MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER,

ELDERLY AND CHILDREN

KAHAMA SCHOOL OF NURSING AND MIDWIFERY.

STUDY TITTLE:

FACTOR CONTRIBUTING MOTHER TO CHILD HIV TRANSIMISSION

TO THE MOTHERS WHO ATTENDING AT KAHAMA RCH IN KAHAMA
TOWN HOSIPITAL COUNCIL AT SHINYANGA REGION TANZANIA.
RESEARCHER: CHRISTIAN MMBANDO

REGESTRATION NO: NS0869/0047/2017

SUPERVISOR: LILIAN CHAMI

RESEARCH PROPOSAL SUBMTTED IN PARTIAL FULFILMENT FOR

THE REQUIREMENTS OF ORDINARY DIPLOMA IN NURSING AND
MIDWIFERY

1
TABLE OF CONTENT

ACKNOWLEDGEMENT.............................................................................................4

LIST OF ABBREVIATIONS........................................................................................4

DEFINITION OF TERMS.............................................................................................5

SUMMARY...................................................................................................................6

CHAPTER ONE............................................................................................................7

1.0 INTRODUCTION............................................................................................7

1.1 backgrounds......................................................................................................7

1.3 justification of the study;.................................................................................11

1.4 objective of the study......................................................................................11

1.4.1 Broad objective.....................................................................................11

1.4.2 Specific objective..................................................................................11

1.5 research question.............................................................................................11

CHAPTER TWO..........................................................................................................12

2.0 LITERATURE REVIEW...............................................................................12

CHAPTER THREE......................................................................................................15

3.0 Research methodology....................................................................................15

3.1 Research design...............................................................................................15

3.2 Study area........................................................................................................15

3.3 Study population.............................................................................................15

3.4 Sample size.....................................................................................................15

3.6 Pilot study.......................................................................................................15

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3.7 Data collection tool.........................................................................................16

3.8 Ethical consideration.......................................................................................16

3.9 Data processing and analysis..........................................................................16

3.10 Dissemination of findings.............................................................................16

3.11 Limitation of the study..................................................................................16

RESEARCH BUDGET.......................................................................................17

WORK PLAN......................................................................................................19

References.............................................................................................................21

3
 ACKNOWLEDGEMENT

Completion of this dissertation has been possible through the co-operation of various

special groups of people who participated with me all the time in proposal

development.

Therefore I express my sincere thanks to Sir HAULE and Madam Lillian my tutor and

other Kahama school of nursing staff for their technical support, in proposal

development.

I would like to send my appreciation to my fellow students for co-operating with me

in one way or another in terms of constructive ideas for the whole period of working

out with this dissertation.

4
 LIST OF ABBREVIATIONS

AIDS Acquired immune deficiency syndrome

ANC Antenatal care

ART Antiretroviral treatment

ARV Antiretroviral

HIV Human immunodeficiency virus

MTCT Mother to child transmission

PMTCT Prevention of mother to child transmission

RCH Reproductive and child health

TB Tuberculosis

UNICEF United Nations Children’s Fund

5
 DEFINITION OF TERMS

AIDS- A disease in which there is a cellular loss of the body’s cellular immunity,
greatly lowering the resistance to infection.

HIV- Is a virus that affect human and if untreated can lead to AIDS.

AZT (also known as Zidovudine (ZDV)) is an antiretroviral drug which inhibits HIV
replication. It is used in the prevention of mother-to-child transmission.

Breast-milk substitute- means any food being marketed or otherwise represented as a

partial or total replacement for breast milk, whether or not suitable for that purpose.

CD4 cells- means main target cells for HIV.

CD4 lymphocytes (a type of white blood cells) are key in both

Humoral and cell-mediated immune responses. Their number decreases during HIV
infection.

Cell-associated virus means HIV which lives inside the cell, measured as HIV-DNA.

Cell-free virus- means parts of the virus not associated with a cell, measured as HIV-
RNA.

6
SUMMARY

Mother to child HIV transmission is caused by different factor like lack of education
about the methods of PMTCT among the woman who live with HIV and also
economic and social factor may lead this,

In Tanzania there is a problem of mother to child HIV transmissions which causes

the death of infant for RI stance at Kahama town out of 24 infant born from affected
Mather one of them are affected with HIV,

Objective of this study is to determine factors contributing Mather to child HIV

transmissions to mothers who attending to Kahama RCH,

Rational of this study is to increase knowledge and awareness to the Mather’s about
prevention of Mather to child HIV transmissions [PMTCT] by identifying the factors
that contributing HIV transmissions from the Mather to child during pregnancy,
lobaur, and after child birth,

On the research methods, the research design will be cross sectional this is because it
allows the collection of data from different group respondents at one point to another
point, research area will Kahama town council hospital found in Shinyanga
Tanzania,

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 CHAPTER ONE

1.0 INTRODUCTION

1.1 Backgrounds

HIV {human immunodeficiency virus} is a virus that affect human and if untreated
can lead to AIDS. And maternal transmission of HIV is transmission of HIV infection
from mother to fetus.

Early introduction of PMTCT and in corrected Method of preventing MTCT from

breast milk are commonly found practices in communities around the world. National
wide data in Indonesia has shown that 39% of infants whose their mothers are HIV
experienced early initiation of breastfeeding (within one hour after birth) and 32% are
exclusively breastfed for less than six months 15% of children aged 6-9months were
continuing to be breast feed and received complementary foods and documented that
solid foods were introduced early as 3 months and appropriate breastfeeding practices
pose significant risk for malnutrition among children under the age of five. (Veronica
S. 2012)

At least 1600 infants are infected with Human Immunodeficiency Virus (HIV) every
day and more than 600,000 infants are infected by the virus annually. About 90% of
these infections occur in developing countries, mainly Sub-Saharan. It There was 2.5
million new HIV infections and this included 330 000 among children less than
15 years. Most of these children were from sub-Saharan Africa and mother-to-child
transmission during pregnancy, on delivery and during breastfeeding were the major
route of infection. It is believed that about two thirds are infected during pregnancy
and around the time of delivery, and about one third are infected through
breastfeeding. (BMN publish 2013).

The study which was done in Zimbabwe in 2010 show that Zimbabwe is one of the
five countries worst affected by the HIV/AIDS pandemic with HIV infection
contributing increasingly to childhood morbidity and mortality. Among the children
born to HIV positive mothers participating in the PMTCT programmer, 25% tested
positive to HIV. The mother having another illness, such as TB or malaria, can
increase the chance of transmission by elevating viral load or by causing immune
8
activation. Studies have shown that a mother infected with HIV during her pregnancy
has a higher chance of then transmitting it to her baby. {BMN publish, 2013}.

Since 2000 the Government of Tanzania has been scaling up the programmer for
Prevention of Mother to Child Transmission of HIV (PMTCT) mainly through
integration of a package of PMTCT services in routine Maternal and Child Health
services to ensure that there is reduction in vertical transmission. By December 2011,
4603 (96%) of Reproductive and Child Health (RCH) facilities had integrated
PMTCT in routine ANC, delivery and Post natal care services; about 64 % of
estimated HIV infected pregnant women and 56 % of babies born to them received
ARVs for PMTCT

And 19 % of pregnant women with advanced HIV infection were started on lifelong
antiretroviral treatment {eMTCT} (,mareth at al 2000).

9
1.2 Problem Statement

Mother to child transmission [MTCT] is used to describe transmission of HIV

infection from pregnant women to their infants.150,000 new HIV infections occurred
in 2015, dramatically declining from 330,000 in [Link] in reducing has been
dramatic since the introduction in 2011 of the ‘Global Plan towards the Elimination
About of New HIV Infections among Children, and Keeping their Mothers Alive’ –
largely because of increased access to related services and increased number of
pregnant women living with HIV being initiated on lifelong antiretroviral medicines.
But it has not been fast enough to reach the targets set by the Global Plan.
Acceleration of treatment for all pregnant and breastfeeding women living with HIV
is still needed to achieve elimination of new infections among children and halve HIV
related deaths among pregnant women and new mothers.

In Tanzania there is a problem of maternal HIV transmission which causes the death
of infants, for instance at Kahama town hospital council out of 24 infants born from
affected mother 1 of them are affected with HIV. Despite the government
interventions on health sector in improving maternal health care and prevention
factors which lead to maternal transmission rate, to expand care in RCH clinic to safe
mother and newborn lives and to improve quality care to the health centers. But
maternal transmission is still the problem.

Therefore it is important to study the factors contributing to maternal transmission

during pregnant, delivery and after delivery [During breast feeding] period and
thereafter to plan for proper intervention to prevent and reduce the risk of maternal
transmission.

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 CONCEPTUAL FRAME WORK

Education factor Social economic factor

Mather to child HIV transmission

Cultural and believes

Education Factor.

Lack of education among the Mothers about the proper measure of taken so that to
prevent to transmit HIV during pregnancy and after birth their baby increase risk of
mother to child HIV transmission among several woman in the society.

Cultural And Believes

Some cultural and believes like some people because of their believes and ignorance
doesn’t attend to the clinic during pregnancy and after delivery for checkup of child
this cause mother don’t checkup of HIV during pregnancy and increase risk of
mother to child transmission, and also the cultural of delivery at home increase risk of
HIV transmission.

Social Economic Factor

Because of economic and social factor the mother doesn’t reach the health facility for
delivery by skilled attendance, and birth at home or at street this increase the risk of
HIV transmission from Mather to child.

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1.3 Justification Of The Study;

The reason for conducting is to identify the factor contributing Mather to child HIV
transmission because it have some number of child get HIV form their Mather during
pregnancy, labor and breast feeding. So the finding will help to reduce the number of
Mather to child HIV transmission.

1.4 OBJECTIVE OF THE STUDY

1.4.1 Broad Objective

 Determine factors contributing to Mather to child HIV transmission to mothers

who attend at Kahama RCH.

1.4.2 Specific Objective

 To identify cultural factors contributing Mather to child HIV transmission

among mothers attending at Kahama RCH.
 To determine social-economic factors contributing to Mather to child
transmission of HIV among pregnant women attend at Kahama RCH.
 To determine Education factor contributing Mather to child HIV transmission
among women attend at Kahama RCH.

1.5 Research Question

i. What are the cultural factors that contributing mother to child HIV
transmission among mothers attending at Kahama RCH?
ii. What are the social economic factors contributing to Mather to child
transmission of HIV among pregnant women attend at Kahama RCH?
iii. What are Education factors contributing to Mather to child transmission of
HIV among mother attending at Kahama RCH?

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 CHAPTER TWO

2.0 LITERATURE REVIEW

Review of literature refers to the extensive, exhaustive and systemic examination of
publication relevant to research project. The literature review provides readers with a
back ground for understanding current knowledge on a topic and illuminates the
significance of the new study. The investigator carried an extensive review of
literature relevant to the research topic to gain insight and collected maximum
information for laying the foundation of the study.

The transmission of HIV from a HIV-positive mother to her child during pregnancy,
labor, delivery or breastfeeding is called mother-to-child transmission. In the absence
of any intervention, transmission rates range from 15% to 45%. This rate can be
reduced to below 5% with effective interventions during the periods of pregnancy,
labor, delivery and breastfeeding.

These interventions primarily involve antiretroviral treatment for the mother and a
short course of antiretroviral drugs for the baby. They also include measures to
prevent HIV acquisition in the pregnant woman and appropriate breastfeeding
practices. The new Sustainable Development Goals place heightened emphasis on

prevention of mother-to-child transmission (PMTCT) in the context of better health

for mothers and their children.

The World Health Organization (WHO) works together with partners to set global
standards for HIV prevention, care and treatment for pregnant women, mothers and
their children; and to develop evidence-based strategies and define global targets,
baselines and indicators that promote the integration of PMTCT into maternal,
newborn and child health services, thus strengthening health systems.

Following the release of new guidelines in 2015, WHO no longer recommends

different choices for PMTCT, but instead advises that all pregnant and breastfeeding
women should receive ART irrespective of clinical stage of disease or CD4 count.
This approach, first pioneered by Malawi, has been subsequently adopted by most
countries with a high burden of HIV. As a result, at the end of 2014, over two thirds

13
of pregnant women with HIV in sub-Saharan Africa were on ART. This coverage
level exceeds that for non-pregnant adults.

The accelerated roll-out of ART for pregnant women was an important factor in the
success of the Global Plan towards the elimination of new HIV infections among
children by 2015 and keeping their mothers alive. Between 2009 and late 2014, many
countries saw the number of new infections in children drop by over 60%; these
countries are now closer than ever to eliminating mother-to-child transmission as a
public health concern. WHO normative work in defining standards and
recommendations for PMTCT is complemented by the Inter-Agency Task Team for
the Elimination of Mother-to-Child Transmission (IATT). The IATT is co-convened
by

WHO and the United Nations Children’s Fund, and include a number of other
partners and stakeholders. Members of the IATT work together to generate tools,
operational materials and technical documents to support the implementation of
normative recommendations and programming of PMTCT and pediatric HIV.(WHO
2016).

Transmission of HIV through breastfeeding has been well documented since 1985.
The first reports indicating the possibility of HIV transmission through breast milk
were in breastfed infants of women who had acquired infection postnatal through
blood transfusions or exposure (Ziegler et al. 1985; Hira et al. 1990; Van de Perre et
al. 1991;Palasanthiran et al. 1993). There were also reports of infants – with no other
known exposure to HIV – who were infected through being wet-nursed and through
pooled breast milk (Nduati et al.1994). There is a theoretical risk of oral transmission
from infant to wet-nurse, with cases having been reported (Visco-Comandini et al.
2005).

Zimbabwe is one of the five countries worst affected by the HIV/AIDS pandemic
with HIV infection contributing increasingly to childhood morbidity and mortality.
Among the children born to HIV positive mothers participating in the PMTCT
programmer, 25% tested positive to HIV. We investigated factors associated with
HIV infection among children born to mothers on the PMTCT programmer,

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Factors which increase the likelihood of transmission of HIV from mother to baby
include:

 A high viral load, especially during labor and delivery. A mother with high
viral load is more likely to transmit HIV, and transmission is most likely to
occur during labor and delivery. However, though transmission is rare in
mothers with undetectable viral load, it does still occur.
 A low CD4 count or CD4 percentage.
 Advanced HIV disease or previous AIDS-defining illness.
 Smoking during pregnancy.
 Use of recreational or illegal drugs during pregnancy. The biological
relationship between drug use and mother-to-baby transmission is not
understood, but a study of 525 women in the US showed that women who
used heroin, methadone, crack or cocaine during pregnancy were almost twice
as likely to transmit HIV to their babies when all other factors were controlled
for.
 Frequent unprotected sex, especially with multiple partners, during pregnancy.
 No HIV therapy during pregnancy or delivery.
 Premature delivery.
 Cervical or vaginal infection (e.g. bacterial vaginosis). The mother having
another illness, such as TB or malaria, can increase the chance of transmission
by elevating viral load or by causing immune activation. Studies have shown
that a mother infected with HIV during her pregnancy has a higher chance of
then transmitting it to her baby. {BMN publish, 2013}

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 CHAPTER THREE

3.0 RESEARCH METHODOLOGY

3.1 Research Design.

The study design will be cross sectional this is because it allows the collection
of data from different groups of respondents at one point to another point.

3.2 Study Area.

The study area will be Kahama town council hospital found in Kahama
Shinyanga Tanzania, It is being selected because there is enough number of
pregnant women who attend ANC.

3.3 Study Population.

The study population of this research includes all pregnant women affected
with HIV/AIDS who will attend at Kahama town council hospital during the
data collection day.

3.4 Sample Size.

A sample of 20 respondents from all pregnant mothers affected with
HIV/AIDS will be used.

3.5 Sampling Procedure.

Random sampling procedure will be used.

3.6 Pilot Study.

The tool for data collection will be tested before the actual data collection in
which 2 subjects will be used for test of this study.

3.7 Data Collection Tool.

The questionnaires will be used to collect information from respondents.

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3.8 Ethical Consideration.
The request letter for conclusion study will be issued and taken to the area of
study to request permission and approached individually to maintain privacy
and confidentiality. Also the participants will be loaded using numbers instead
of their names, the study will be voluntary, no anyone will forced to
participate in the study.

3.9 Data Processing And Analysis.

All information will be analyzed manually by using data master sheet and
presented in research report by using tables, bar charts, pie charts and
histogram.

3.10 Dissemination Of Findings.

The research report will be compromise three copies and will be distributed as
follows;
 Personal copy
 Kahama school of nursing
 Kahama town hospital council.

3.11 Limitation Of The Study.

Some of the participants may have not gone to school that could make difficult
for them to fill the questionnaires; language also can be a problem for the
participants who do not know Kiswahili and English so it will be difficult to
communicate with them as well as to fill the questionnaires, and also the have
limitation of time in my study.

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 RESEARCH BUDGET.

A c t i v i t i e P a r t i c u l a Q u a n t i t i e A m o u n t
s r s s
Proposal Internet 500mb for 10,000/=
development services 20days@500/= 4,000/=
Printing 40pages@100/= 8,000/=
Typing 40pages@700/= 500/=
Ruler 1 @500/= 1,000/=
Pen 5pc @ 200/= 10,000/=
White Papers 1leam@10,000/= 5,000/=
Punching machine 1@5000/= 2,000/=
Spring file 1@2000/

Data Questionnair
collection e: 4pages@700/= 2,800/=
 Typing 4pages@100/= 400/=
 Printing 20copies@200/= 4,000/=

 Photocopying

Report Typing and Printing 50pages@700 3 5 , 0 0 0 / =

production /=

T o t a l 8 2 7 0 0 / =

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WORK PLAN

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 work plan

DECEMBER JANUARY FEBRUARY MARCH

2020 2021 2021 2021

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Propos
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pment

Submi
ssion
of
propos
al

Data
collect
ion

Data
analys
is

Report
writin
g one
draft

Submis
20
sion of
final
report
REFERENCES.

1. Ayouba A et al. (2003). Mother-to-child transmission of human immunodeficiency

virus in

relation to the season in Yaounde, Cameroon. American Journal of Tropical Medicine

and Hygiene, 69(4):447–9.

2. Bulterys M (2000). Breastfeeding in women with HIV. Journal of the American

Medical

Association, 284(8):956; author reply 956–7.

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3. Harms G, Mayer A, Karcher H., (2010). Prevention of mother to child transmission
of HIV in Kenya, Tanzania and Uganda. Report of Government of Tanzania PMTCT
Project. International Coordination office. Berlin, Germany; 1-26.

4. World Health Organization (2013). Antiretroviral drugs for treating pregnant

women and preventing HIV infection in infants in resource-limited settings: towards
universal access.

5. Visco-Comandini et al. (2005) . HIV transmission through breastfeeding

6. Schmidt V. Ivar Christian Bang (1869 - 1918), founder of modern clinical

microchemistry. Clin Chem. 1986;32(1):213–215. [PubMed]

APPENDIX 2: QUESTIONNAIRES
INTERVIEW ADMINISTERS QUESTIONNAIRE FOR PREGNANT WOMEN
WHO AFFECTED WITH HIV/AIDS ON TRANSMISSION OF HIV INFECTION
TO NEWBORN.

INSTRUCTION:
Fill in the blanks all answer you felt and put letter A, B, C and D inside the box in
front provided.
1. Information obtained will be confidential.
2. Name not required please feel free to give the information.
3. Fill in the blanks.

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4. Put in correct answer.

Personal Information.
Sex.....................................................................
Age....................................................................
Religion.................................................................
Tribe....................................................................

1. What is your level of education?

(a) no education
(b) Primary ( )
(c) Secondary
(d) High education

2. What is your occupation?

(a) Peasant
(b) House wife ( )
(c) Employee
(d) Others

3. Marital status.
(a) Married..................................... ( )
(b) Not married...............................

Education Factor.

4. Have you heard about Mather to child HIV transmission?

a) Yes.
b) No ( )

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6. Can newborn get HIV infection from pregnant mother who affected with HIV
infection?
a) Yes
b) No ( )

7. If yes what is the reason?

(a).....................................................................................................................................
..................
(b).....................................................................................................................................
..................

Cultural And Believes

8. In you society their have the culture to delivery at home?

(a) Yes
(b) No ( )

9. Did you attend to the clinic as soon as you know you have pregnancy?
(a) Yes
(b) No
(c) Some how
10. In you society men saporty the pregnancy woman on following health services?
(a) Yes
(b) No
(c) Some how

Social Economic Factor

11. How far away from you home to health facility?

(a) Near
(b) Far
(c) Very far

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12. You can access the transportation to reach health facility early in case of
emergency?
(a) Yes
(b) No
(c) Not sure
13. Infrastructure it can cause barrier for you to reach health facility?
(a) Yes
(b) No

DODOSO (KISWAHILI)
DODOSO KWA AKINA MAMA WAJAWAZITO WANAOISHI NA
MAAMBUKIZI YA VIRUSI VYA UKIMWI JUU YA MAAMBUKIZI YA
VIRUSI VYA UKIMWI TOKA KWA MAMA KWENDA KWA MTOTO.

MAEELEKEZO:
1. Taarifa zote zitakazotolea zitakuwa ni siri.
2. Jina halihitajiki, tafadhali kuwa huru kutoa taarifa.
3. Jaza sehemu ilioachwa wazi.
4. Weka herufi ya jibu sahihi kwenye kisanduku mbele ya swali.

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 Maelezo binafsi.
Jinsia...............................................................
Umri................................................................
Dini................................................................
Kabila...............................................................

Maswali
1. Una elimu gani?
(a) Haujasoma
(b) Msingi ( )
(c) Sekondari
(d) Elimu ya juu

2. Unafanya kazi gani?

(a) Mkulima ( )
(b) Mama wa nyumbani
(c) Muajiriwa
(d) Kazi nyingine taja..................................................................................

3. Hali ya ndoa
a) Olewa.............................................. ( )
b) Sijaolewa.........................................

Sababu Za Kielimu

4. Je ulishawahi kusikia juu ya maambukizi ya virusi vya ukimwi toka Kwa mama
kwenda Kwa mtoto?
a) Ndiyo.
b)Hapana. ( )

26
6. Je Mama Mjamzito mwenye maambukizi ya virusi vya ukimwi anaweza
kumuambukiza mtoto?
a)Ndiyo.............................................................
b)Hapana......................................................... ( )

7. Kama jibu ndiyo ni kwa sababu gani?

a).......................................................................................................................................
.................
b).......................................................................................................................................
.................

Sababu Za Kitamaduni

8. Kwenye jamii yako kuna utamaduni wa kujifungulia nyumbani?

(a) Ndio
(b) Hapana ( )

9. Huwa unahuzuria kiliniki mara tu unapogundua una mimba

(a) Ndio
(b) Hapana. ()
(c) Mara chache

10 kwenye jamii yako wanaume wana wasapoti wamama wajawazito kwenye

masuala ya afya

(a)Ndio ()

(b)Hapana

Sababu Za Kijamii Na Kiuchumi

11. Kuna umbali gani kutoka nyumbani kwako mpaka kwenye kituo cha afya?
(a). Karibu ( )
(b).Mbali
(c).Mbali Sana

27
12. Unaweza kupata usafiri wa haraka wa kufika hosipitali Kama kukitokea zarura?

(a). ndio

(b).hapana ()

(c).sina uhakika

13. Miundombinu inaweza Kwa kikwazo kwako kufika kwenye kituo cha afya Kwa
wakati?

(a). ndio
(b).hapana ()

28