Missed opportunities in the Prevention of the Mother to Child Transmission Programme in a sub–district of the North West Province, South Africa

Abstract

According to global statistics more than half of all people living with HIV are women, the majority of whom live in sub-Saharan Africa. South Africa adapted the WHO guidelines on PMTCT to the local situation. In South Africa the prevalence of HIV amongst pregnant women attending public antenatal care is high, although new infections are declining. Studies on missed opportunities in PMTCT have been conducted in other areas of South Africa, but none in the North West Province. Three health institutions deemed to have more patient attendance were chosen for the study from a particular sub-district. The purpose of this study was to identify and describe the missed opportunities in the PMTCT programme in a sub-district of the North West Province, the results of which may assist in the improvement of PMTCT services. A descriptive study design was used to identify and describe the missed opportunities in the PMTCT programme during pregnancy, labour and postnatal period. The sample consisted of 125 the records of pregnant women whose babies were born in January 2010. Entry to the health care facilities was gained through written permissions from the Department of Health and the facilities. Missed opportunities identified were that 0.8% (1/125) of pregnant women whose records were audited, was not tested for HIV infections and 9.6% (12/125) had no information on testing. Of the 35 women who were found to be HIV positive, only 74.3% (26/35) had confirmatory test done while it was not done in 2.9% (1/35). Furthermore, only 57.1% (20/35) had their blood for CD4 cell count taken, for 2.9% (1/35) no blood was taken for CD4 cell count and there was no information for the remaining 40.0% (14/35). Only 2.9% (1/35) HIV positive pregnant women continued with HAART during labour, 62.9% (22/35) received ARVs for PMTCT and for 34.2% (12/35) there was no information recorded. Prophylaxis for prolonged rupture of membranes was not given in 5.7% (2/35) of these women during labour. There were no records of any TB screening for such women and infant feeding counselling were never carried out. Lack of recording was the major problem identified in this study.