1921
Volume 98, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Integrating public health interventions with antenatal clinic (ANC) visits may motivate women to attend ANC, thereby improving maternal and neonatal health, particularly for human immunodeficiency virus (HIV)-infected persons. In 2009, in an integrated ANC/Preventing Mother-to-Child Transmission program, we provided free hygiene kits (safe storage containers, water treatment solution, soap, and oral rehydration salts) to women at their first ANC visit and refills at subsequent visits. To increase fathers’ participation, we required partners’ presence for women to receive hygiene kits. We surveyed pregnant women at baseline and at 12-month follow-up to assess ANC service utilization, HIV counseling and testing (HCT), test drinking water for residual chlorine, and observe handwashing. We conducted in-depth interviews with pregnant women, partners, and health workers. We enrolled 106 participants; 97 (92%) were found at follow-up. During the program, 99% of pregnant women and their partners received HCT, and 99% mutually disclosed. Fifty-six percent of respondents had ≥ 4 ANC visits and 90% delivered at health facilities. From baseline to follow-up, the percentage of women who knew how to use (23% versus 80%, < 0.0001), had residual chlorine in stored water (0% versus 73%, < 0.0001), had confirmed use (0% versus 70%, < 0.0003), and demonstrated proper handwashing technique (21% versus 64% < 0.0001) increased. Program participants showed significant improvements in water treatment and hygiene, and high use of ANC services and HCT. This evaluation suggests that integration of hygiene kits, refills, and HIV testing during ANC is feasible and may help improve household hygiene and increase use of health services.

Loading

Article metrics loading...

The graphs shown below represent data from March 2017
/content/journals/10.4269/ajtmh.17-0328
2018-03-26
2019-11-16
Loading full text...

Full text loading...

/deliver/fulltext/14761645/98/5/tpmd170328.html?itemId=/content/journals/10.4269/ajtmh.17-0328&mimeType=html&fmt=ahah

References

  1. Msuya J, , 2005. Horizontal and Vertical Delivery of Health Services: What Are the Tradeoffs? Washington, DC: World Bank. Available at: http://www-wds.worldbank.org/external/default/WDSContentServer/IW3P/IB/2003/10/15/000160016_20031015125129/additional/310436360_200502761000211.pdf. Accessed February 9, 2015.
  2. Bhutta ZA, Black RE, , 2013. Global maternal, newborn, and child health—so near and yet so far. N Engl J Med 369: 22262235. [Google Scholar]
  3. WHO, 2014. Trends in Maternal Mortality, 1990–2013. Estimates by WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division. Available at: http://apps.who.int/iris/bitstream/10665/112682/2/9789241507226_eng.pdf. Accessed February 9, 2015.
  4. UNICEF, 2013. Levels and Trends in Child Mortality, Report 2013. Estimates Developed by the UN Interagency Group for Child Mortality Estimation. Available at: http://www.childinfo.org/files/Child_Mortality_Report_2013.pdf. Accessed February 9, 2015.
  5. National Statistical Office Zomba, Malawi, 2011. Malawi Demographic and Health Survey, 2010. Available at: http://dhsprogram.com/pubs/pdf/FR247/FR247.pdf. Accessed February 9, 2015.
  6. WHO, 2011. Global HIV/AIDS Response: Epidemic Update and Health Sector Progress Towards Universal Access, Progress Report, 2011. World Health Organization. Available at: http://whqlibdoc.who.int/publications/2011/9789241502986_eng.pdf?ua=1. Accessed February 9, 2015.
  7. Joint United Nations Programme on HIV/AIDS, 2012. Together We Will End AIDS. Available at: http://www.unicef.org/aids/files/aids__togetherwewillendaids_en.pdf. Accessed February 9, 2014.
  8. World Health Organization, 2013. Cholera, 2012. Weekly Epidemiolical Record 88: 321–336. Available at: http://www.who.int/wer/2013/wer8831.pdf. Accessed February 9, 2015.
  9. Sheth AN, Russo ET, Menon M, Wannemuehler K, Weinger M, Kudzala AC, Tauzie B, Masuku HD, Msowoya TE, Quick R, , 2010. Impact of the integration of water treatment and handwashing incentives with antenatal services on hygiene practices of pregnant women in Malawi. Am J Trop Med Hyg 83: 13151321. [Google Scholar]
  10. Loharikar A, Russo E, Sheth A, Menon M, Kudzala A, Tauzie B, Masuku HD, Ayers T, Hoekstra RM, Quick R, , 2013. Long-term impact of integration of household water treatment and hygiene promotion with antenatal services on maternal water treatment and hygiene practices in Malawi. Am J Trop Med Hyg 88: 267274. [Google Scholar]
  11. Centers for Disease Control and Prevention, 2013. Impact of an innovative approach to prevent mother-to-child transmission of HIV—Malawi, July 2011–September 2012. MMWR Morb Mortal Wkly Rep 62: 148151. [Google Scholar]
  12. Becker S, Mlay R, Schwandt HM, Lyamuya E, , 2010. Comparing couples’ and individual voluntary counseling and testing for HIV at antenatal clinics in Tanzania: a randomized trial. AIDS Behav 14: 558566. [Google Scholar]
  13. Farquhar C, Kiarie JN, Richardson BA, Kabura MN, John FN, Nduati RW, Mbori-Ngacha DA, John-Stewart GC, , 2004. Antenatal couple counseling increases uptake of interventions to prevent HIV-1 transmission. J Acquir Immune Defic Syndr 37: 16201626. [Google Scholar]
  14. Alusio A, Richardson BA, Bosire R, John-Stewart G, Mbori-Ngacha D, Farquhar C, , 2011. Male antenatal attendance and HIV testing are associated with decreased infant HIV infection and increased HIV-free survival. J Acquir Immune Defic Syndr 56: 7682. [Google Scholar]
  15. Jones DL, Peltzer K, Villar-Loubet O, Shikwane E, Cook R, Vamos S, Weiss SM, , 2014. Reducing the risk of HIV infection during pregnancy among South African women: a randomized controlled trial. AIDS Care 25: 702709. [Google Scholar]
  16. Xue J, 2010. Use of nutritional and water hygiene packages for diarrhoeal prevention among HIV-exposed infants in Lilongwe, Malawi: an evaluation of a pilot prevention of mother-to-child transmission post-natal care service. Trop Med Int Health 15: 11561162. [Google Scholar]
  17. Lugada E, Millar D, Haskew J, Grabowsky M, Garg N, Vestergaard M, Kahn JG, Muraguri N, Mermin J, , 2010. Rapid implementation of an integrated large-scale HIV counseling and testing, malaria, and diarrhea prevention campaign in rural Kenya. PLoS One 5: e12435. [Google Scholar]
  18. Kalembo FW, Zgambo M, Mulaga AN, Yukai D, Ahmed NI, , 2013. Association between male partner involvement and the uptake of prevention of mother-to-child transmission of HIV (PMTCT) interventions in Mwanza district, Malawi: a retrospective cohort study. PLoS One 8: e66517. [Google Scholar]
  19. Al Jazeera, 2014. Life and Death in Malawi. Al Jazeera. Available at: http://www.aljazeera.com/programmes/lifelines/2014/05/life-death-malawi-2014520111738767922.html. Accessed January 14, 2015.
  20. Torpey K, Kabaso M, Kasonde P, Dirks R, Bweupe M, Thompson C, Mukadi YD, , 2010. Increasing the uptake of prevention of mother-to-child transmission of HIV services in a resource-limited setting. BMC Health Serv Res 10: 29. [Google Scholar]
  21. Russo ET, Sheth A, Menon M, Wannemuehler K, Weinger M, Kudzala AC, Tauzie B, Masuku HD, Msowoya TE, Quick R, , 2012. Water treatment and handwashing behaviors among non-pregnant friends and relatives of participants in an antenatal hygiene promotion program in Malawi. Am J Trop Med Hyg 86: 860865. [Google Scholar]
  22. Quick R, , 2003. Changing community behaviour: experience from three African countries. Int J Environ Health Res 13: S115S121. [Google Scholar]
  23. Phelan S, , 2010. Obesity in the American population: calories, cost and culture. Am J Obstet Gynecol 203: 522524. [Google Scholar]
  24. Parker AA, Stephenson R, Riley PL, Ombeki S, Komolleh C, Sibley L, Quick R, , 2006. Sustained high levels of stored drinking water treatment and retention of hand-washing knowledge in rural Kenyan households following a clinic-based intervention. Epidemiol Infect 134: 10291036. [Google Scholar]
  25. Wood S, Foster J, Kols A, , 2012. Understanding why women adopt and sustain home water treatment: insights from the Malawi antenatal care program. Soc Sci Med 75: 634642. [Google Scholar]
  26. Arnold BF, Khush RS, Ramaswamy P, Rajkumar P, Durairaj N, Ramaprabha P, Balakrishnan K, Colford JM, Jr., 2015. Reactivity in rapidly collected hygiene and toilet spot check measurements: a cautionary note for longitudinal studies. Am J Trop Med Hyg 92: 159162. [Google Scholar]
  27. Mphatswe W, Mate KS, Bennett B, Ngidi H, Reddy J, Barker PM, Rollins N, , 2012. Improving public health information: a data quality intervention in KwaZulu-Natal, South Africa. Bull World Health Organ 90: 176182. [Google Scholar]
  28. Arnold BF, Colford JM, Jr., 2007. Treating water with chlorine at point-of-use to improve water quality and reduce child diarrhea in developing countries: a systematic review and meta-analysis. Am J Trop Med Hyg 76: 354364. [Google Scholar]
  29. Pavlinac PB, Naulikha JM, Chaba L, Kimani N, Sangaré LR, Yuhas K, Singa BO, John-Stewart G, Walson JL, , 2014. Water filter provision and home-based filter reinforcement reduce diarrhea in Kenyan HIV-infected adults and their household members. Am J Trop Med Hyg 91: 273280. [Google Scholar]
  30. Lule JR, 2005. Effect of home-based water chlorination and safe storage on diarrhea among persons with human immunodeficiency virus in Uganda. Am J Trop Med Hyg 73: 926933. [Google Scholar]
  31. Peletz R, Simunyama M, Sarenje K, Baisley K, Filteau S, Kelly P, Clasen T, , 2012. Assessing water filtration and safe storage in households with young children of HIV-positive mothers: a randomized, controlled trial in Zambia. PLoS One 7: e46548. [Google Scholar]
  32. O’Reilly C, 2014. Improved health among people living with HIV/AIDS who received packages of proven preventive health interventions, Amhara, Ethiopia. PLoS One 9: e107662. [Google Scholar]
  33. Morgan L, 2013. Financial incentives and maternal health: where do we go from here? J Health Popul Nutr 31 (Suppl 2): S8S22. [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.17-0328
Loading
/content/journals/10.4269/ajtmh.17-0328
Loading

Data & Media loading...

  • Received : 20 Apr 2017
  • Accepted : 15 Jan 2018
  • Published online : 26 Mar 2018

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error