparent in geographic variations in missed opportunities for PMTCT, especially among rural and under-resourced areas. Similarly, Ndonga and Mn (2019) also underscore that the uptake of PMTCT services by women in Nairobi was largely affected by the healthcare infrastructure and interactions between healthcare providers and clients. These findings echo those of Loarec et al (2021) who, while specifically focused on hepatitis B in Mozambique, suggested that maternal health services remain important entry points for disease prevention, but only if well resourced and trusted by their communities. This underscores the general importance of maternal knowledge and attitudes for the use of ANC services for public health interventions.
In view of these debates, maternal knowledge and attitudes associated with PMTCT still gain scholarly and policy attention, especially in areas such as sub-Saharan Africa where maternal and child health outcomes still remain precarious. Yeshaneh, Polyakov, Zaini, & Pedrin (2023) say that knowledge-enhancing interventions need to be accompanied by positive attitude change interventions to promote long-term behavioural change. In addition, Harrison et al. (2021) argue that even in the HIV-positive mothers, lack of a comprehensive understanding of the transmission pathways and prevention options has led to poor adherence to treatment regimens. Therefore, ANC strengthening to ensure good information is given, misconceptions are dispelled and supportive attitudes developed is increasingly viewed as a key component to attaining the global goal of eliminating MTCT.
Complementing this global and regional discussion, localised studies are needed to bring out local and context-specific challenges and opportunities. Other studies like Nwanja et al. (2023) in Nigeria have shown that there is a community-based approach to HIV testing that can increase the knowledge of women, decrease the stigma and improve attitudes towards PMTCT. Similarly, Parvine et al. (2025) found in Bangladesh that the level of awareness of pregnant women predicted their practice of preventive activities significantly, showing that knowledge-attitude-practice linkages are universal. Thus, studying women's knowledge, attitudes and practises regarding PMTCT in a specific context like Madakiya PHC will be very informative about the dynamics of health in the community, and also the effectiveness of interventions in place. Such local evaluations can be used to develop evidence-based interventions that can be used to improve maternal and child health and contribute to the global HIV control.

1.2 Statement of the Problem
Mother-to-child transmission of HIV is still a public health issue in the sub-Saharan African region and Nigeria has one of the largest burdens of paediatric HIV infections in the world (Olakunde et al., 2019; Tamir et al., 2024). Despite scale up of prevention of mother to child transmission (PMTCT) services through antenatal routine care (ANC), there are still gaps and inconsistencies in the scale up of preventive interventions, as shown by national reports from different countries (Olakunde et al., 2022; Udeji et al., 2024), particularly in the rural and semi urban areas. Ideally, all pregnant women attending ANC will have adequate knowledge of PMTCT, positive attitudes towards HTS and treatment and adhere to PMTCT practises. However, there are studies that strengthen the fact that most women are unaware of some important aspects regarding HIV transmission during pregnancy, delivery and breastfeeding and, therefore, putting their infants at risk of infection (Yeshaneh et al., 2023; Tura, 2019). The gap between women's access to PMTCT services and their knowledge, attitudes and practices shows the continued challenge to achieving elimination targets.
Previous studies in Nigeria and other African countries have documented that there is heterogeneity in maternal awareness, attitude and utilisation of PMTCT services which is due to stigma, sociocultural belief and structural barrier (Dirisu et al., 2020; Saka et al., 2021). For instance, Olopha et al. (2021) noted a wide regional variation in knowledge levels and Ngadaya et al. (2021) noted that many women despite their knowledge of services did not translate such knowledge into prevention practises. Ideally, the maternal population ought to be well informed, motivated and empowered to be able to fully comply with the PMTCT protocol so as to ensure that infants are born HIV free. However, little information is available on the local knowledge, attitudes and practises of women, particularly in Madakiya PHC. This paper seeks to fill this gap by providing context-based evidence of issues influencing women's knowledge and use of PMTCT service to support better design of policies and interventions in rural Nigerian settings.
1.3 Objectives of the Study
The broad objective of this study is to examine the knowledge and attitudes on prevention of mother-to-child transmission (PMTCT) of HIV among women attending antenatal care (ANC) at Madakiya Primary Health Centre (PHC).
The specific objectives are to:
1.Assess the level of knowledge of prevention of mother-to-child transmission of HIV among women attending ANC in Madakiya PHC.
2.Examine the attitudes of women towards prevention of mother-to-child transmission of HIV in Madakiya PHC.
3.Evaluate the preventive measures of mother-to-child transmission of HIV practiced among women attending ANC in Madakiya PHC.
4.Identify the factors influencing the attitudes and practices of preventive measures of mother-to-child transmission of HIV among women attending ANC in Madakiya PHC.
OTHER PARTS OF CHAPTER ONE INCLUDE:
1.4 Research Questions
1.5 Hypotheses
1.6 Significance of the Study
1.7 Scope of the Study
1.8 Operational Definition of Terms

CHAPTER TWO
LITERATURE REVIEW  (Preview)
This chapter critically examines relevant literature that would assist in explaining the research problem and, furthermore, recognizes the efforts of scholars who had previously contributed immensely to similar research. The chapter intends to deepen the understanding of the study and close the perceived gaps. This chapter, therefore, focuses on the concept of HIV, the concept of mother-to-child transmission of HIV, knowledge of prevention of mother-to-child transmission of HIV, attitudes towards prevention of mother-to-child transmission of HIV, and factors influencing the prevention of mother-to-child transmission of HIV among women attending antenatal care. The chapter covers the following subheadings:
2.1 Conceptual Framework
2.2 Theoretical Framework
2.3 Empirical Review
2.4 Summary of Literature Review

CHAPTER THREE
RESEARCH METHODOLOGY (Preview)
Research Design: The study adopted a descriptive research design.
Population of the Study: The population of the study comprises women attending antenatal care at Madakiya PHC.
Sample Size Determination: The study adopted the Taro Yamane formula to determine a sample size of 150 participants.
Sampling Technique: The study employed a stratified sampling technique and convenience sampling to select the individual respondents.
Research Instrument: The study utilized a structured questionnaire as the instrument for data collection.
Methods of Data Analysis: The collected data were analyzed using frequencies and percentages to summarize and present the demographic characteristics of the respondents and their opinions. The data were analyzed using SPSS and presented in tables, charts, and graphs.

CHAPTER FOUR: DATA PRESENTATION AND ANALYSIS
MAJOR FINDINGS (Preview)
The analysis results were presented in tables. Based on the results obtained from the analysis, the following findings are made:

i. The study found that women attending ANC in Madakiya PHC generally demonstrated moderate or slightly low attitudes towards the prevention of mother-to-child transmission (PMTCT) of HIV, as evidenced by mean scores ranging from 2.8 to 3.0, which were above the acceptance benchmark of 2.50.

ii. The study found that women attending ANC in Madakiya PHC demonstrated moderate or slightly low practices of PMTCT preventive measures, as evidenced by mean scores ranging from 2.8 to 3.0, which were above the acceptance benchmark of 2.50.

iii. The study found that health education, support from partners and family, accessibility of healthcare facilities, knowledge gained during ANC sessions, counselling, reassurance, and peer support positively influenced women's attitudes and practices towards PMTCT of HIV, as evidenced by mean scores ranging from 3.4 to 3.6, which were above the acceptance benchmark of 3.0.

iv. The study found that the level of knowledge of PMTCT of HIV among women attending ANC in Madakiya PHC was not generally low, as evidenced by a chi-square value of 4.80, degree of freedom of 1, and p-value of 0.028 (p < 0.05), leading to the rejection of the null hypothesis.

v. The study found a statistically significant relationship between women's attitudes and their utilization of PMTCT preventive measures in Madakiya PHC, as evidenced by a chi-square value of 9.62, degree of freedom of 3, and p-value of 0.022 (p < 0.05), leading to the rejection of the null hypothesis.

CHAPTER FIVE:DISCUSSION OF FINDINGS
This chapter covers the following outline:
5.1 Key findings
5.2 Implication of the Findings
5.3 Limitations of the Study
5.4 Summary of the Study
5.5 Conclusion
5.6 Recommendations
5.7 Suggestions for Further Studies

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