UWCScholar :: Browsing by Author "van Wyk, Brian"

Browsing by Author "van Wyk, Brian"

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A realist evaluation of the antiretroviral treatment adherence club programme in the metropolitan area of the Western Cape Province, South Africa
(University of the Western Cape, 2018) Mukumbang, Ferdinand C.; van Wyk, Brian
In South Africa, 7.1 million people living with HIV/AIDS (PLWHA) of whom about 56% were accessing antiretroviral therapy (ART) in 2016, accounted for approximately 20% of people on ART globally. The successful initiation of PLWHA on ART has engendered challenges of poor retention in care and suboptimal adherence to medication. While standard treatment and care schemes show the potential to retain patients in ART care, their success is challenged by congested health-care facilities, long waiting times and shortages of health-care providers. The antiretroviral adherence club intervention was rolled out in primary health-care facilities in the Western Cape Province of South Africa to relieve clinic congestion and improve retention in care, and treatment adherence in the face of growing patient loads. Evidence from the literature suggests that these models of ART service delivery are more effective than corresponding facility-based care. Nevertheless, there is little understanding of how these care models work to achieve their intended outcomes. To this end, a theory-driven approach to evaluate the adherence club intervention was proposed.
Aging with HIV: Increased risk of HIV comorbidities in older adults
(MDPI, 2022) Roomaney, Rifqah Abeeda; van Wyk, Brian; Pillay-van Wyk, Victoria
With improved access to antiretroviral treatment (ART), adults with HIV live longer to reach older age. The number of older adults living with HIV is increasing steadily, giving rise to a new population of interest in HIV research and for invigorated considerations in health service delivery and policy. We analysed the profile of comorbidities in older people (50 years and older) living with HIV in South Africa. We conducted a secondary analysis of all individuals over 15 years who tested HIV positive in the Fifth South African National HIV Prevalence, Incidence, Behaviour and Communication Survey, 2017. We conducted multivariate logistic regression to determine the factors associated with having HIV comorbidity using Stata 15.0 software. We entered 3755 people living with HIV into the analysis, of whom 18.3% (n = 688) were 50 years or older.
Barriers to adherence to antiretroviral treatment in a regional hospital in Vredenburg, Western Cape, South Africa
(AOSIS, 2016) Azia, Ivo N.; Mukumbang, Ferdinand C.; van Wyk, Brian
BACKGROUND: South Africa currently runs the largest public antiretroviral treatment (ART) programme in the world, with over 80% of people living with HIV and/or AIDS on ART. However, in order to appreciate the benefits of using ART, patients are subject to uncompromising and long-term commitments of taking at least 95% of their treatment as prescribed. Evidence shows that this level of adherence is seldom achieved because of a multilevel and sometimes interwoven myriad of factors. Objective: We described the challenges faced by patients on ART in Vredenburg with regard to ART adherence. METHODS: A descriptive qualitative research design was used. Eighteen non-adhering patients on ART in the Vredenburg regional hospital were purposefully selected. Using a semistructured interview guide, we conducted in-depth interviews with the study participants in their mother tongue (Afrikaans). The interviews were audio-taped, transcribed verbatim and translated into English. The data were analysed manually using the thematic content analysis method. RESULTS: Stigma, disclosure, unemployment, lack of transport, insufficient feeding, disability grants and alternative forms of therapy were identified as major barriers to adherence, whereas inadequate follow-ups and lack of patient confidentiality came under major criticisms from the patients. CONCLUSION: Interventions to address poverty, stigma, discrimination and disclosure should be integrated with group-based ART adherence models in Vredenburg while further quantitative investigations should be carried out to quantify the extent to which these factors impede adherence in the community.
Burden of multimorbidity in South Africa: Implications for health policy and service delivery
(University of the Western Cape, 2022) Roomaney, Rifqah Abeeda; van Wyk, Brian
South Africa is challenged to manage the quadruple burden of disease experienced by its population. Furthermore, the burden of multimorbidity – that is, people living with more than one disease condition – is increasing. Multimorbidity challenges the way the health system is organised as it traverses different health programmes. However, little research has investigated the phenomenon in South Africa. The study describes the epidemiology – prevalence, patterns and risk factors - of multimorbidity in South Africa, and makes recommendations for health policy and service delivery.
Closing the HIV treatment gap for adolescents in Windhoek, Namibia: A retrospective analysis of predictors of viral non-suppression
(MDPI, 2022) Munyayi, Farai Kevin; van Wyk, Brian
Windhoek joined the Fast-Track Cities Initiative in 2017 to optimize HIV service delivery for adolescents, promoting adherence and sustaining viral suppression. Recent surveys and programmatic data show that the treatment gap remains greatest among children and adolescents living with HIV. A retrospective cohort analysis of adolescents living with HIV (ALHIV) receiving antiretroviral therapy (ART) at Windhoek healthcare facilities was conducted. Routine clinical data were extracted from the electronic Patient Monitoring System (ePMS). The SPSS statistical package was used to determine viral non-suppression and perform inferential statistics. 695 ALHIV were analysed with median age of 16 years (IQR = 13–18). Viral non-suppression at 1000 copies/mL threshold was 12%. Viral non-suppression was associated with age at ART initiation, duration on ART, current ART regimen and WHO Clinical Stage. In multivariate analysis, longer duration on ART was a protective factor for viral non-suppression (13–24 months vs. >24 months: aOR = 8.92, 95% CI 2.60–30.61), while being on third line regimen (vs. first line) was protective against viral non-suppression (aOR = 0.11, 95% CI 0.03–0.49). A significant treatment gap is evident for ALHIV with high viral non-suppression levels. Interventions are required to counter treatment fatigue to keep adolescents engaged in ART, and timely switching to rescue regimens for failing adolescents.
Comparing patients’ experiences in three differentiated service delivery models for HIV treatment in South Africa
(SAGE Publications, 2022) Mukumbang, Ferdinand C.; Ndlovu, Sibusiso; van Wyk, Brian
Differentiated service delivery for HIV treatment seeks to enhance medication adherence while respecting the preferences of people living with HIV. Nevertheless, patients’ experiences of using these differentiated service delivery models or approaches have not been qualitatively compared. Underpinned by the tenets of descriptive phenomenology, we explored and compared the experiences of patients in three differentiated service delivery models using the National Health Services’ Patient Experience Framework. Data were collected from 68 purposively selected people living with HIV receiving care in facility adherence clubs, community adherence clubs, and quick pharmacy pick-up. Using the constant comparative thematic analysis approach, we compared themes identified across the different participant groups. Compared to facility adherence clubs and community adherence clubs, patients in the quick pharmacy pick-up model experienced less information sharing; communication and education; and emotional/psychological support. Patients’ positive experience with a differentiated service delivery model is based on how well the model fits into their HIV disease self-management goals.
Conceptualisation and operationalisation of mental wellness: Developing an instrument to measure mental wellness among adolescents living with HIV in South Africa
(University of the Western Cape, 2022) Orth, Zaida; van Wyk, Brian
Adolescents living with HIV (ALHIV) are a key population in the fight against HIV and AIDS. The comparatively poorer treatment outcomes of ALHIV in relation to child and adult HIV populations indicate the need for a health response to improve adolescent ART service delivery. Research suggests that improving mental wellness may be imperative to improving HIV-treatment behaviours such as long-term adherence and engagement in care. However, little is known about what mental wellness means for ALHIV. It is further unknown what critical mental wellness concepts should be targeted in adolescent interventions. Ultimately, understanding mental wellness in ALHIV is essential to design programmes that will help them navigate their chronic condition to lead healthy and productive lives.
Conceptualising the factors affecting retention in care of patients on antiretroviral treatment in Kabwe District, Zambia, using the ecological framework
(Hindawi Publishing Corporation, 2017) Mukumbang, Ferdinand C.; Mwale, Joyce Chali; van Wyk, Brian
BACKGROUND. HIV remains a major public health challenge in Zambia.The roll-out of antiretroviral treatment (ART) has engendered new challenges in retention in care. OBJECTIVE. To conceptualise the factors affecting retention in care of ART patients at three primary healthcare facilities using the ecological framework. METHOD. Qualitative data were collected through in-depth interviews with 45 ART patients and three focus group discussions with 20 healthcare providers from three primary healthcare facilities in Kabwe district, Zambia, and subjected to thematic content analysis. RESULTS. Individual level barriers to retention in care included side effects, gaining weight, belief in faith healing, and use of herbal remedies and alcohol. Interpersonal barriers such as stigma and nondisclosure of HIV status were reported. At the institutional level, inadequate space in the clinic, long waiting times, long travel distances, and shortage of third-line drugs presented barriers to retention in care. Food shortages and patient mobility were reported as community barriers to retention in care. CONCLUSION.The ecological framework conceptualises the complex and dynamic factors affecting retention inART care and highlights the need formultifaceted interventions that combine health education, disease management, and opportunities for income generation in a socially responsive and accountable environment.
Determinants of viral suppression among adolescents on antiretroviral treatment in Ehlanzeni district, South Africa: a cross-sectional analysis
(BMC, 2021) Okonji, Emeka F.; van Wyk, Brian; Mukumbang, Ferdinand C.
Achieving undetectable viral load is crucial for the reduction of HIV transmissions, AIDS-related illnesses and death. Adolescents (10 to19 years) living with HIV (ALHIV) on antiretroviral treatment (ART) have worse treatment adherence and lower viral suppression rates compared to adults. We report on the clinical factors associated with viral suppression among ALHIV in the Ehlanzeni district, Mpumalanga in South Africa.A cross-sectional analysis was conducted with 9386 ALHIV, aged 10 to 19 years, who were enrolled in 136 ART clinics in the Ehlanzeni district. Clinical and immunological data were obtained from electronic medical records (Tier.net). ALHIV were categorised as having achieved viral suppression if their latest viral load count was<1000 ribonucleic acid (RNA) copies/mL. Using a backward stepwise approach, a multivariate logistic regression analysis was performed to identify factors independently associated with viral suppression.
Development of a patient-centred in-service training programme for midwives to increase client satisfaction with child-birth care in Kumasi, Ghana
(University of the Western Cape, 2017) Dzomeku, Veronica Millicent; van Wyk, Brian; Knight, Lucia
Background: Satisfaction with the care mothers receive during child-birth is known to have a very strong influence on their future use of facility-based care during child-birth. Women and children continue to die from complications associated with pregnancy and child-birth and the majority of the causes that lead to mortality are related to labour and delivery. For this reason it is imperative for mothers to access facility-based child-birth care to receive skilled birth care. Mothers report dissatisfaction with facility-based child-birth care as one of the reasons for home births without skilled attendants. The presence of the skilled birth attendants is known to reduce maternal and neonatal mortality rates because of their ability to diagnose any early complications, and to intervene appropriately. Aim: The aim of the current study was to develop an in-service training programme for midwives to provide patient-centred child-birth care that would increase client satisfaction with child-birth care. Method and findings: The intervention research model by Rothman and Thomas (1994) – Design and development (D & D) – was used as the research framework. Only the first four of the six phases of the D & D model were applied in this study. In the first phase, a situational analysis was done using a qualitative study. The expectations, experiences, and satisfaction with child-birth care of antenatal and postnatal mothers, were explored. The research was conducted in four health institutions within the Kumasi Metropolis. Between 12 and 15 participants were purposively sampled in each hospital. Data were collected by means of individual in-depth interviews using an interview guide and data were analysed using content analysis. The study found that mothers expected to receive respectful care and safe care. Mothers had encouraging experiences and discouraging experiences during their child-birth care. The discouraging experiences did not align with their expectations of care, leading to dissatisfaction with child-birth care. In the second phase of the study an integrative literature review was conducted to identify evidence-based best practices to deal with client dissatisfaction with health care. The integrative literature review indicated that in-service training was commonly used as best-practice to improve health professionals' knowledge, skills and attitudes towards work and consequently to improve health outcomes for patients, including client satisfaction. In the third phase of the study, the in-service training programme to enhance patient-centred care was developed using Chinn and Kramer (2005) guidelines for programme development and steps to programme development by Management Sciences for Health (2012). The fourth phase entailed an assessment of feasibility and usability of the in-service training programme using 6 midwives in a district Hospital. The procedure was guided by the I-Tech Technical Implementation guide (2010). The outcomes of the assessment was used to refine and revise the developed in-service training programme. Conclusion: This study sought to develop an intervention to increase client satisfaction with child-birth care service by engaging the following processes in phases: • Assessing the expectations and experiences of mothers about child-birth care services. • An integrative literature review for evidence-based best practice to tackle client dissatisfaction with health care. • Designing a patient-centred care in-service training programme together with experts in the field of maternal and child health. • As assessment of feasibility and usability of the in-service training programme by means of a pilot test to refine the programme. Recommendations: It was recommended among others that, the study is carried out on a national scale to cover all administrative regions of Ghana. It is further recommended that the study findings and the programme developed form part of the continuous professional assessment course requirement for nurses and midwives.
Discourses of mental wellness among adolescents living with HIV in Cape Town, South Africa
(Dove Press, 2022) Orth, Zaida; van Wyk, Brian
Adolescence is a unique period of development where individuals transition from childhood to adulthood, and where they are at heightened risk for developing mental health problems and engaging in risky behaviours. In addition, adolescents living with HIV (ALHIV) must learn to cope with challenges related to the biological impact of a chronic condition, adhering to lifelong treatment, and managing HIV-related psychological and social challenges. Mental wellness as a precursor to mental wellbeing, is vital to facilitate persistent adherence and engagement in care for optimal treatment outcomes for ALHIV. However, little is known about how ALHIV understand and talk about mental wellness in the context being on HIV treatment.
Effectiveness, acceptability, and feasibility of technology-enabled health interventions for adolescents living with HIV in low- and middle income countries: A systematic review protocol
(Public Library of Science, 2023) Crowley, Talitha; Petinger, Charne; van Wyk, Brian
Adolescents living with chronic conditions such as HIV (ALHIV) are challenged to remain adherent and engaged in HIV care. Technology offers a promising platform to deliver behaviour-change interventions to adolescents. The largest proportion of ALHIV resides in sub-Saharan Africa; yet little is known about the effectiveness, feasibility and acceptability of technology-enabled interventions to deliver and support health care to ALHIV in resource-constraint settings. This study aims to explore the literature and synthesise the evidence for the effectiveness, acceptability, and feasibility of technology-enabled health interventions for ALHIV in low and middle-income countries (LMIC). Eight electronic databases (Ebscohost, CINAHL, ERIC, MEDLINE, PubMed, SCOPUS, Science Direct, and Sabinet) and Google Scholar will be searched to identify technology-enabled health interventions for ALHIV in LMIC published from 2010–2022. Quantitative and qualitative studies reporting on technology-enabled health interventions for predominantly adolescents (10–19 years) will be included.
Evaluation of a psychosocial support intervention on adherence and retention in care among adolescents on antiretroviral treatment in Ehlanzeni District Municipality, Mpumalanga, South Africa
(University of the Western Cape, 2022) Okonji, Emeka Francis; van Wyk, Brian
In 2021, it was estimated that globally approximately 1.8 million adolescents (aged 10-19 years) were living with HIV, of whom over 90% resided in sub-Saharan Africa. While the global number of adolescents living with HIV fell by 57% from 2000 to 2020, the number of AIDS-related deaths amongst adolescents in eastern and southern Africa increased during the same period. Adolescents living with HIV (ALHIV) face many challenges related to adherence to antiretroviral treatment (ART) and remaining engaged in care. Some of these challenges result from the physiological and psychosocial characteristics of their stage of development. It is hypothesized that providing psychosocial support may mitigate high levels of anxiety, fear of disclosing their HIV-positive status, low self-esteem, low self-efficacy, depressive disorders, and suicide reported amongst adolescents living with HIV.
An evaluation of Isoniazid prophylaxis treatment and the role of Xpert MTB/RIF test in improving the diagnosis and prevention of tuberculosis in children exposed to index cases with pulmonary tuberculosis in Kigali, Rwanda
(University of the Western Cape, 2018) Birungi, Francine Mwayuma; van Wyk, Brian; Graham, Stephen Michael; Nicol, Jeaninne Uwimana
Background: Tuberculosis (TB) is a major cause of morbidity and mortality among children (<15 years) in resource-limited countries. The World Health Organization (WHO) identified active contact screening and isoniazid preventive therapy (IPT) as essential actions for detecting and preventing childhood TB. Despite their benefits and inclusion in the policy of most National TB Programme (NTP) guidelines of the resource-limited countries, there is still a wide gap between policy and implementation. The implementation of contact screening for active case finding might be improved by the decentralised use of the Xpert MTB/RIF test in gastric lavage (GL) specimens, but this has not been previously assessed. Furthermore, although the provision of IPT to eligible child contacts has been a focus for implementation by the NTP of Rwanda since 2005, implementation has not previously been evaluated. The assessment of IPT uptake and adherence as well as associated factors could be informative for the programme. Therefore, we aimed to assess the diagnostic yield of Xpert MTB/RIF in GL among child contacts with suspected pulmonary tuberculosis (PTB) and the uptake of and adherence to IPT by eligible child contacts to make recommendations towards strengthening TB diagnostic and prevention in children in Kigali, Rwanda. Methods: The proposed study setting Kigali, the capital city of Rwanda, was the location for 30% of the national PTB case notifications in 2013-14.A conceptual framework based on ecological theory was used in this study. Quantitative, qualitative and mixed (using both quantitative and qualitative research methods in one study) research methods were applied, and various research designs were used depending on the research questions. The study involved a cross-sectional analysis of the diagnostic yield of Xpert MTB/RIF in GL among all child contacts with suspected TB. Across-sectional and prospective cohort study design was used to assess the uptake and adherence of IPT among eligible child contacts.
Experiences of adolescents living with HIV on transitioning from pediatric to adult HIV care in low and middle-income countries: a qualitative evidence synthesis protocol
(Public Library of Science, 2024) Petinger, Charné; Crowley, Talitha; van Wyk, Brian
In South Africa, it is estimated that approximately 320,000 adolescents living with HIV (ALHIV) will transition from pediatric to adult antiretroviral treatment (ART) by 2028. However, the age period of 10–19 years is accompanied by a myriad of barriers that challenge the transition process, and continued adherence to ART. The transition process involves ALHIV taking charge of their own health and disease management which raises challenges for their retention in care. Managing transition becomes particularly challenging in low-resource contexts as their healthcare systems are not adapted to the specific needs it requires. There is a need to garner an understanding of existing transition practices which address the specific needs of adolescents and is optimized to their requirements and available resources within a low- or middle-income country context. This review will include all qualitative and mixed method studies which will facilitate a deeper understanding the experiences of ALHIV on transition experiences. The review will specifically look at studies conducted in low- and middle-income countries. The included studies must be presented in the English language and published between 2010–2023. The search strategy will be finalized with consultation with an information specialist. All three reviewers will be present throughout all stages of the review. One reviewer will work independently on the initial screening of studies and another reviewer will assist in checks. After data is extracted, the data will be thematically analyzed with the use of Atlas.Ti computer software. No ethics approval is required and the review will be published in peer reviewed journals and submitted to conferences.
Experiences of support by unsuppressed adolescents living with HIV and their caregivers in Windhoek, Namibia: a qualitative study
(Frontiers Media SA, 2024) Munyayi, Farai kevin; van Wyk, Brian
Adolescents living with HIV (ALHIV) lag behind younger children and adults in the achievement of HIV care and treatment targets for HIV epidemic control. Treatment outcomes for adolescents may be influenced by their experiences with the support provided in HIV programs. We report on the experiences of virally unsuppressed adolescents and their caregivers with the current support in primary healthcare settings in Namibia. A qualitative descriptive and exploratory study was conducted in 13 public primary healthcare facilities in Windhoek, Namibia. A total of 25 in-depth interviews were conducted with unsuppressed adolescents (n = 14) and their caregivers (n = 11) between August and September 2023. The audio-recorded interviews were transcribed verbatim, and uploaded into ATLAS.ti software, and subjected to thematic content analysis. Three main support domains for the unsuppressed adolescents emerged from our analysis, namely: psychosocial, clinical and care, and socioeconomic support. The psychosocial support was delivered through peer support (teen clubs and treatment supporters) and enhanced adherence counselling mostly. The clinical and care support included implementing adolescent-friendly HIV services, differentiated service delivery approaches, and caregivers and healthcare worker care support for improved ART adherence, clinic attendance and continuous engagement in care. Socioeconomic support was provided for nutritional support, transport to access clinics, and school supplies, as well as income-generating projects. Psychosocial, clinical and care, and socioeconomic support are key elements in addressing the needs of adolescents challenged with achieving viral suppression. Health systems may benefit from whole-of-society and whole-of-government approaches to meet the needs of ALHIV that are beyond the scope of health service delivery such as nutritional, education and socioeconomic influences on both the health and well-being of ALHIV.
An exploration of group-based HIV/AIDS treatment and care models in Sub-Saharan Africa using a realist evaluation (Intervention-Context-Actor-Mechanism- Outcome) heuristic tool: a systematic review
(BioMed Central, 2017) Mukumbang, Ferdinand C.; Van Belle, Sara; Marchal, Bruno; van Wyk, Brian
Introduction: It is increasingly acknowledged that differentiated care models hold potential to manage large volumes of patients on antiretroviral therapy (ART). Various group-based models of ART service delivery aimed at decongesting local health facilities, encouraging patient retention in care, and enhancing adherence to medication have been implemented across sub-Saharan Africa. Evidence from the literature suggests that these models of ART service delivery are more effective than corresponding facility-based care and superior to individual-based models. Nevertheless, there is little understanding of how these care models work to achieve their intended outcomes. The aim of this study was to review the theories explicating how and why group-based ART models work using a realist evaluation framework. Methods: A systematic review of the literature on group-based ART support models in sub-Saharan Africa was conducted. We searched the Google Scholar and PubMed databases and supplemented these with a reference chase of the identified articles. We applied a theory-driven approach—narrative synthesis—to synthesise the data. Data were analysed using the thematic content analysis method and synthesised according to aspects of the Intervention-Context-Actor-Mechanism-Outcome heuristic-analytic tool—a realist evaluation theory building tool. Results: Twelve articles reporting primary studies on group-based models of ART service delivery were included in the review. The six studies that employed a quantitative study design failed to identify aspects of the context and mechanisms that work to trigger the outcomes of group-based models. While the other four studies that applied a qualitative and the two using a mixed methods design identified some of the aspects of the context and mechanisms that could trigger the outcomes of group-based ART models, these studies did not explain the relationship(s) between the theory elements and how they interact to produce the outcome(s).
A facility-based family support intervention to improve treatment outcomes for adolescents on antiretroviral therapy in the Cape Metropole, South Africa
(SAGE, 2021) Orth, Zaida; van Wyk, Brian
Adolescents living with human immunodeficiency virus (HIV) (ALHIV) globally, report worse treatment outcomes compared to adults and children on antiretroviral therapy (ART). We conducted a photovoice study with eighteen ALHIV to explore experiences and challenges of being on ART, and individual interviews with 5 health workers to describe the challenges in treating ALHIV. The facility implemented the Family club intervention to facilitate caregivers (parent/guardians) supporting ALHIV on treatment. The health workers revealed that “disclosing HIV status” to children was the biggest challenge for caregivers and health workers. Participating ALHIV reported that family support and having a positive mentality were instrumental for continued treatment adherence. However, disclosure of HIV status to friends remained a challenge due to pervasive community stigma. Treatment fatigue and side-effects were also barriers to adherence. Family support was instrumental in facilitating adherence support for ALHIV. However, this (intervention) should include peer support to improve positive mental well-being in ALHIV.
Factors associated with viral non-suppression among HIV positive adults on antiretroviral therapy in Luapula Province, Zambia.
(Universty of the Western Cape, 2024) Mvududu, Don Tafadzwa Kudzanai; van Wyk, Brian
HIV is a significant global public health concern, with approximately 38 million individuals living with HIV by the end of 2021 globally. Zambia has a high HIV burden, with an adult prevalence of 11% in 2021. Despite significant progress in the uptake of antiretroviral therapy (ART) by individuals living with HIV, Zambia still struggles to reach the epidemic control targets of 95-95-95 set by UNAIDS, with recent reports estimating viral suppression rate at 90%. It is therefore, imperative to investigate the factors that are associated with viral non-suppression, particularly in rural settings like Luapula Province, Zambia, where few research has been done to date. The current study describes the prevalence and factors associated with viral non-suppression among HIV positive adults on ART in Luapula Province, Zambia.
Factors influencing the choice of child delivery location among women attending antenatal care services and immunization clinic in Southeastern Nigeria
(Global Health and Education Projects, Inc., 2017) Egharevba, Johnbull; Pharr, Jennifer; van Wyk, Brian; Ezeanolue, Echezona
BACKGROUND AND OBJECTIVE: In Nigeria, most deliveries take place at home or with traditional birth attendants (TBAs). This study examined the factors that influenced or determined utilization of healthcare facility delivery services among women who attended antenatal care (ANC) services. METHODS: A cross-sectional survey was conducted with 220 women who registered for ANC at a hospital and delivered within 18 months. Associations between independent variables and choice of healthcare facility delivery were analyzed. Multiple logistic regression was also used to identify the predictors of choice of delivery among women. RESULTS: Of the 220 women who registered for ANC, 75% delivered at a healthcare facility while 15% delivered with a TBA or at home. In the final model, number of children, having planned to deliver at a hospital, labor occurring at night, and labor allowing time for transportation were significant predictors of child delivery location among the women. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS: Utilization of the health facilities for childbirth may increase if pregnant women are encouraged to book early for ANC and if during ANC, pregnant women were counseled to detect labor signs early. In addition to focused and intensified counseling for women with more children, support should be provided that includes financial provisions for transportation to the healthcare facility.

Browsing by Author "van Wyk, Brian"

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