As shown in Table 1, the study recruited 164 caretakers. Majority of these participants were females aged below 30 years, were married, and had studied up to primary level.
Table 1
Demographic Characteristics of the Participants.
VARIABLE
|
CATEGORY
|
FREQUENCY
|
PERCENTAGE
|
1.GENDER
|
Female
|
125
|
76.2
|
|
Male
|
39
|
23.8
|
|
|
164
|
100
|
2.AGE
|
18–25
|
26
|
15.9
|
|
26–30
|
47
|
28.7
|
|
31–35
|
24
|
14.6
|
|
36–40
|
33
|
20.1
|
|
41–45
|
34
|
20.7
|
|
|
|
100
|
3.MARITAL STATUS
|
Single
|
14
|
8.5
|
|
Married
|
128
|
78.0
|
|
Separated
|
13
|
8.0
|
|
Widow/ widower
|
9
|
5.5
|
4.EDUCATION LEVEL
|
None
|
46
|
28
|
|
Primary
|
96
|
58.5
|
|
Secondary
|
20
|
12.2
|
|
Tertiary
|
2
|
1.3
|
|
|
164
|
100
|
5. HEARD ABOUT EID
|
No
|
33
|
20.1
|
Yes
|
131
|
79.9
|
Only 11% (15 of the 164 participants) were fully aware of the frequency and proper scheduling of the EID services. They all received information from the hospital with 4 having received information from both hospital and radio talk shows by health workers.
Eighty one percent (133/164) of the caretakers reported having utilized EID services at Rushere Hospital. 83.5% (111/133) wanted to know the status of the baby, 6.8%( 9/133) were following Doctors orders, 5.2%( 7/133) knew their HIV/AIDS positive status and thus decided to also take their babies for testing and 4.5%( 6/133) took their babies for testing to prevent them from contracting the virus .
31 out of 164 did not take their babies for EID service and the reasons are mentioned below in table with their frequency. (Table 2)
Table 2
Shows reasons why babies did not receive EID with their frequencies and percentages
Reasons for not testing the children
|
Frequency
|
percentage
|
Wife’s role to take child for testing
|
8
|
25.8
|
Busy
|
6
|
19.3
|
Unaware
|
6
|
19.3
|
Baby died before first PCR
|
5
|
16.1
|
Pending/ under age
|
2
|
6.5
|
Age at testing was overdue
|
2
|
6.5
|
Its father’s role to take child for testing
|
2
|
6.5
|
Table 3
|
No PCR
|
1 PCR
|
2 PCR tests
|
3 PCR Tests
|
Frequency
|
28
|
38
|
21
|
77
|
Percentage
|
17%
|
23.2%
|
12.8%
|
47%
|
Caretakers who completed all 3 tests wanted to know the status of the child (48/77) and (29/77) were following health workers’ orders. Reasons for not completing the tests included 34.8% lack of knowledge (of the need to complete all tests), 13% inconsistencies in results (either loss or delay in return), 13%distance from the facility and 8.7%being busy. 30.4%baby positive at the first test or second test. (Table 3)
Two themes were generated: Barriers and Drivers (to the utilization of EID services)
The theme of Drivers was generated from.
√ Good knowledge and attitude of health care providers
√ Availability of test kits
√ Follow up of missed appointments
Good knowledge and attitude of health care providers
The health workers were well aware of the age when the different PCR tests were supposed to be performed and records showed that all the three tests were being performed at the facility.
The health workers registered mothers according to their EDD cohorts. When HIV positive mothers delivered at this hospital, they recorded the infant immediately in the register and followed them. When the time reached for the first PCR, the health workers tested the HEIs.
‘During antenatal when a mother tests positive, she is counseled on HIV and how to live with HIV and when she has been on ART, we should collect the viral load on the first visit. When she turns positive on first visit, we should initiate her on ART and give her appointment date and advise her to deliver at the facility and the baby should take Nevirapine syrup within 24-72hours then we guide the mother on when to take the first PCR.
She should take the first PCR at 6 weeks on the first contact of the baby within an average of 4–8 weeks, we should remove the 1st PCR then we give her the return date to pick the results because we don’t do the testing on this facility so they take the samples to a different facility then do the second PCR on 9 months and when the baby reaches 1year they wean off the baby, 6 weeks after cessation of breastfeeding we do the 3rd PCR.
Then when the 3rd PCR results turn negative, we stop the CTX and we advise the mother to bring the baby at 18months, then at 18 months we do rapid test and when it turns negative we discharge the baby and the mother continues with the care. If the baby turns positive, we refer her to ART. We do 3PCRs and one rapid test.’ (D4 female health worker)
Availability of test kits
Health workers reported that EID test kits are consistently available. This is an important driver of the utilization of EID;
“The test kits are always there. We have never run short of them. Before they get finished, we look at how many kits are remaining in the store and then we make an order. The good thing is that the driver normally comes twice in a week, so if I see that we are running short of them, I tell the driver to come with them.”ID5 lab technician
Follow up of missed appointments
Through phone calls and outreaches
‘I came for testing and also tested my child. When I went back home, the nurse kept calling to inform me about the next visit when I should bring my baby for testing again.’ FGD1 female member
“When this baby was born, I brought it to the hospital for testing. The results were out negative but the doctors advised me to keep bringing it to the dates they allocated for further testing. The baby went through the whole process of testing and I used to bring it myself. The services are good .When I come here, I find the services and they work on me.”FGD 1 male member
“Right now we are having a lot of outreach because of my approach, because of my population. We need to have a task delivery model, which can suite them. Here, when you deliver services which are only facility-based, you are leaving out a lot of population because you will find that some of these facilities are 10 to 15 kilometers from where the population lives. However, then we have been having what we call outreach. Like now we have outreaches for immunization supported by what, then we can have out reaches for what. Therefore the other approach was make sure we integrate, so that when we are going to immunize children in parish X, can you also be able to follow E.I.D mothers?”D3
‘there is what we call implementation and there is what we call understanding the gymnastics of your population where you are working. If you pass a policy and it is going to work, it may be effective in Bushenyi, if you understand the population dynamics of Bushenyi; if go to Bushenyi Municipality and you find they the population they are squeezed and they are next to each other. Therefore that means it if you want to improve your E.I.D services in a method that was done in Bushenyi, clearly the population set up in my district may not be a favorable way of doing it because as you have seen the population is sparsely populated and as you have been talking about Karamoja. However, then what does it mean? It means we need what we call District Specific Interventions supported for E.I.D, and the way you are supporting Bushenyi and the way you support Kiruhura, things cannot work. Now for those two interventions I had to lead the struggle myself with my intervention probably at some cost or no cost, to see that things improved basing on how my population is spread out, basing on the characteristics of my population.’D3
The theme of barriers to the utilization of EID emerged from the sub-themes of;
Distance from the health facility
Respondents mentioned the lack of transport money to a health facility as a barrier to utilization of EID services.
“Distance between the hospital and the places where we stay is very far. Sometimes you don’t have transport to come to the hospital or even some mothers deliver along the way because they couldn’t reach here in time. If they could extend government hospitals to every sub county, it would be easy for us to access those services. For example, I pay twenty thousand for a motorcycle to and from the hospital. That’s a lot of money for me as a peasant.” FGD2 female member
Delay at the health facility
“.....we delay so much at the facility that we get hungry and uncomfortable in one place for a very long time.”FGD2 female member
Inconsistencies in turnaround time (TAT); Results delay or fail to come back.
“.....delay in receiving results since the test is not carried out at the facility. In the past few months, they could call when a child turns positive before the results reach the facility, but they no longer call us which affects us.” (FGD1 member)