Sociodemographic characteristics of the study participants
Among the 103 participants, majority were within the age of 36-45years (41.7%), followed by 18-35 years (24.3%), 46-55 years (23.3%) and 56-74 years (10.7%). Moreover, majority were married (55.3%), had 2 to 3 children and attended Junior High School (39.8%). Most were self-employed (68.9%) and were Akans (81.6%) who lived either in the urban (92.2%) or rural (7.8) residence. Furthermore, larger number of the study participants were Christians (89.9%). Also, most of the participants earned less than GHc500.00 and took 31-60 minutes to reach the HIV clinic (Table 1).
Table 1: Sociodemographic characteristics of the study participants
Variable
|
Frequency (n=103)
|
Percentage (%)
|
Age group (years)
|
|
|
18-35
|
25
|
24.3
|
36-45
|
43
|
41.7
|
46-55
|
24
|
23.3
|
56-74
|
11
|
10.7
|
Marital status
|
|
|
Single
|
24
|
23.3
|
Divorced
|
8
|
7.8
|
Widowed
|
14
|
13.6
|
Married
|
57
|
55.3
|
Employment status
|
|
|
Not employed
|
25
|
24.3
|
Self employed
|
71
|
68.9
|
Employed
|
7
|
6.8
|
Number of children
|
|
|
1
|
21
|
20.4
|
2-3
|
52
|
50.5
|
≥ 4
|
30
|
29.1
|
Educational level
|
|
|
No formal education
|
14
|
13.6
|
Primary
|
23
|
22.3
|
JHS
|
41
|
39.8
|
SHS
|
20
|
19.4
|
Tertiary
|
5
|
4.9
|
Residence
|
|
|
Rural
|
8
|
7.8
|
Urban
|
95
|
92.2
|
Ethnicity
|
|
|
Akan
|
84
|
81.6
|
Northerner
|
16
|
15.5
|
Ewe and Ga
|
3
|
2.9
|
Religion
|
|
|
Christian
|
91
|
89.9
|
Muslim
|
11
|
10.8
|
Monthly income (Ghana cedis)
|
|
|
< 500
|
49
|
48
|
500-1000
|
34
|
33.3
|
> 1000
|
19
|
18.6
|
Time to reach clinic (minutes)
|
|
5-30
|
22
|
21.8
|
31-60
|
49
|
48.5
|
> 60
|
30
|
29.7
|
Data is presented as frequency and percentage
Lifestyle characteristics of the study participants
Of the 103 participants enrolled in the study, majority did not take alcohol (93.2%) and no one smokes. Also, most of the participants have never shared needle (97.1%) or transfused blood (91.3%). More than half of the participants occasionally take fruits (58.3%), visit the hospital when sick (51.5%), exercise (62.1%) and do not know their partners HIV status (55.3%) (Table 2).
Table 2: Lifestyle characteristics of the study participants
Variable
|
Frequency(n=103)
|
Percentage (%)
|
Alcohol intake
|
|
|
No
|
96
|
93.2
|
Yes
|
7
|
6.8
|
Alcohol (how often)
|
|
|
Daily and weekly
|
1
|
14.3
|
Occasionally
|
6
|
85.7
|
Smoking
|
|
|
No
|
103
|
100
|
Exercise
|
|
|
No
|
39
|
37.9
|
Yes
|
64
|
62.1
|
Exercise how often
|
|
|
Daily
|
35
|
54.7
|
Weekly
|
20
|
31.3
|
Occasionally
|
9
|
14.1
|
Fruit intake how often
|
|
|
Daily
|
14
|
13.6
|
Weekly
|
29
|
28.2
|
Occasionally
|
60
|
58.3
|
Action when you feel sick
|
|
|
Heal on its own
|
12
|
11.7
|
Herbal medicine
|
12
|
11.7
|
Buy drugs from pharmacy
|
26
|
25.2
|
Visit hospital
|
53
|
51.5
|
No of sexual partners
|
|
|
0-2
|
27
|
28.7
|
3-5
|
52
|
55.3
|
>5
|
15
|
16
|
Ever shared needle drugs
|
|
|
No
|
100
|
97.1
|
Yes
|
3
|
2.9
|
Blood transfusion
|
|
|
No
|
94
|
91.3
|
Yes
|
9
|
8.7
|
Know partners HIV status
|
|
|
No
|
57
|
55.3
|
Yes
|
46
|
44.7
|
Partners HIV status
|
|
|
Negative
|
32
|
69.6
|
Positive
|
14
|
30.4
|
Data is presented as frequency and percentage
Prevalence of MTCT and MTCT rate per child
Of the 103 study participants, the prevalence of MTCT was 21.4% whereas there was no transmission in the remaining 81 representing 78.6%. (Figure 2A). Also, the prevalence of HIV among MTCT per child birth was 9.9%. (Figure 2B).
Figure 2: Prevalence of MTCT (A) and MTCT rate per child (B) among women living with HIV/AIDS (WLWH) in Kumasi, Ghana
Responses to questions on knowledge of mother-to-child-transmission of HIV among study participants
The study observed that, none of the responses to questions on knowledge such as HIV can be transmitted from mother to child (p = 0.467), HIV can be transmitted during breastfeeding (p = 0.770), HIV transmission can be prevented through caesarean section (p = 0.457) were significantly associated with MTCT of HIV among study participants (Table 3).
Table 3: Responses to questions on knowledge on mother-to-child-transmission of HIV among study participants
Variable
|
Total (n=103)
|
|
No MTCT (n=81)
|
MTCT (n=22)
|
p-value
|
HIV can be transmitted from mother to child
|
|
|
|
|
0.467a
|
No
|
2 (1.9)
|
|
2 (2.5)
|
0 (0.0)
|
|
Do not know
|
2 (1.9)
|
|
1 (1.2)
|
1 (4.5)
|
|
Yes
|
99 (96.1)
|
|
78 (96.3)
|
21 (95.5)
|
|
HIV can be transmitted during pregnancy
|
|
|
|
|
0.054b
|
Do not know
|
1 (1.0)
|
|
0 (0.0)
|
1 (4.5)
|
|
Yes
|
102 (99.0)
|
|
81 (100)
|
21 (95.5)
|
|
HIV can be transmitted during labor
|
|
|
|
|
0.588a
|
No
|
2 (1.9)
|
|
2 (2.5)
|
0 (0.0)
|
|
Do not know
|
6 (5.8)
|
|
4 (4.9)
|
2 (9.1)
|
|
Yes
|
95 (92.2)
|
|
75 (92.6)
|
20 (90.9)
|
|
HIV can be transmitted during breastfeeding
|
|
|
|
|
0.770a
|
No
|
1 (1.0)
|
|
1 (1.2)
|
0 (0.0)
|
|
Do not know
|
3 (2.9)
|
|
2 (2.5)
|
1 (4.5)
|
|
Yes
|
98 (96.1)
|
|
77 (96.2)
|
21 (95.5)
|
|
HIV can be prevented through the use of ARVs MTCT
|
|
|
|
|
0.457b
|
Do not know
|
2 (1.9)
|
|
2 (2.5)
|
0 (0.0)
|
|
Yes
|
101 (98.1)
|
|
79 (97.5)
|
22 (100.0)
|
|
HIV transmission can be prevented through caesarean section
|
|
|
|
|
0.175a
|
No
|
9 (8.7)
|
|
5 (6.2)
|
4 (18.2)
|
|
Do not know
|
46 (44.7)
|
|
36 (44.4)
|
10 (45.5)
|
|
Yes
|
48 (46.6)
|
|
40 (49.4)
|
8 (36.4)
|
|
HIV can be prevented by avoiding breastfeeding
|
|
|
|
|
0.520a
|
No
|
3 (2.9)
|
|
2 (2.5)
|
1 (4.5)
|
|
Do not know
|
11 (10.7)
|
|
10 (12.3)
|
1 (4.5)
|
|
Yes
|
89 (86.4)
|
|
69 (85.2)
|
20 (90.9)
|
|
Have you heard of drug that prevents mother to child transmission
|
|
|
|
|
0.318a
|
No
|
10 (9.7)
|
|
8 (9.9)
|
2 (9.1)
|
|
Do not know
|
10 (9.7)
|
|
6 (7.4)
|
4 (18.2)
|
|
Yes
|
83 (80.6)
|
|
67 (82.7)
|
16 (72.7)
|
|
Note: MTCT: mother-to-child-transmission, HIV: Human immunodeficiency virus, ARVs: Antiretrovirals, ap-values computed by Chi-square test, bp-values computed by Fischer exact test, p-values < 0.05 and bolded means statistically significant
Proportion of knowledge level on mother-to-child transmission of HIV among women living with HIV (WLWH)
About 92.2% WLWH had adequate knowledge as compared to the inadequate knowledge (7.8%) of WLWH (Figure 3).
Sociodemographic predictors of mother-to-child transmission of HIV
In a univariate logistic regression model, higher age category of 36-45 years (cOR: 8.25, 95% CI: (1.00-68.35); p = 0.050), 56-74 years (cOR: 20.00, 95% CI (1.9-204.73); p = 0.012) were significantly associated with MTCT.
Also, in the multivariate logistics regression analysis model, age range 36-45 years (aOR: 20.1, 95% CI (1.45-278.87); p = 0.025) and 56-74 years (aOR: 76.42, 95% CI (1.87-3131.45) P = 0.02) remain significantly associated with mother-to-child transmission of HIV (Table 4).
Table 4: Sociodemographic predictors of mother-to-child transmission of HIV
Variable
|
cOR (95% CI)
|
p-value
|
aOR (95% CI)
|
p-value
|
Age category (years)
|
|
|
|
|
18-35
|
1.00
|
-
|
1.00
|
-
|
36-45
|
6.32 (1.00-68.35)
|
0.042
|
18.33 (1.45-278.87)
|
0.048
|
46-55
|
8.25 (0.68-58.72)
|
0.034
|
20.1 (1.03-325.57)
|
0.025
|
56-74
|
20.00 (1.9-204.73)
|
0.012
|
76.42 (1.87-3131.45)
|
0.022
|
Marital status
|
|
|
|
|
Single
|
0.44 (0.11-1.70)
|
0.232
|
-
|
-
|
Divorced
|
0.44 (0.05-3.88)
|
0.459
|
|
-
|
Widowed
|
1.23 (0.33-4.54)
|
0.758
|
-
|
-
|
Married
|
1.00
|
-
|
-
|
-
|
Number of children
|
|
|
|
|
0-1
|
0.25 (0.05-1.28)
|
0.096
|
-
|
-
|
2-3
|
0.37 (0.22-1.75)
|
0.371
|
-
|
-
|
4 or more
|
1.00
|
-
|
-
|
-
|
Educational level
|
|
|
|
|
No formal education
|
2.22 (0.19-25.72)
|
0.523
|
-
|
-
|
Primary
|
2.57 (0.26-26.85)
|
0.430
|
-
|
-
|
JHS
|
0.57 (0.05-6.02)
|
0.630
|
-
|
-
|
SHS
|
0.44 (0.06.19)
|
0.546
|
-
|
-
|
Tertiary
|
1.00
|
-
|
-
|
-
|
Residence
|
|
|
|
|
Rural
|
2.4 (0.53-10.94)
|
0.258
|
-
|
-
|
Urban
|
1.00
|
-
|
-
|
-
|
Employment status
|
|
|
|
|
Not employed
|
2.33 (0.24-23.04)
|
0.468
|
-
|
-
|
Self employed
|
1.47 (0.16-13.25)
|
0.729
|
-
|
-
|
Employed
|
1.00
|
-
|
-
|
-
|
Ethnicity
|
|
|
|
|
Akan
|
1.00
|
-
|
-
|
-
|
Northerner
|
1.93 (0.59-6.35)
|
0.278
|
-
|
-
|
Ewe and Ga
|
2.13 (0.18-24.91)
|
0.548
|
-
|
-
|
Religion
|
|
|
|
|
Christian
|
1.00
|
-
|
-
|
-
|
Muslim
|
3.63 (0.99-13.29)
|
0.052
|
-
|
-
|
Monthly income (cedis)
|
|
|
|
|
< 500
|
2.76 (0.56-13.70)
|
0.215
|
-
|
-
|
500-1000
|
2.62 (0.49-13.83)
|
0.258
|
-
|
-
|
> 1000
|
1.00
|
-
|
-
|
-
|
Time to reach clinic (minutes)
|
|
|
|
|
5-30
|
1.00
|
-
|
-
|
-
|
31-60
|
2.56 (0.512-12.84)
|
0.252
|
-
|
-
|
> 60
|
4.286 (0.82-22.32)
|
0.084
|
-
|
-
|
Note: cOR: Crude odd ratio, aOR: Adjusted odd ratio, CI: Confidence interval, p-values computed by logistics regression prediction model, p-values < 0.05 and bolded means statistically significant
Clinical factors as predictors of mother-to-child transmission of HIV among study participants
In the univariate logistics regression analyses model, there was a significant increase in likelihood on participant, who do not have knowledge of HIV status prior to pregnancy (cOR=9.13) CI; (3.01-27.68), (p < 0.001). Also, participants’ children who do not received ART prophylaxis was significantly affected (cOR=8.25), CI: (2.91-23.40), (p < 0.0001).
However, other variables such as complications during pregnancy, mode of delivery and breastfeeding a child showed no significant association with MTCT of HIV (Table 5).
Table 5: Clinical factors as predictors of mother-to-child transmission of HIV among study participants.
Variable
|
cOR (95% CI)
|
p-value
|
aOR (95% CI)
|
p-value
|
Knowledge of HIV status prior to pregnancy
|
|
|
|
|
No
|
9.13 (3.01-27.68)
|
< 0.0001
|
3.63 (0.793-16.57)
|
0.097
|
Yes
|
1.00
|
-
|
1.00
|
-
|
Complications during pregnancy
|
|
|
|
|
No
|
1
|
|
-
|
-
|
General hospitalization
|
0.53 (0.11-2.54)
|
0.4240
|
-
|
-
|
Intrahepatic cholestasis and Diabetes
|
0.00 (0.00-inf.)
|
0.9990
|
-
|
-
|
Pre-eclampsia
|
3.42 (0.20-57.31)
|
0.3920
|
-
|
-
|
Mode of delivery
|
|
|
|
|
Vaginal delivery
|
1.00
|
-
|
-
|
-
|
Elective caesarean
|
0.99 (0.10-9.40)
|
0.9900
|
-
|
-
|
Emergency caesarean
|
1.18 (0.29-4.77)
|
0.8140
|
-
|
-
|
Breastfed child
|
|
|
|
|
No
|
1.00
|
-
|
-
|
-
|
Yes
|
>100 (0.000-inf.)
|
0.9990
|
-
|
-
|
Child received ART prophylaxis
|
|
|
|
|
No
|
8.25 (2.91-23.40)
|
< 0.0001
|
11.72 (2.23-61.64)
|
0.004
|
Yes
|
1.00
|
-
|
1.00
|
-
|
Note: HIV: Human immunodeficiency virus, ART: Antiretroviral therapy, cOR: Crude odd ratio, aOR: Adjusted odd ratio, CI: Confidence interval, inf: Infinity, p-values computed by logistics regression prediction model, p-values < 0.05 and bolded means statistically significant
Lifestyle factors as predictors of mother-to-child transmission of HIV among study participants.
All the variables under lifestyle in a univariate logistic regression model showed no significant association with MTCT of HIV (p > 0.05) (Table 6).
Table 6: Lifestyle factors as predictors of mother-to-child transmission of HIV among study participants.
Variable
|
cOR (95% CI)
|
p-value
|
Alcohol intake
|
|
|
No
|
1.68 (0.19-14.74)
|
0.6400
|
Yes
|
1.00
|
-
|
Alcohol (how often)
|
|
|
Daily and weekly
|
0.00 (0.00-inf.)
|
> 0.9999
|
Occasionally
|
1.00
|
-
|
Exercise
|
|
|
No
|
1.40 (0.514-3.8)
|
0.5110
|
Yes
|
1.00
|
-
|
Exercise (how often)
|
|
|
Daily
|
2.37 (0.26-21.9)
|
0.4500
|
Weekly
|
3.43 (0.35-33.80)
|
0.2900
|
Occasionally
|
1.00
|
-
|
Fruit intake (how often)
|
|
|
Daily
|
1.00
|
-
|
Weekly
|
1.25 (0.21-7.41)
|
0.8060
|
Occasionally
|
2.00 (0.40-9.98)
|
0.3980
|
Action when you feel sick
|
|
|
Heal on its own
|
1.00
|
-
|
Herbal Medicine
|
1.00 (0.055-18.09)
|
> 0.9999
|
Buy drugs from pharmacy
|
4.05 (0.44-37.43)
|
0.2200
|
Visit hospital
|
3.58 (0.42-30.40)
|
0.2430
|
Number of sexual partners group
|
|
|
0-2
|
1.00
|
-
|
3-5
|
0.94 (0.31-2.89)
|
0.9130
|
>5
|
1.273 (0.30-5.48)
|
0.7460
|
Ever shared needle/drugs
|
|
|
No
|
1.88 (0.16-21.76)
|
0.6130
|
Yes
|
1.00
|
-
|
Blood transfusion
|
|
|
No
|
>100 (0.000-inf.)
|
0.9990
|
Yes
|
1.00
|
-
|
Know partners HIV status
|
|
|
No
|
2.6 (0.93-7.32)
|
0.0700
|
Yes
|
1.00
|
-
|
Partners HIV status
|
|
|
Negative
|
1.17 (0.19-7.25)
|
0.8690
|
Positive
|
1.00
|
-
|
Note: HIV: Human immunodeficiency virus, cOR: Crude odd ratio, CI: Confidence interval, inf: Infinity, p-values computed by logistics regression prediction model
Association between knowledge and MTCT
The study observed that level of knowledge (p = 0.794) was not significantly associated with mother-to-child transmission of HIV (Figure 4)
Figure 4: Association between knowledge level and mother-to-child transmission (MTCT) among women living with HIV/AIDS (WLWH)