ABSTRACT
Background: Antenatal care (ANC) services are the care provided by skilled healthcare professionals to pregnant women to ensure the best health for both mother and baby during pregnancy and after delivery. In Namibia, utilization of antenatal care services has been reported to be dropping from 97% in 2013 to 91% in 2016. Objectives: The objectives of this study were to investigate the factors affecting the utilization of ANC services. Methods: A quantitative approach and a cross-sectional analytical design were used to carry out the study. The study population was all mothers who delivered and were admitted to the postnatal ward of Intermediate Hospital Katutura and Windhoek Central Hospital during the time of the study. Data were collected from 320 participants using self-administered structured questionnaires. The data were analyzed using the Statistical Package for Social Science (SPSS) Version 25 software. Results: Participants were aged between 16 and 42 years with a mean age of 27 years. The results show that 229 (71.6%) utilized ANC while 91(28.4%) did not utilize ANC services. Factors such as the negative attitude of health care workers, long distance to and from health facilities, lack of transport money to travel to and from the health facilities, lack of knowledge regarding antenatal care, attitude towards pregnancy, and others, were found as hindrances to the utilization of antenatal care services. Participants also indicated motivators for ANC utilization such as preventing complications, knowing their HIV status, getting health education, knowing the estimated date of delivery, and identifying and treatment of medical conditions. The study reveals the higher knowledge of participants on ANC utilization, most participants have the right to make decisions and had positive attitudes toward the quality of ANC services. The level of attitude toward pregnancy was associated with the utilization of antenatal care services with an odd ratio OR=2.132; and P=0.014. Conclusions: The study identified factors that affect utilization of ANC services such as age, marital status, mother's education, partner's formal education, negative attitude toward health providers, long distance to and from ANC health care facilities, fear of HIV test and results, Covid-19 regulations, inability to determine the pregnancy at the earlier stages and financial constraints Based on this study findings, it is recommended that the utilization of ANC might be improved through effective community mobilization and outreach maternity services to educate and improve awareness on the importance of ANC.
ABSTRACT
INTRODUCTION: Access to CD4+ testing remains a common barrier to early initiation of antiretroviral therapy among persons living with HIV/AIDS in low- and middle-income countries. The feasibility of task-shifting of point-of-care (POC) CD4+ testing to lay health workers in Namibia has not been evaluated. METHODS: From July to August 2011, Pima CD4+ analysers were used to improve access to CD4+ testing at 10 selected public health facilities in Namibia. POC Pima CD4+ testing was performed by nurses or lay health workers. Venous blood samples were collected from 10% of patients and sent to centralised laboratories for CD4+ testing with standard methods. Outcomes for POC Pima CD4+ testing and patient receipt of results were compared between nurses and lay health workers and between the POC method and standard laboratory CD4+ testing methods. RESULTS: Overall, 1429 patients received a Pima CD4+ test; 500 (35.0%) tests were performed by nurses and 929 (65.0%) were performed by lay health workers. When Pima CD4+ testing was performed by a nurse or a lay health worker, 93.2% and 95.2% of results were valid (p = 0.1); 95.6% and 98.1% of results were received by the patient (p = 0.007); 96.2% and 94.0% of results were received by the patient on the same day (p = 0.08). Overall, 97.2% of Pima CD4+ results were received by patients, compared to 55.4% of standard laboratory CD4+ results (p < 0.001). CONCLUSIONS: POC CD4+ testing was feasible and effective when task-shifted to lay health workers. Rollout of POC CD4+ testing via task-shifting can improve access to CD4+ testing and retention in care between HIV diagnosis and antiretroviral therapy initiation in low- and middle-income countries.
