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Available online at ajdhs.com 

Asian Journal of Dental and Health Sciences 
Open Access to Dental and Medical Research 

Copyright  © 2023 The  Author(s): This is an open-access article distributed under the terms of the CC BY-NC 4.0 
which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided the 

original author and source are credited 
 

 

 

Factors Hindering Elimination of Mother to Child Transmission of HIV 
Service Uptake among HIV Positive Women at Comboni Hospital 
Kyamuhunga Bushenyi District 

Nankya Viola1, Esther Kimono1, Ndagire Nuruh1 and *Emmanuel Ifeanyi Obeagu2  

1 School of Nursing Science, Kampala International University, Uganda 

2 Department of Medical Laboratory Science, Kampala International University, Uganda 

Article Info: 
_______________________________________ 
Article History: 
Received 28 March 2022      
Reviewed  09 May 2023 
Accepted 27 May 2023 
Published 15 June 2023 

_______________________________________ 
Cite this article as:  

Viola N, Kimono E, Nuruh N, Obeagu EI, Factors 
Hindering Elimination of Mother to Child 
Transmission of HIV Service Uptake among HIV 
Positive Women at Comboni Hospital 
Kyamuhunga Bushenyi District, Asian Journal of 
Dental and Health Sciences. 2023; 3(2):7-14 

DOI: http://dx.doi.org/10.22270/ajdhs.v3i2.39       

_______________________________________
*Address for Correspondence:   

Emmanuel Ifeanyi Obeagu, Department of 
Medical Laboratory Science, Kampala 
International University, Uganda 
Email: emmanuelobeagu@yahoo.com   

Abstract 
___________________________________________________________________________________________________________________ 

In the absence of preventive measures HIV infected mothers transmit the infection to their babies 
during pregnancy delivery and breastfeeding. However, improving eMTCT service uptake and 
continuum of care still remains a significant impediment in the western region of Uganda. The study was 
to explore factors hindering eMTCT service uptake among HIV positive women at Comboni Hospital 
Kyamuhunga. A descriptive cross-section design was used and majorly simple random sampling was 
employed with a number of 36 respondents and interviewed response were analysed using SPSS 
version to determine the association between the independent and dependent variable.  

 The findings of the study revealed that there are a range of factors that hinder HIV positive women on 
eMTCT service uptake, disclosure of HIV status with 77.7%, lack of partner and family support with 
75%, dependence on partners with 80.6%, long waiting times at facility and no linkage to support 
groups with 33.3%and 47.2% respectively.  In conclusion Strengthening community awareness on the 
importance of eMTCT service uptake, improving on time management by health workers, engaging male 
involvement in eMTCT care, improve youth friendly services, empowering women, putting emphasis on 
disclosure of status and supporting young mothers is so crucial. 

Keywords: elimination, mother to child transmission, HIV service uptake, HIV positive women 

 

 

INTRODUCTION 

Globally 90% of HIV infection in children is as result of MTCT 
and this transmission occurs in 20-30% of HIV positive 
pregnant women during pregnancy, labour and breastfeeding 
1. Access to comprehensive HIV services reduces the risk of 
transmission to below 5% in communities that practice 
breastfeeding and to 2% in the communities that do not 
practice breastfeeding 2. 

Poverty, lack of access to comprehensive HIV information and 
health care services, harmful cultural practices all contribute 
to new cases of MTCT economically stable mothers are able to 
afford infant milk formulas and supplements’ in place of breast 
milk while poor mothers cannot, so poorer mothers are left 
with no option than to exclusively breastfeed their babies 
there by increasing the risk of HIV transmission through the 
breast milk and of which can lead to malnutrition if not 
breastfeed 3. 

Sub-Saharan Africa the eMTCT service coverage remains 
<50% 1. Increased vulnerability to HIV infection has been due 
to intimate partners violence, which is more common among 
young HIV positive mothers and those who are economically 
dependent on their male partners that is 10% in aged 15-20 
years and 59% in older ones , women living with HIV 

experienced intimate partners violence were significantly less 
likely to start to adhere on ART therapy and they had worse 
clinical outcomes than other HIV positive women 4-11. 

Uganda HIV prevalence was associated with age and inversely 
associated with the level of education, the need for specific 
personnel for counselling, male partners involvement and 
availability of access for those who need treatment 12, 
pregnant adolescents faced a challenge of stigma, 
discrimination in health care settings. 

METHODOLOGY 

Study design and rationale 

The study adopted a descriptive cross-sectional design, it is 
descriptive because the researcher observed, described and 
documented aspect of situation, it is cross sectional because 
the study involved qualitative data collection at point of time. 
The rationale was to obtain detailed description of factors 
hindering eMTCT services. 

Study area 

The study was conducted at Comboni hospital found in 
western Uganda. 

                       Open Access                                                                                                                                                                                                         Research Article                                          

http://jddtonline.info/
http://dx.doi.org/10.22270/ajdhs.v3i2.39
mailto:emmanuelobeagu@yahoo.com
https://crossmark.crossref.org/dialog/?doi=10.22270/ajdhs.v3i2.39&amp;domain=pdf
https://orcid.org/0000-0002-4538-0161


Viola et al                                                                                                                                        Asian Journal of Dental and Health Sciences. 2023; 3(2):7-14 

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The study population 

The study targeted all HIV positive mothers attending eMTCT 
clinic at Comboni Hospital Kyamuhunga during the month of 
data collection those willing to participate; mentally and 
physically capable.  

Sample size determination 

The sample size was determined using formula developed by 
Tora Yamane in 1967 

. Which is stated as [ n= N/(1+ Np2)]. 

Where n sample size  

N study population 

P level of significance (0.05) 

[ n= N/(1+ Np2)] 

N=40/(1+40*(0.05)2=40/1+0.1=40/1.1 

  N= 36 

 Sampling procedure and rationale 

The study was carried out using probability sampling method 
particularly simple random sampling so as to reduce bias, the 
number of women present at the ART clinic were enlisted, 
equal number of papers were assigned YES or NO and folded 
then mixed in a box and each woman was given a chance to 
pick one. Those who randomly picked yes were  given papers 
to fill, one who  picked no was not  eligible to participate in the 
study and when sample size was not realised, another round 
of picking were assigned yes or no by those who were  not 
seen selected in the first round. 

Inclusion criteria 

The study included HIV positive mothers attending eMTCT 
clinic who were found at Comboni Hospital Kyamuhunga 

during the study. Only people willing to participate and who 
consented were included in the study. 

Exclusion criteria 

All people who were unwilling to participate and those who 
did not consent, those that were mentally and physically 
incapable to stand the interview were excluded and those who 
withdrew after consenting. 

Research instruments 

Pre- tested structured questionnaires with close ended 
questions designed and distributed to the respondents who 
had consented to participate in the interview. The researcher 
conducted face to face interview with respondents who were 
requested to fill in their responses according to their 
understanding and will. In case the respondents did not 
understand English an interpreter helped in the translation of 
questions. 

Data collection procedure 

The researcher got an introductory letter from the school 
which she presented to the hospital administrator who 
endorsed me to the in charge eMTCT clinic to give permission 
for data collection. The researcher introduced herself to the 
participants and explained to them the purpose of the 
research. Questionnaires having serial number were given to 
respondents to fill and those who were not be able to read and 
write were guided by the research assistant. Then the 
researcher checked through the filled questionnaires before 
leaving the data collection area to ensure their completeness.  

DATA ANALYSIS 

The data collected was analyzed using SPSS version 20, 
tabulated and presented inform of pie charts and tables using 
Microsoft excel 2013. 

 

Table 1: Showing demographic characteristics of respondents    N= 36 

variable Factor  Frequency  Percentage (%)   

Age (years) 15-19 2 5.6  

20-24 7 19.4 

25-29 16 44.4 

30 and above 12 33.3 

Religion Christian-protestant 12 33.3  

Christian-catholic 17 47.2 

Moslem 5 13.9 

Adventist 2 5.6 

Marital status Married 28 77.8 

Single 4 11.1 

Divorced 4 11.1 

Level of education 
Never attended school 2 5.6 

Primary 14 38.9 

Secondary 15 41.7 

Tertiary institution 5 13.9 

Source: Field data, August, 2019 

 



Viola et al                                                                                                                                        Asian Journal of Dental and Health Sciences. 2023; 3(2):7-14 

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According to the study findings in the table 1 above, results 
revealed that majority 16(44.4%) respondents belonged to the 
age group of 25 – 29 years while only 2(5.6%) respondents 
belonged to the age group of 15-19 meaning that the age 
group of 25-29 was 1.2 times more likely to be involved in the 
study. This revealed that majority of the respondents were 
mature enough and therefore gave reliable information about 
factors hindering eMTCT service uptake among HIV positive 
women.    

Respondents were also asked about their religion and the 
responses were as shows below; results revealed that majority 
of the respondents, 17 (47.2%) respondents revealed that 
they were Christian-catholic while the least number of the 
respondents were Adventists and were set as the reference 

category. The Adventist were set as reference category by a 
multinomial regression.  More so, majority of the respondents, 
28(77.8%) respondents were married while only 4 
respondents were single and divorced as supported by 11.1%. 
It was therefore indicated that married respondents were 2 
times more like to take part in the study than the single ones.  

Respondents were also asked about their educational levels. 
Most of the respondents revealed that they studied only 
secondary education as supported by 15 (41.7%) respondents 
while the least number of respondents 5 (13.9%) had tertiary 
level of education. It was therefore revealed that primary and 
secondary levels of education had more chances of being 
involved in the study to give reliable information.  

   

Table 2: Showing the socio-economic factors hindering eMTCT service uptake   N= 36  

Variable  Frequency  Percentage (%) 

Occupation Business woman 13 36.1 

House wife  8 22.2 

Civil servant 5 13.9 

Peasant farmer 10 27.8 

Financial supporter    Husband 29 80.6 

Relatives 7 19.4 

Family members 2 2 5.6 

3 4 11.1 

4 10 27.8 

5 6 16.7 

Others  14 38.9 

No of children 1 3 8.3 

2 9 25.0 

3 7 19.4 

4 8 22.2 

5 2 5.6 

Others specify 2 5.6 

None 5 13.9 

Social support group Yes 19 52.8 

No 17 47.2 

Source: Field data, August, 2019 

 

According to the study findings in the table 2 above, results 
revealed that majority 13 (36.1%) respondents were business 
women while 5 (13.9%) were civil servants hence they have 
money for transport to access serves. 

More so, the respondents were asked to tell their financial 
supporters. It was therefore revealed that most of them were 
getting the support from their husbands as supported by 29 
(80.6%) respondents while other were receiving their 
financial support from their relatives 7(19.4/%) meaning that 
they depend on their husbands for support. 

Furthermore, it was revealed that majority 34 (83.4%) 
respondents had more than 4 family members. A least number 
of respondents 6, (16.7%) were having less than 4 family 
members.  Respondents were also asked about the number of 
children they had and majority of them had 2 children as 
supported by 9 (25.0%) respondents, 3 (8.3%) had only 1 
child meaning those with large family spend much and are left 
out with less and therefore mis out appointments.  

The response from social support was also presented in the 
figure below

   



Viola et al                                                                                                                                        Asian Journal of Dental and Health Sciences. 2023; 3(2):7-14 

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Figure 1:  Showing response about social support   N=36 

Table 3: Mothers were asked whether they interacted with health workers during Health education services ANC    N=36 

Variable  Response  Frequency   Percentage (%)  

Interact with Health workers during ANC? Yes  32 88.9 

No  4 11.1 

Health education services  Yes 33 91.7 

No 3 8.3 

Total   36 100.0 

Source: Field data, August, 2019  

 

According to the study findings in the table 3 above, results 
revealed that majority 34, (88.9%) respondents agreed with 
the question while only 4 (11.1%) respondents said that they 
do not interact with health workers. This showed that women 
get enough advice from Health worker regarding ANC. The 
results are shown in figure 2 below.     

 

Figure 2: Showing interaction with health workers during 
ANC          N=36 

According to the study findings in the table 3 above, results 
revealed that majority 33 (91.7%) respondents agreed that 
they received health education services during ANC while only 
3 (8.3%) respondents said no to the question meaning that the 
information given was reliable and supported the study under 
investigation. The results above were also presented in a 
figure as show below.   

 

Figure 3: Showing Health Education services during ANC 

N=36 

Table 4: Showing whether mothers took long time waiting 
for services at the hospital          N=36 

Response  Frequency Percent (%) 

Yes 12 33.3 

No 24 66.7 

Total 36 100.0 

Source: Field data, August, 2019 

 

 

52.8 

47.2 

Yes No

88.9 

11.1 

Yes No

91.7 

8.3 

Yes No



Viola et al                                                                                                                                        Asian Journal of Dental and Health Sciences. 2023; 3(2):7-14 

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According to the study findings in the table 4 above, results 
revealed that majority 24 (66.7%) respondents said that they 
were not taking long time waiting for services at the hospital 
while 12 (33.3%) respondents agreed that they were taking 
long time waiting for services at the hospital. This means that 
the hospital was doing its part not to delay patients for 
services. Figure 4 below shows the response above. 

 

Figure 4: Showing whether they take Long time waiting 
for services at the hospital N=36 

 

Table 5: Showing the overall quality of services   N=36 

Response  Frequency Percent 

Poor 1 2.8 

Fair 10 27.8 

Good 22 61.1 

Very good 3 8.3 

Total 36 100.0 

Source: Field data, August, 2019 

 

According to the study findings in the table 5 above, results 
revealed that majority 22 (61.1%) respondents revealed that 
the services were good as supported by while only 1 
respondent revealed that the services are poor and this 
showed that the overall quality of services were relatively 
good.  

Table 6: Showing whether mothers were satisfied with 
waiting time at the ANC  N=36 

Response  Frequency Percent 

Satisfied 11 30.6 

Moderately 
satisfied 

12 33.3 

Unsatisfied 13 36..1 

Total 36 100.0 

Source: Field data, August, 2019  

 

According to the study findings in the table 6 above, results 
revealed that majority 13 (36.1%) respondents were un 
satisfied while only 11 (30.6%) respondents revealed that 
they were satisfied with waiting time at the ANC. The results 
therefore revealed that most of the people at the ANC are not 
satisfied with waiting time meaning they spend there a lot of 
time.  

Table 7: Showing whether mother attended ANC services  
 N=36 

Attend ANC services Frequency  Percent  

Yes 36 100.0 

No 0 0.0 

If yes to ANC, where    

This facility Comboni hospital 31 86.1 

Other public health facility 
(Nyabubare Health Centre IV) 

4 11.1 

Others (Ishaka Adventist Hospital)  1 2.8 

Source: Field data, August, 2019   

 

According to the study findings in the table 7 above, results 
revealed that majority 31 (86.1%) respondents were receiving 
it from Comboni hospital; others were receiving it from other 
public health facilities. The results therefore supported that 
the highest number of respondents attended their ANC 
services at Comboni Hospital. The figure illustrates the results 
got from attendance of ANC services.   

 

Figure 5: Showing attendance of ANC services       N=36 

 

Table 8: Showing the 1st ANC visit   N=36 

Response  Frequency Percent 

First trimester 5 13.9 

Second trimester 21 58.3 

Third trimester 10 27.8 

Total 36 100.0 

Source: Field data, August, 2019    

 

According to the study findings in the table 8 above, results 
revealed that majority 21 (58.3%) respondents visited ANC in 
their second trimester while 5 (13.9%) respondents received 
their ANC services during their first trimester. This meant that 
most women do not attend ANC during their first trimester 
which very risky towards their lives and the lives of their 
babies. The results are presented in table9 below.    

33.3 

66.7 

Yes No

86.1 

11.1 

2.8 

Comboni Hospital

Nyabubare Health Centre

Ishaka Adventist Hospital



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Table 9: Showing times mothers attended ANC for the last 
pregnancy    N=36 

Times  Frequency Percent 

Once 4 11.1 

Twice 9 25.0 

Three times 13 36.1 

More than three times 10 27.8 

Total 36 100.0 

Source: Field data, August, 2019   

According to the study findings in the table 9 above, results 
revealed that majority 13 (36.1%) respondents revealed that 
they attended ANC three times while only 4 (11.1%) 
respondents visited ANC once meaning they do not complete 
the recommended number for ANC Visits.  

Table 10: Showing whether mothers received ARVS 
during ANC  N=36 

Response  Frequency Percent (%) 

Yes 33 91.7 

No 3 8.3 

Total 36 100.0 

Source: Field data, August, 2019   

According to the study findings in the table 10 above, results 
revealed that majority 33 (91.7%) respondents received ARVs 
while 3 (8.3%) respondents disagreed with the statement 
meaning drugs are accessed and given. The results were also 
presented in a pie as indicated in figure9 below. 

 

Figure 6: Showing whether mothers received ARVS during 
ANC N=36 

Table 11: Showing whether mothers’ partners attended 
ANC with them   N= 36 

Response  Frequency Percent (%) 

Yes 9 25.0 

No 27 75.0 

If yes, whether the 
partner knew HIV status 

 

Yes 08 22.2% 

No 28 77.7% 

Source: Field data, August, 2019   

According to the study findings in the table 11 above, results 
revealed that majority 27 (75.0%) respondents said that their 
partners do not attend ANC with them while 9 (25.0%) 
respondents revealed that their partners attend ANC with 
them meaning male involvement is poor and disclosure is a 
problem.  

Table 12: Showing whether mothers used family planning 
after delivery. N= 36 

Response  Frequency Percent 

Yes 24 66.7 

No 9 25.0 

No response  3 8.3 

If yes which type    

Injectaplan 14 38.9 

Implanon 5 13.9 

Jadalle 2 5.6 

Combines oral contraceptives  2 5.6 

Others (Lactation amenoria) 4 11.1 

No response  9 25.0 

Source: Field data, August, 2019   

According to the study findings in the table 12 above, results 
revealed that majority 24 (66.7%) respondents agreed that 
they use family planning after delivering  while 3 (8.3%) did 
not respondent to the question. It was revealed from 
descriptive statistics that the respondents who said yes to the 
statement had 2 times of chances to be involved in the study 
as compared to the respondents who said no.  

 

Figure 7: Showing use of family planning after delivering 

N=36 

In addition to the above, respondents were also asked on 
which type of family planning they use after delivery and the 
following were the responses.  14 (38.9%) respondents 
revealed that they were using Injecta plan as their type of 
family planning giving a significance of 0.301 while only 4 
respondents supported other types of family planning 
accounting for 11.1%. From the descriptive statistics, it was 
found out that Injecta plan had 1.4 times chances of being used 
as compared to other methods of family planning.  

DISCUSSION 

In response to age brackets of the respondents, majority of the 
respondents, 16 (44.4%) belonged to the age group of 25 – 29 
years. 

91.7 

8.3 

Yes No

24 

9 

3 

Yes No No response



Viola et al                                                                                                                                        Asian Journal of Dental and Health Sciences. 2023; 3(2):7-14 

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Results revealed that majority of the respondents said that 
they studied only secondary education as supported by 15 
(41.7%) respondents. It was therefore revealed that primary 
and secondary levels of education had more chances of being 
involved in the study than other levels of education. This 
finding suggests that educated women may be more 
knowledgeable about MTCT of HIV and understand the 
benefits of testing for HIV during pregnancy. This finding 
reaffirms the results from other Sub-Saharan African countries 
showing that mothers with a secondary educational level or 
above are likely to be more knowledgeable about mother-to-
child transmission 13. 

According to the first objective, majority number of the 
respondents were business women as supported by 13 
(36.1%). Type of business which is associated with household 
income is also significantly associated with a higher number of 
ANC visits, and hence contributes to improved eMTCT service 
uptake. Various studies support this finding. For instance, a 
systematic review of 28 studies in developing countries noted 
that household economic factors and women’s employment 
are critical factors in determining the use of ANC services 14.  

More so, the respondents were asked to tell their financial 
supporters. It was therefore revealed that most of them were 
getting the support from their husbands as supported by 29 
(80.6%) respondents. 

Furthermore, it was revealed that majority of the families had 
more than 4 family members as indicated by a total of 34 
(83.4%) respondents.    

Respondents were asked whether they interact with health 
workers during ANC and most of the respondents (34, 
(88.9%) agreed with the question. 

A big number of respondents 33 (91.7%) agreed that they 
received health education services during ANC. The results 
showed that the information given was reliable and supported 
the study under investigation. The above results are in 
relation with the study conducted in Vietnam explored 
Comprehensive care and support programmes along with 
proper HIV/ Aids education information provision needs to be 
carefully developed 15.  

It was revealed that majority of the respondents 24(66.7%) 
said that they were not taking long time waiting for services at 
the hospital This means that the hospital was doing its part 
not to delay patients for services.  

Respondents were also asked how they rate the overall quality 
of services at the ANC by the healthy workers. Majority of the 
respondents revealed that the services were good as 
supported by 22 (61.1%)   and this showed that the overall 
quality of services were relatively good.  

Respondents were asked whether they satisfied with waiting 
time, 13 (36.1%) were unsatisfied therefore revealed that 
most of the people at the ANC are not satisfied with waiting 
time meaning they spend there a lot of time.   

Respondents were further asked where they attended their 
ANC services. Majority of them revealed that they were 
receiving it from Comboni hospital as supported by 31 
(86.1%). All the respondents revealed that they attended ANC 
services. The results therefore supported that the highest 
number of respondents attended their ANC services    

It was revealed that majority of the respondents 21 
representing (58.3%) visited ANC in their second trimester. 
This meant that most women do not attend ANC during their 
first trimester which is very risky towards their lives and the 
lives of their babies.  

Majority number of the respondents agreed that they received 
ARVs during pregnancy as indicated by 33 respondents 
accounting for (91.7%). On the other hand, majority of the 
respondents revealed that their partners do not attend ANC 
with them as indicated by 27 (75.0%).  

It was revealed that majority of the respondents 24 (66.7%) 
agreed that they use family planning after delivering. It was 
revealed from descriptive statistics that the respondents who 
said yes to the statement had 2 times of chances to be involved 
in the study as compared to the respondents who said No. 
Amongst all the respondents.  

In addition to the above, respondents were also asked on 
which type of family planning they use after delivery and the 
following were the responses.  14 respondents accounting for 
(38.9% revealed that they were using Injectaplan as their type 
of family planning method.  From the descriptive statistics, it 
was found out that Injectaplan had 1.4 times chances of being 
used as compared to other methods of family planning. 

CONCLUSION 

A woman’s age was also factor to consider, women in age 
group 25-29 were significantly associated to eMTCT utilization 
and this could be because mothers in this age group have a 
high fertility rate and they are knowledgeable to the service 
provided to them. However, adolescent mothers were found 
not attending ANC who belonged to the age group of 15-19. 
This could be because of stigma and poor youths friendly 
services.   

The study tested that women with secondary and tertiary level 
of education are more likely to utilize eMTCT. This was right 
because women who are educated know the importance of 
bearing a healthy baby who is not HIV infected.  

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https://doi.org/10.1017/S002193200999040X
https://doi.org/10.2147/IJWH.S23124
https://doi.org/10.1108/03068291111139258

