Factors associated with pregnancies among HIV-positive women in a prevention of mother-to-child transmission programme / Factores asociados con embarazos entre mujeres VIH positivas en un programa de prevención de la transmisión de madre a hijo

OBJECTIVE: This study identified factors contributing to pregnancies in HIV-positive women who were on a prevention of HIV from mother-to-child transmission (PMTCT) programme in Letlhakeng Subdistrict, Botswana. METHOD: A cross-sectional descriptive survey was employed using an interviewer administered (face-to-face) questionnaire to obtain information from 35 HIV-positive pregnant women registered for a PMTCT programme. Use was made of a non-probability sampling method to obtain information from all the pregnant women who sought antenatal care (ANC) during the survey period. RESULTS: The age of the participants ranged between 18 and 37 years with a modal age of 30 years and a mean of29.02 years (standard deviation of 5.29). The majority of the participants were single (66%) and had two or more children (74%). About half of the participants (49%) had secondary school education and a high proportion ofthem knew their HIV-positive status for more than one year prior to the interview day (77%) while the same number of them were unemployed. Pregnant participants seemed to know their HIV status prior to pregnancy. Sharing information about the HIV status of their partners and the participant's financial dependence on their partners did not show any significant association with their pregnancy status. However, the partner's desire for parent-hood (p < 0.05, 95% CI), the age difference between them and their partners (p < 0.05, 95%CI) and the use of condoms (p < 0.05, 95% CI) indicated significant associations between decision-making and the pregnancies. CONCLUSION: Pregnancy is common among HIV-positive women who are on a PMTCT at Letlhakeng sub-district as was shown by this study and this may constitute a serious health risk to the child and to the population in general.

OBJETIVO: Este estudio identificó factores que contribuyen a los embarazos en mujeres VIH positivas que tomaban parte en un programa de prevención de la transmisión del VIH de madre a hijo (PMTCT) en el subdistrito Letlhakeng, Botswana. MÉTODO: Se empleo un estudio descriptivo transversal, usando un cuestionario (cara a cara) administrado por el entrevistador para obtener información de 35 mujeres VIH positivas en estado de gestación, registradas para un programa PMTCT. Se usó un método de muestreo no probabilístico para obtener la información de todas las mujeres embarazadas que buscaron atención prenatal (APN) durante el periodo de estudio. RESULTADOS: La edad de las participantes fue entre 18 y 37 anos, con una edad modal de 30 años y una media de 29.02 años (desviación estándar de 5.29). La mayoría de las participantes eran solteras (66%) y tenían dos o más ninos (74%). Alrededor de la mitad de las participantes (49%) habían alcanzado la ensenanza media y una alta proporción de ellas conocían su condición de VIH positiva desde hacía más de un ano antes del día de la entrevista (77%), mientras el mismo número de ellas se hallaban desempleadas. Las participantes embarazadas parecían conocer su estado VIH con anterioridad al embarazo. Compartir la información sobre el estado de VIH de sus parejas y la dependencia financiera de las participantes respecto de sus parejas, no mostró ninguna asociación significativa con su estado de embarazo. Sin embargo, el deseo de paternidad de sus parejas (p < 0.05, 95% CI), la diferencia de edad entre ellas y sus parejas (p < 0.05, 95% CI) y el uso de condones (p < 0.05, 95% CI) indicó asociaciones significativas entre la toma de decisión y los embarazos. CONCLUSIÓN: El embarazo es común entre mujeres VIH positivas que toman parte en un programa de tipo PMTCT en el subdistrito Letlhakeng, tal cual lo ha mostrado este estudio. Esto puede constituir un serio riesgo de salud para el nino y la población en general.

Let's talk reproductive health -- young people's voices.

PIP: This article presents extracts from comments made by young people in various parts of the world about the meaning of the term "safe motherhood." A Ghanian woman noted that young girls, who often bear a heavier workload than boys but receive less food, need to be given the same diet as boys. A young Senegalese mother relayed that she found out she was pregnant when she went to a hospital with stomach pains shortly before her 14th birthday. Until then she had no idea that sexual intercourse led to pregnancy. A Mexican youth cited the problems that accompany adolescent pregnancy and motherhood, and a young woman in India called for delivery of proper medical care to all young mothers and presentation of health education about safe motherhood in schools. An Egyptian youth extolled the benefits of a project that involved young people from rural youth organizations in safe motherhood IEC (information, education, and communication) activities. Previously, adolescents had not received any special attention. Finally, a youth working in a family planning educational booth in Botswana stated that many youth who engage in sexual intercourse at an early age have no idea of the consequences of their actions.^ieng

People living with HIV / AIDS talk about their families.

PIP: Five positive and negative experiences of families dealing with AIDS are recounted. Imrat in Malaysia is an HIV-infected son who was not rejected by his family. Prudence of Botswana is an infected widow with five children who had a less positive experience with her in-laws, while Eric of Sweden considers his friends to constitute his family. His relationships with friends have only strengthened since his HIV-positive status became known. Mary of Zimbabwe, however, was infected with HIV by her husband. She was formerly angry at him for having brought home the virus, but they have since stop quarreling and are focusing upon building a stronger relationship. Finally, the brief story of Juan in Colombia is told. Thirty-two years old, married, and with a 17-month old daughter, Juan did not tell his wife that he was actively bisexual. Once infected with HIV, Juan's wife threw him out, more because he had sex with men than because of his HIV serostatus.^ieng

National community health worker programs: how can they be strengthened?

This article is based on a collaborative research study of policy and practice in national community health worker (CHW) programs in developing countries. The study involved a review of the relevant literature, case studies in Botswana, Colombia and Sri Lanka, and an international workshop where the future of such programs was discussed. The findings of this research are discussed under four headings: unrealistic expectations, poor initial planning, problems of sustainability, and the difficulties of maintaining quality. It is clear that existing national community health worker programs have suffered from conceptual and implementation problems. However, given the interest and political will, governments can address these problems by adopting more flexible approaches within their CHW programs, by planning for them within the context of all health sector activities rather than as a separate activity, and by immediately addressing weaknesses in task allocation, training and supervision. CHWs represent an important health resource, whose potential in extending coverage and providing a reasonable level of care to otherwise underserved populations must be fully tapped.

PIP: A collaborative research study of policy and practice in large, national community health worker (CHW) programs in developing countries was conducted. The report was based on a review of the literature, case studies in Botswana, Colombia and Sri Lanka, and an international workshop on the future of CHW programs. The objective of the study was to reexamine the implementation of national CHW programs, looking at policy, planning and management implications to suggest improvements. The chief findings were poor initial planning, unrealistic expectations of the workers, difficulties in maintaining quality and problems of sustainability. National CHW programs have suffered from conceptual and implementation problems. With political will, however, governments can adopt more flexible approaches by planning CHW programs within the context of overall health sector activities, rather than as a separate activity. Weaknesses in training, task allocation and supervision need to addressed immediately. CHWs represent an important health resource whose potential in providing and extending a reasonable level of health care to undeserved populations must be fully tapped.