Support for caregivers during puerperium to enhance the PMTCT programme
Khunou, Maggie Mmammyadi
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An estimated 33.0 million people are currently living with HIV/AIDS worldwide. Of these, 15.5 million are women, and 2.2 million children under the age of 5 years who have mainly been infected through mother-to-child transmission. Mothers and babies are increasingly infected and about 90% of these are in sub-Saharan Africa. The same trend can be identified in South Africa, which has one of the highest incidences and prevalence rates of HIV/AIDS in the world with 5-6 million people living with HIV/AIDS. Women of childbearing age constitute 55% of all HIV positive adults and a quarter of pregnant women (28%) in South Africa are HIV positive. The HIV/AIDS epidemic is overburdening hospital systems and it will continue to grow within the context of already massively overstretched public resources. This increase also impacts on health services in the North West Province which are facing an alarming increase in mothers and babies living with HIV/AIDS. One of the strategies that are implemented to reduce maternal deaths is the Prevention-of-Mother-to-Child Transmission (PMTCT) Programme and massive roll out of Antiretrovirals during puerperium. One of the goals of the PMTCT programme is to prevent transmission of HIV/AIDS from mothers to babies and reduce child, perinatal and neonatal morbidity and mortality. This strategy is integrated with Non-Governmental Organizations (NGOs) and community-based organizations (CBOs) in care of mothers and babies living with HIV/AIDS during puerperium. Successful implementation of this programme requires social support and community involvement because of short hospitalization during the postnatal period. Caregivers are trained to perform various tasks and fulfil certain roles due to lack of human resources. Caregivers implementing the PMTCT programme experience problems which lead to stress and one of the causes of this stress manifests in feelings of inadequacy and isolation. They are faced with problems pertaining to mothers not adhering to treatment, and poverty is an additional source of stress as it negatively affects the quality of the PMTCT services they need to provide. This research was conducted in the Bojanala region, Rustenburg Sub-District of the North West Province in South Africa. A descriptive, exploratory, qualitative research design was utilized to explore and describe the lived experiences of caregivers while implementing the PMTCT programme as well as perceptions of health workers coordinating the PMTCT programme in order to gain a more thorough understanding of the support needed by caregivers during puerperium. Two populations were used. In population one, purposive sampling was used to select caregivers. In population two inclusive sampling was used to select health workers. In-depth interviews were conducted with both populations with the aim to collect data. From the research findings similarities were identified between the two populations regarding support, namely: (a) Caregivers need personal support in the form of counselling as well as support networks to enable them to deal with the problems they are faced with. (b) Caregivers need financial support to afford basic essentials and better remuneration to meet their financial needs. (c) Caregivers need to be trained in areas in which they lack knowledge -continued development and empowerment is essential. They also need to be trained specifically in PMTCT and they need a PMTCT consultant to always be available to support them. (d) Improvement of the PMTCT services by providing transport to follow up mothers, protective resources to protect themselves against infections as they are at risk of infections, water is essential as a basic human right, provision with food parcels to mothers who are poverty stricken and the PMTCT health services to be intensified from the antenatal period. (e) Management to establish a caring environment by displaying a caring attitude, respecting them and providing them with rewards to improve morale and performance. Recommendations were made for the fields of nursing education, nursing research and community health practice with recommendations to establish a structure of support for caregivers to enhance the PMTCT programme during puerperium. These recommendations were discussed under the five themes presented above.
- Health Sciences