www.idosr.

org Katigi
©IDOSR PUBLICATIONS
International Digital Organization for Scientific Research ISSN:2579-0730
IDOSR JOURNAL OF BIOLOGY, CHEMISTRY AND PHARMACY 8(1)15-32, 2023.
Factors Influencing the Elimination of Mother to Child HIV Transmission
Services at Mbarara Regional Referral Hospital, Mbarara District, Uganda.
Katigi, Lodger

School of Nursing sciences, Kampala International University Western campus, Uganda.

ABSTRACT
This study was carried out at Mbarara Regional Referral Hospital, Mbarara District with the
purpose of identifying the factors influencing low utilization of elimination of Mother to
child Transmission (eMTCT) services by pregnant mothers. A descriptive design was
employed and 81 respondents were selected using simple random sampling method. Data
was collected using interview guides. The study found out that respondents faced various
socio-economic factors influencing utilization of eMTCT services by pregnant mothers. For
instance, although all respondents 81 (100%) had ever heard about eMTCT services and 50
(62%) obtained information about eMTCT services from health workers, most 50 (61.7%)
understood eMTCT as giving ARVs to the mother and baby and 40 (80%) prevention of
MTCT as a benefit of eMTCT. However, 60 (74.1%) felt stigmatized because of using eMTCT
services and most 40 (66.7%) were stigmatized by their friends and 40 (49%) sometimes got
support from their husbands in accessing eMTCT services. Other factors included 20
(24.7%) labeling and stigmatization, 16 (19.7%) lack of support, 13 (16.2%) unemployment
and 12 (14.8%) poverty among others. Respondents also faced various health facility factors
influencing utilization of eMTCT services by pregnant mothers and although most 50 (62%)
reported that they had ever attended eMTCT services, most 35 (70%) did not find the
services confidential, 30 (60%) said eMTCT services were not available all the time despite
50 (62%) health workers having positive attitudes towards pregnant mothers utilizing
eMTCT services. In conclusion, the study found out that pregnant mothers faced both socio
economic and health facility factors influencing utilization of eMTCT services at Mbarara
Regional Referral Hospital. The key recommendations included improving male partner
support, ensuring ready availability of services, health education about how to reduce
stigma attached to the illness as well as the importance and benefits of eMTCT services.
Keywords: HIV infections, ARVs, eMTCT, health workers
INTRODUCTION
Elimination of Mother to Child moment in time and elimination is when
Transmission of Human the disease or infection incidence falls to
Immunodeficiency Virus (eMTCT) is a zero within a geographical area [3, 11, 12,
major health service provided to 13, 14, 15].
expectant mothers infected with HIV [1, 2, According to Adewole et al. [4], globally,
3, 4, 5, 6]. It has been noted that there is in developed and developing countries,
an increase in number of babies infected the eMTCT strategy had proved to be
with (HIV) most especially within the effective in prevention of vertical
developing countries of which Uganda is transmission of HIV, but other reports on
among. eMTCT involvement among male partners
[2; 3, 7, 8, 9, 10] stated that every year, indicate that the lack of knowledge and
330,000 babies were infected with HIV positive attitude towards eMTCT by
and the major route of HIV becoming women aged 15 – 45 years of age have a
Mother to Child Transmission (MTCT). direct impact on their attendance of
The term validation was used when a eMTCT programs [16, 17,18].
country had successfully met the criteria In Sub Saharan African countries, the
for eliminating mother to child utilization of eMTCT services remains
transmission (eMTCT) of HIV at a specific low. For instance, although Nigeria has an

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estimated national HIV prevalence of centers III and IV which showed a high
4.6%, the third largest number of people level of coverage for the service.
living with HIV/AIDS in the world and it is However, despite this high coverage and
estimated that in 2014, Nigeria had an the fact that the services were free of
estimated 2.95 million people currently charge, attendance to this program among
infected with HIV and 278,000 children women aged 15 – 45 years of age
were living with HIV, while more than 90% remained somewhat lower than expected
of the infections among children occur [8].
through MTCT [2]. However, the According to Uganda National Central
utilization of eMTCT services remains low Public Health Laboratory-Exposed Infant
due to factors such as lack of Diagnosis Dashboard (CPHL-EID) [9].
confidentiality and privacy at health Mbarara Regional Referral Hospital was at
facilities, poverty, long distance to health a positivity rate of 3.3% meaning out of
facilities as well negative attitudes of 240 tests 8 became positive.
health workers towards mothers [2, 19, And only 60% of positive mothers who
20]. were due for a re-test during labor and
According to Baryomunsi et al. [5], in delivery were tested for HIV, and only 40%
studies carried out in East African of positive mothers during labor and
countries like Tanzania and Kenya, delivery were initiated on ART
findings have shown that eMTCT is well immediately. (SIMS –Site Improvement
provided at hospital and health center Monitoring System, USAID RHITES). It was
level, but the level of utilization of these thus against this background that the
services by women aged 15 – 45 years of researcher would like to carry out a study
age remains low. The particular factors to identify these factors and suggest
influencing low utilization of eMTCT solutions to improve service utilization.
services included lack of awareness about Aim of the study
the services, lack of support as well as The purpose of the study was to identify
level of education of household head. the factors influencing utilization of
Homsy et al. [6] reported in their study in eMTCT services by pregnant mothers at
Ugandan hospitals that eMTCT was well Mbarara Regional Referral Hospital,
provided and readily available across Mbarara District.
various levels of health facilities, its Specific objectives
utilization by mothers remains lower than 1) To identify the socio demographic
expected due to various factors such as factors influencing low utilization
poverty, lack of funds for transport, of eMTCTservices by pregnant
unavailability of reliable and affordable mothers at Mbarara Regional
transport as well as lack of interest in Referral Hospital, Mbarara District.
eMTCT services among others. 2) To determine the socio-economic
Problem Statement factors influencing low utilization
In Uganda, HIV/AIDS remains a major of eMTCT services by pregnant
public health problem and it was mothers at Mbarara Regional
estimated that up to 95% of babies who Referral Hospital, Mbarara District.
were infected with HIV acquired infection 3) To identify the health facility
through Mother to Child Transmission related factors influencing low
(MTCT), and over 90% of HIV infections in utilization of eMTCT
children less than 15 years was due to services by pregnant mothers at
MTCT and 15 - 45% of children born to Mbarara Regional Referral Hospital,
women aged 15 – 45 years of age acquired Mbarara District.
infection in the absence of intervention
such as eMTCT [7].
According to Asiimwe et al. [7], in every
district of Uganda there is an eMTCT
center based in district hospitals and
eMTCT services offered at the health

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Research Questions encouragement of pregnant mothers to
1) What are the socio demographic access and utilize these services.
factors influencing low utilization The study is also intended to assist policy
of eMTCTservices by pregnant makers and planner by identifying and
mothers at Mbarara Regional isolating potential areas which still
Referral Hospital, Mbarara District? require more funding and development in
2) What are the socio economic terms of ensuring better provision of
factors influencing low utilization eMTCT services in all regions of Uganda.
of eMTCT services by pregnant This study served the purpose of
mothers at Mbarara Regional identifying the factors influencing low
Referral Hospital, Mbarara District? utilization of eMTCT services by pregnant
3) What are the health facility related mothers. This may thus assist the
factors influencing low utilization administration of Mbarara Regional
of eMTCT services by pregnant Referral Hospital as well as health
mothers at Mbarara Regional workers, especially those in ANC clinic to
Referral Hospital, Mbarara District? come up with ways of health educating
Justification of the study pregnant mothers about eMTCT and its
The study may aid the clinicians, Mbarara importance to improve utilization of
Regional Referral Hospital these services.
administration/management in The results from this study provided a
addressing the problem of low utilization valuable reference point for future
of eMTCT services. This could be studies on this issue and also contributed
achieved through targeted promotion of to the available body of research on the
the services as well as sensitization and factors influencing low utilization of
eMTCT services by pregnant mothers.
METHODOLOGY
Study Design people and is 260 km by road south west
The study was descriptive cross sectional of Kampala Uganda’s capital city.
employing both quantitative and Mbarara Regional Referral Hospital
qualitative data collection methods. This provides many health services including
study design was selected because it but not limited to internal medicine,
assisted in getting the required data for pediatrics and obstetrics and gynecology,
the study. ANC and post natal services, surgery
Study setting and rationale among many other services.
The study was conducted at the ANC in Study Population
Mbarara Regional Referral Hospital. It was The study included pregnant mothers
selected because of its convenience to the attending ANC services at Mbarara
researcher and there was limited Regional Referral Hospital in Mbarara
information regarding factors influencing District.
low utilization of eMTCT services by Sample Size and sampling method
mothers attending at Mbarara Regional The sample size was got from the
Referral Hospital, Mbarara District. The formula;
hospital has a bed capacity of 350 and is N=z2pq
situated in Mbarara district, South- d2
western Uganda. The hospital with its The Kish and Leslie formula (1965)
wide-ranging departments and modern Where, n represents the sample size.
diagnostic facilities, are managed by d represents precision of study, a
qualified and experienced medical precision of 0.1(10%) will be used due to
personnel. Mbarara Regional Referral limited resources and the time factor
hospital policy is to deliver affordable consideration during the study.
and wide-ranging health care services to z-Represents standard normal deviation
Ugandans. The hospital had a projected corresponding to 95% confidence interval
catchment population of 3.2 million which is 1.96.

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p-Represents proportional characteristics 3. Health facility related factors
where no reasonable estimate is given, Data Collection Procedure
0.7(70%) was used. After the approval of the research
q-Represents 1-p. proposal, the letter of introduction was
Therefore; n=(1.96)2x 0.7(1-0.7) obtained from the school that was
(0.1)2 presented to the Hospital Director of
n =81 respondents. Mbarara Regional Referral Hospital and
Sampling procedure the ANC seeking approval. After securing
Simple random sampling method was approval, the researcher sampled out the
applied in this research to obtain the respondents and the questionnaires were
required number of respondents. The administered to the selected respondents
researcher wrote words YES and NO on who were able to read and understand the
pieces of paper and inserted them into an questions and wrote down the reply in the
enclosed box. The researcher offered spaces meant for the purpose in the
potential respondents an opportunity to questionnaire.
participate in the study by picking papers Data management
from the enclosed box and any Data management included data editing
respondent who picked a paper with the before leaving the area of study to ensure
word YES written on it were requested to that there were no mistakes or areas left
participate. This was continuously used blank, and any found were corrected
until the total of 81 respondents was before leaving the respondent. The
achieved. Simple random sampling interview guides were put in an envelope
method was used due to the ready and kept under lock and key awaiting data
availability of respondents at the ANC analysis and it was only accessible to the
clinic and also because it ensured that researcher.
bias was avoided and everybody got an Data analysis, processing and
equal opportunity to participate in the presentation
study. Data was collected in a period of Data was analysed using both qualitative
one week there were four ANC days in a and quantitative methods. For qualitative
week meaning every clinic day 20 data, themes were developed for
respondents were allowed to participate responses that related to similar issues.
in the study. For quantitative data, analysis involved
Inclusion criteria calculations of percentages, and
The researcher selected pregnant mothers presented graphically. Conclusions were
who met study criteria, were in good drawn by determining the frequency in
condition to participate in the study and the data and at this level biases were
agreed to consent and include them in the detected. Data pieces were collected
study. through document search, interviews and
Exclusion criteria questionnaire were analyzed on a
The study excluded women who were not qualitative basis involving data reduction,
pregnant, those pregnant but not organization and interpretation.
attending ANC services, those who were Frequency distribution tables, charts and
in poor condition and not able to graphs were made.
participate as well as any respondents Ethical Considerations
who had not consented to participate in A scientific/ethical approval letter was
the study. obtained from the administration of
Definition of Variables Kampala International University,
The study addressed the following introducing the researcher and seeking
variables; approval to carry out the study from
Independent variables Mbarara Regional Referral Hospital. Once
Utilization of eMTCT services approval had been granted, the researcher
Dependent variables was introduced to the in-charge of the
1. Socio demographic factors ANC who hence introduced the researcher
2. Socio economic factors to the respondents. Participants were

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assured of maximum privacy of all the objectives of the study had been well
information given and numbers instead of explained to participants and they had
names were used to identify respondents. consented to participate in the study.
The study only commenced after the
RESULTS
Demographic and Social Characteristics assessed to determine its relationship
The interview guide included questions with the factors influencing low
on demographic and social characteristics utilization of eMTCT services by pregnant
such as age, marital status, level of mothers at Mbarara Regional Referral
education, occupation, level of education Hospital, Mbarara District. The results
of husband/partner and occupation of were presented as follows.
husband/partner. This information was

40 35.8
35
29
30
24.7
25 22.2
20
20 17.3 18
14
15
10
5
0
18 – 25 years 26 – 35 years 36 – 45 years 45 years and above

Frequency Percentage (%)

Figure 1: Distribution of respondents by age n=81

Results from figure 1 above, showed that (24.7%) who were 36 – 45 years, 18 (22.2%)
29 (35.8%) respondents were in the age were 45 years and above while the least
range of 26 – 35 years, followed by 20 14 (17.3%) were 18 – 25 years.

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43.2
45
37.1
40 35
35 30
30
25
20
12.3
15 10
6 7.4
10
5
0
Single Married Widowed Co-habiting

Frequency Percentage (%)

Figure 2: Distribution of respondents by marital status n=81

From figure 2 above, findings showed that 10 (12.3%) were single while the least 6
35 (43.2%) respondents were co-habiting, (7.4%) were widowed.
followed by 30 (37.1%) who were married,
Table 1: Distribution of respondents by religion n=81
Religion Frequency Percentage (%)
Protestant 20 24.7
Catholic 40 49.4
Muslim 12 14.8
Pentecostal 9 11.1
Total 81 100

The majority of respondents 40 (49.4%) while the least 9 (11.1%) were

were Catholic, followed by 20 (24.7%) who Pentecostals.
were Protestant, 12 (14.8%) were Muslims

Professional
14%
House wife
31%

Self employed
55%

Figure 3: Distribution of respondents by occupation n=81

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From figure 3 above, showed the majority house wives while the least 11 (14%) were
of respondents 45 (55%) were self- professionals.
employed, followed by 25 (31%) were
Table 2: Distribution of respondents by level of education n=81
Level of education Frequency Percentage (%)
No education 19 23.5
Primary only 25 30.8
Secondary 22 27.2
Tertiary 15 18.5
Total 81 100

Results showed that 25 (30.8%) (23.5%) did not attain any education while
respondents attained primary level the least 15 (18.5%) attained tertiary level
education, followed by 22 (27.2%) who education.
attained secondary level education, 19

40 37.1
35
30.8 30
30
25 24.7
25
20
20
15
10 7.4
6
5
0
1 child 2 children 3 children Others (specify) 4 children
and above

Frequency Percentage (%)

Figure 4: Distribution of respondents by number of children n=81

From figure 4 above, findings showed that children, 20 (24.7%) had 4 children and
30 (37.1%) respondents had 3 children, above while the least 6 (7.4%) had 1 child.
followed by 25 (30.8%) who had 2

Socio economic factors influencing utilization of eMTCT services by pregnant mothers

Table 3: Ever heard about eMTCT services, n=81
Responses Frequency Percentage (%)
Yes 81 100
No 0 0
Total 81 100
All of the respondents 81 (100%) had ever heard about eMTCT services.

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Friends
25%

Media Health
13% worker
62%

Figure 5: Source of information about eMTCT services n=81

From figure 5 above, the majority of obtained information from friends while
respondents 50 (62%) obtained the least 11 (13%) obtained information
information about eMTCT services from from media.
health workers, followed by 20 (25%) who

Table 4: Respondents’ understanding of eMTCT services n=81

Responses Frequency Percentage (%)
Giving ARVs to the mother and baby 50 61.7
Continuous monitoring of mother and 31 38.3
child
Total 81 100

Most respondents 50 (61.7%) understood understood it as monitoring of mother

eMTCT as giving ARVs to the mother and and child.
baby while the least 31 (38.3%)
Table 5: Awareness of benefits of using eMTCT services n=81
Responses Frequency Percentage (%)
Yes 50 61.7
No 31 38.3
Total 81 100

Results showed that 50 (61.7%) (38.3%) were not aware of the benefits of
respondents were aware of the benefits of using eMTCT services.
using eMTCT services while the least 31
Table 6: Benefits of using eMTCT services n=50
Benefits Frequency Percentage (%)
Prevention of MTCT 40 80
Ensuring that the baby is born 10 20
healthy and strong
Total 50 100

Out of the 50 respondents who were prevention of MTCT while the least 10
aware of the benefits of using eMTCT (20%) reported ensuring that the baby is
services, most 40 (80%) reported born healthy and strong.

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Table 7: Level of education of partners n=81
Level of education Frequency Percentage (%)
No education 16 19.7
Primary only 31 38.3
Secondary 21 25.9
Tertiary 13 16.1
Total 81 100

Results showed that 31 (38.3%) education, 16 (19.7%) did not attain any
respondents reported that their partners education while the least 13 (16.1%)
attained primary level education, followed attained tertiary level education.
by 21 (25.9%) who attained secondary

60 55.6

50 45
40
30 25.9
18.5 21
20 15
10
0
Self employed Professional Peasant farmer

Frequency Percentage (%)

Figure 6: Occupation of respondents’ partners n=81

From figure 6above, most respondents 45 who were peasant farmers while the least
(55.6%) reported that their partners were 15 (18.5%) were professionals.
self-employed, followed by 21 (25.9%)
Table 8: What friends and family said about eMTCT services n=81
Responses Frequency Percentage (%)
It is a good service 50 61.7
It is a bad service 31 38.3
Total 81 100

The majority of respondents 50 (61.7%) while the least 31 (38.3%) said it is a bad
reported that their friends said eMTCT is service and this was attributed to the
a good service because it helped prevent stigma attached to HIV.
transmission of HIV from mother to child
Table 9: Whether respondents felt at all stigmatized because of using eMTCT services
n=81
Responses Frequency Percentage (%)
Yes 60 74.1
No 21 25.9
Total 81 100

The majority of respondents 60 (74.1%) services while the least 21 (25.9%) did not
felt stigmatized because of using eMTCT feel stigmatized using eMTCT services.

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Table 10: Who stigmatized respondents n=60
Responses Frequency Percentage (%)
My friends 40 66.7
My family 20 33.3
Total 60 100

Out of the 60 respondents who reported while the least 20 (33.3%) were
being stigmatized, most 40 (66.7%) said stigmatized by their family.
they were stigmatized by their friends

Never
21%
Sometimes
49%
Always
30%

Figure 7: Whether respondents got support from their husbands in accessing eMTCT
services n=81
From figure 7 above, results showed that said they always got support while the
40 (49%) respondents sometimes got least 17 (21%) said they never got support
support from their husbands in accessing from their husbands.
eMTCT services, followed by 24 (30%) who
Table 11: Socio economic factors influencing utilization of eMTCT services among
pregnant mothers n=81
Socio economic factors Frequency Percentage (%)
Unemployment 13 16.2
Poverty 12 14.8
Lack of support 16 19.7
Lack of knowledge/awareness 10 12.3
Negative attitudes towards services 10 12.3
Labeling and stigmatization 20 24.7
Total 81 100

Results showed that 20 (24.7%) unemployment, 12 (14.8%) reported

respondents mentioned labeling and poverty while the least 10 (12.3%)
stigmatization as a socio-economic factor reported lack of knowledge/awareness
influencing utilization of eMTCT services, and 10 (12.3%) mentioned negative
followed by 16 (19.7%) reported lack of attitudes towards services respectively.
support, 13 (16.2%) mentioned

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Health facility factors influencing utilization of eMTCT services by pregnant mothers

Yes
40%
No No
38% 60%
Yes
62%

Figure 10: Whether eMTCT services

were available all the time n=50
Figure 8: Ever attended eMTCT services From the figure 10 above, out of the 50
n=81 respondents who had ever attended
From figure 8 above, most respondents 50 eMTCT services, results showed that most
(62%) reported that they had ever 30 (60%) reported that eMTCT services
attended eMTCT services while the least were not available all the time and this
31 (38%) had never attended eMTCT affected their utilization of the eMTCT
services. services as health workers would not be
available while the least 20 (40%) said the
services were available all the time.

Yes Never
30% 16%

No
70% Always
Sometimes
24%
60%

Figure 9: Whether respondents found Figure 11: Whether health workers were
the services confidential n=50 available to offer eMTCT services at all
From the 9 above, out of the 50 times n=50
respondents who had attended eMTCT From the figure 11 above, most
services, most 35 (70%) did not find the respondents 30 (60%) reported that health
services confidential while the least 15 workers were sometimes available to offer
(30%) found the services confidential. eMTCT services at all times, followed by
12 (24%) who said they were always
available while the least 8 (16%) said they
were never available.

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80 61.7
50
60

40 24.7
20
11 13.6
20

0
Once 2 – 3 times More than 3 times

Frequency Percentage (%)

Figure 12: Number of times pregnant mothers should test for HIV n=81
From the figure 12 above, results showed HIV 2 – 3 times, followed by 20 (24.7%)
that 50 (61.7%) respondents reported that who mentioned once while the least 11
pregnant mothers should be tested for (13.6%) reported more than 3 times.
Table 12: Duration of breast feeding for a mother with HIV n=81
Duration Frequency Percentage (%)
6 months 15 18.5
1 year 24 29.6
More than one year 20 24.7
Should not breast feed 12 14.8
I don’t know 10 12.4
Total 81 100
Results showed that 24 (29.6%) than one year, 15 (18.5%) reported 6
respondents reported that mothers with months, 12 (14.8%) reported that mothers
HIV should breast feed for one year, should not breast feed while the least 10
followed by 20 (24.7%) reported more (12.4%) did not know.

Negative
38%

Positive
62%

Figure 13: Attitude of health workers towards pregnant mothers utilizing eMTCT
services, n=81
From the figure 13 above, the majority of services as they were welcoming and
respondents 50 (62%) reported that health polite to the mothers while the least 31
workers had positive attitudes towards (38%) had negative attitudes towards
pregnant mothers utilizing eMTCT pregnant mothers utilizing eMTCT

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services as they were rude and unwelcoming.
Table 13: Problems encountered in utilizing eMTCT services at the hospital n=81
Problems Frequency Percentage (%)
Long waiting time to receive 19 23.4
services
Unavailability of services 15 18.5
sometimes
Lack of privacy and confidentiality 23 28.4
Long distance to the hospital 13 16.1
Negative attitudes of health 11 13.6
workers
Total 81 100

Results showed that 23 (28.4%) reported unavailability of services sometimes, 13

lack of privacy and confidentiality as a (16.1%) reported long distance to the
problem they encountered in utilizing hospital while the least 11 (13.6%)
eMTCT services at the hospital, followed mentioned negative attitudes of health
by 19 (23.4%) reported long waiting time workers.
to receive services, 15 (18.5%) mentioned
DISCUSSION
Demographic and Social Characteristics respondents belonged to various faith
Results showed that 29 (35.8%) denominations. However, this did not
respondents were in the age range of 26 – have any bearing on the study.
35 years, followed by 20 (24.7%) who were The majority of respondents 45 (55%)
36 – 45 years, 18 (22.2%) were 45 years were self-employed. However, although
and above. This showed that most level of income was not assessed, it
respondents were relatively mature which implied that since most respondents were
implied that health care services at economically active, they would be in
Mbarara Regional Referral Hospital were better position to access and utilize ANC
mostly appreciated and utilized by older and eMTCT services provided in their
people as compared to younger ones. areas. This study finding was contrary to
Findings showed that 35 (43.2%) Orne-Gliemann et al. [10] whose study
respondents were co-habiting, followed about improved knowledge and practices
by 30 (37.1%) who were married, which among end-users of mother-to-child
implied that since most respondents were transmission of HIV prevention services
married or resided with their partners, in rural Zimbabwe found out that poverty,
they would be able to at least count on unemployment, low socio-economic
the emotional, physical and financial status as well as lack of support and
support of their partners and ensure involvement by the male partner.
adequate access and utilization of ANC Results showed that 25 (30.8%)
and eMTCT services. This concurs with a respondents attained primary level
study done by Orne-Gliemann et al. [10] education, followed by 22 (27.2%) who
about improved knowledge and practice attained secondary level education. This
among end-users of mother to child demonstrated that most respondents had
transmission of HIV prevention services attained a fair level of education and
in rural Zimbabwe who found out that, would thus be more aware and
lack of support and involvement by male knowledgeable about eMTCT as well as its
partners hinder utilization of eMTCT objectives and benefits which could
services. further positively influence their
The majority of respondents 40 (49.4%) attendance and utilization of the services.
were Catholic, followed by 20 (24.7%) who This study finding was in agreement with
were Protestant, 12 (14.8%) were Muslims Cartoux et al. [11] who documented in
while the least 9 (11.1%) were their study about acceptability of
Pentecostals. This showed that all the voluntary HIV testing by women aged 15 –

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45 years in developing countries that attained primary level education, followed
some of the socio demographic factors by 21 (25.9%) who attained secondary
influencing utilization of eMTCT services education, 16 (19.7%) did not attain any
by pregnant mothers included low level of education. This showed that most
educational attainment by the woman and respondents’ partners had attained a fair
her partner and failure to appreciate the level of education and would thus be
importance/benefits of this service. expected to possess more knowledge
Socio economic factors influencing about eMTCT and the importance of
utilization of eMTCT services by supporting their partners to ensure
pregnant mothers adequate access to and utilization of
All of the respondents 81 (100%) had ever eMTCT services. This study finding was
heard about eMTCT services and 50 (62%) contrary to Cartoux, Meda and Van de
obtained information about eMTCT Perre [11] who documented in their study
services from health workers. This about acceptability of voluntary HIV
implied that since all the respondents testing by women aged 15 – 45 years in
were aware of the eMTCT services, they developing countries that some of the
would ensure improved use of the socio demographic factors influencing
services. This study contrasts to Adewole utilization of eMTCT services by pregnant
et al. [4] who mentioned in their study mothers included low level of educational
about the prevention of mother-to-child attainment by the woman and her partner
transmission of HIV/AIDS in Nigeria that and failure to appreciate the
one of the important socio demographic importance/benefits of this service. The
factors influencing utilization of eMTCT majority of respondents 50 (61.7%)
services by pregnant mothers included reported that their friends said eMTCT is
inadequate knowledge about the benefits a good service because it helped prevent
of eMTCT services. transmission of HIV from mother to child
Most respondents 50 (61.7%) understood which could promote the utilization of
eMTCT as giving ARVs to the mother and the eMTCT services.
baby while the least 31 (38.3%) The majority of respondents 60 (74.1%)
understood it as monitoring of mother felt stigmatized because of using eMTCT
and child. Furthermore, 50 (61.7%) services and out of the 60 respondents
respondents were aware of the benefits of who reported being stigmatized, most 40
using eMTCT services and out of the 50 (66.7%) said they were stigmatized by
respondents who were aware of the their friends while the least 20 (33.3%)
benefits of using eMTCT services, most 40 were stigmatized by their family. This
(80%) reported prevention of MTCT while showed that stigmatization remained
the least 10 (20%) reported ensuring that prevalent and this could affect utilization
the baby is born healthy and strong. This of eMTCT services among mothers.
implied that since most respondents were Results showed that 40 (49%) respondents
fully aware of the benefits of eMTCT sometimes got support from their
services, they would put in place husbands in accessing eMTCT services,
measures to ensure improved utilization followed by 24 (30%) who said they
of the services. This study finding was in always got support while the least 17
agreement with Mpinganjira et al. [12] (21%) said they never got support from
whose study reported that mother-to- their husbands. This showed that support
child transmission of HIV infection and its from respondents’ partners was not
prevention that unavailability of consistent and this could greatly affect
information about the benefits and the utilization of eMTCT services. This
advantages of eMTCT services among study finding was in agreement with
pregnant mothers were some of the socio- Jebesse and Teka [13] whose study about
economic factors influencing utilization knowledge and attitude towards mother
of eMTCT services. to child transmission of HIV and its
Results showed that 31 (38.3%) prevention among post-natal mothers in
respondents reported that their partners Tikur Anbessa and Zewditu Memorial

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Hospital, Addis Ababa found out that perceived or actual provision of
level of support from partners/husbands unconfidential services.
directly affected eMTCT service Out of the 50 respondents who had ever
utilization as mothers sometimes lacked attended eMTCT services, results showed
transport money to the health facilities. that most 30 (60%) reported that eMTCT
Results showed that 20 (24.7%) services were not available all the time
respondents mentioned labeling and and this affected their utilization of the
stigmatization as a socio-economic factor eMTCT services as health workers would
influencing utilization of eMTCT services, not be available while most respondents
followed by 16 (19.7%) reported lack of 30 (60%) reported that health workers
support, 13 (16.2%) mentioned were sometimes available to offer eMTCT
unemployment, 12 (14.8%) reported services at all times. This study finding
poverty while the least 10 (12.3%) was in agreement with Homsy et al. [6]
reported lack of knowledge/awareness study which showed that non availability
and 10 (12.3%) mentioned negative of services and health workers were some
attitudes towards services respectively. of the health facility factors influencing
This showed that respondents were fully utilization of eMTCT services by pregnant
aware of the various socio-economic mothers.
factors influencing utilization of eMTCT Results showed that 50 (61.7%)
services. This study finding was in respondents reported that pregnant
agreement with Igwegbe and Ilika [14] mothers should be tested for HIV 2 – 3
who revealed in their study about times, 24 (29.6%) respondents reported
knowledge and perceptions of HIV/AIDS that mothers with HIV should breast feed
and mother to child transmission among for one year, followed by 20 (24.7%)
antenatal mothers at Nnamdi Azikiwe reported more than one year, 15 (18.5%)
University Teaching hospital, Nnewi, reported 6 months, 12 (14.8%) reported
Nigeria that socio economic factors that mothers should not breast feed while
influencing utilization of eMTCT services the least 10 (12.4%) did not know. This
by pregnant mothers included lack of showed that respondents lacked
knowledge about the services, lack of sufficient knowledge about the
interest as well as unemployment among recommended duration of breast feeding
others. which implied that if this is not corrected,
Health facility factors influencing mothers may yet transmit HIV to the baby
utilization of eMTCT services by through breast feeding. Hence there is
pregnant mothers need to health educate mothers about
Most respondents 50 (62%) reported that safe breast feeding.
they had ever attended eMTCT services The majority of respondents 50 (62%)
which demonstrated that eMTCT services reported that health workers had positive
were well attended by mothers which is a attitudes towards pregnant mothers
positive step for the prevention of MTCT. utilizing eMTCT services as they were
Out of the 50 respondents who had welcoming and polite to the mothers
attended eMTCT services, most 35 (70%) which implied that since health workers
did not find the services confidential had positive attitudes towards pregnant
which implied that lack of confidentiality mothers, it would lead to improved
could lead to poor utilization of the attendance and utilization of eMTCT
eMTCT services provided. This study services. This study finding was contrary
finding was in line with Ginsburg et al. to Eyakuze, [2] whose study reported that
[15] who reported in their study about the utilization of eMTCT services remains
provision of care following prevention of low due to factors such as lack of
mother-to-child HIV transmission services confidentiality and privacy at health
in resource-limited settings that some of facilities, poverty, long distance to health
the health facility related factors facilities as well negative attitudes of
influencing low utilization of eMTCT health workers towards mothers.
services by pregnant mothers included

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Results showed that 23 (28.4%) reported worse the unavailability of services
lack of privacy and confidentiality as a coupled with opening and closing times
problem they encountered in utilizing were health facility factors influencing
eMTCT services at the hospital which was low utilization of eMTCT services by
in agreement with Ginsburg et al. [15] pregnant mothers.
who reported in their study about Findings showed that 13 (16.1%)
provision of care following prevention of respondents reported long distance to the
mother-to-child HIV transmission services hospital while 11 (13.6%) respondents
in resource-limited settings that some of mentioned negative attitudes of health
the health facility related factors workers. This showed that respondents
influencing low utilization of eMTCT were aware of the various factors
services by pregnant mothers included influencing utilization of eMTCT services.
perceived or actual provision of un This study finding was in line with
confidential services. Eyakuze, [2] whose study reported that
Results showed that 19 (23.4%) reported the utilization of eMTCT services remains
long waiting time to receive services and low due to factors such as lack of
15 (18.5%) mentioned unavailability of confidentiality and privacy at health
services sometimes. This study finding facilities, poverty, long distance to health
was supported by Meda et al. [16] who facilities as well negative attitudes of
explained how understaffing led to long health workers towards mothers.
waiting time to receive the services and
CONCLUSION
The study found out that respondents health facility factors included 23 (28.4%)
faced various socio-economic factors lack of privacy and confidentiality, 19
influencing utilization of eMTCT services (23.4%) long waiting time to receive
by pregnant mothers. For instance, services, 15 (18.5%) unavailability of
although all respondents 81 (100%) had services sometimes and 13 (16.1%) long
ever heard about eMTCT services and 50 distance to the hospital among others.
(62%) obtained information about eMTCT Recommendations
services from health workers, most 50 Recommendations to the Ministry of
(61.7%) understood eMTCT as giving ARVs Health
to the mother and baby and 40 (80%) The Ministry of Health should improve
prevention of MTCT as a benefit of upon the available sensitization
eMTCT. However, 60 (74.1%) felt campaigns and programs about eMTCT.
stigmatized because of using eMTCT The Ministry of Health should further
services and most 40 (66.7%) were endeavor to provide literature to all HIV
stigmatized by their friends and 40 (49%) positive mothers about the importance
sometimes got support from their and benefits provided by eMTCT services.
husbands in accessing eMTCT services. The Ministry of Health should also re-
Other factors included 20 (24.7%) labeling launch HIV/AIDS programs to health
and stigmatization, 16 (19.7%) lack of educate community members about the
support, 13 (16.2%) unemployment and 12 causes of HIV and how it could be
(14.8%) poverty among others. prevented in an effort to reduce the high
Respondents also faced various health prevalent levels of stigma still attached to
facility factors influencing utilization of the diseases and experienced by people
eMTCT services by pregnant mothers and living with HIV/AIDS.
although most 50 (62%) reported that they Recommendations for health workers at
had ever attended eMTCT services, most Mbarara Regional Referral Hospital
35 (70%) did not find the services Health workers at Mbarara Regional
confidential, 30 (60%) said eMTCT Referral Hospital should endeavor to
services were not available all the time carry out community outreach and
despite 50 (62%) health workers having sensitization about the importance of
positive attitudes towards pregnant eMTCT services.
mothers utilizing eMTCT services. Other

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The health workers should also invite the Antenatal women should take it upon
participation and involvement of male themselves to invite the involvement and
partners in the services as this also has participation of their husbands as this
various benefits and advantages. provided many potential benefits and
Health workers should at Mbarara advan5.4 Implications to nursing practice.
Regional Referral Hospital should The implications of these findings to
endeavor to make the eMTCT services the nursing practice include the
more efficient and reduce the waiting following:
time of mothers to receive the services. Health workers, especially those working
Furthermore, health workers should at Mbarara Regional Referral Hospital
ensure maximum privacy and have an important role to play in
confidentiality during the provision of increasing awareness and utilization of
eMTCT services. eMTCT services provided at the hospital.
Recommendations for pregnant mothers This could be done through carrying out
at Mbarara Regional Referral Hospital regular sensitization, community
Pregnant mothers at Mbarara Regional outreach and health education of
Referral Hospital should endeavor to community members about the
make adequate use of eMTCT services importance and benefits provided by
provided in their community as this eMTCT services.
safeguards the health of their children
and prevents MTCT.
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