Lost-to-follow-up in the Prevention of Mother to Child Transmission Option B+ cascade of Services in the Public Hospitals of Illubabor zone, Western Ethiopia

Abstract

Background: World Health Organization recommends that for effectiveness of prevention of mother-to-child transmission option B+ services; mothers should retain in the prevention of mother-to-child transmission option B+ cascade of services. Ethiopia have been implementing prevention of mother-to-child transmission program since 2001 and shifted to option B+ in 2012.However the program implementation is faced with challenges of high missed opportunities and lost-to-follow up; threatening effectiveness of program.  So assessing and indentifying factors affecting lost-to-follow up is important to ensure program effectiveness.  Objective: The main objective was to determine the lost-to-follow up rate among pregnant and laboring mothers in the antepartem and intrapartem prevention of mother-to-child transmission option B+ cascade of services in public hospitals of Illubabor zone, Western Ethiopia.Methods and Materials: Facility based retrospective cross-sectional study design using both quantitative and qualitative data was conducted from June 10-July 10, 2014.Program document reviewed to determine the lost-to-follow up rate from September 2013 to end of the evaluation period. In-depth interview conducted with program managers, implementers and clients to identify barriers for lost-to-follow up. Quantitative data entered through epi-data 3.1 and exported to SPSS 17 for further analysis. Qualitative data analyzed through content analysis for each section of assessment and supplemented to quantitative data.Result: From a total of 1905 pregnant mothers visited antenatal clinic for the first time 1794(94.2%),1826(95.9%) and 1749(91.8%) had received pre-test counseling, testing and post-test counseling services. Among whom 35(1.9%) tested positive, and 30(85.7%) initiated on antiretrovirals.Further from a total of 2332(84.1%) laboring mother with unknown status 2154(92.4%) received on-coach HCT services, 19(0.8%) tested positive and 18(94.7%) initiated on antiretroviral according to the national guideline. In addition from a total of 41 HIV+ mothers received delivery services;39(75.6%) of infants initiated on antiretroviral and none of mother-infant pair linked to postpartum continuum of care. In general there is significant lost-to-follow up rate in the antepartem and intrapartem continuum of care services. The reason reported being inadequacy of skilled health care provider, intermittent supply of test kits and OI drugs, lack of privacy at examination rooms, long waiting time to get services and inaccessibility of services.Conclusion: There is a significant lost-to-follow up rate in the antepartem and intrapartem continuum of prevention of mother-to-child transmission option B+ services. So program resources should be supplied consistently, health care providers should be trained, defaulter tracing mechanism should be established and regular supportive supervision should be conducted. Moreover a due emphasis should be given to privacy of service rooms and waiting time; for the fact that program clients needs assurance of this conditions to retain in care.

Keywords: Lost-to-follow up, PMTCT option B+, Antepartem, Intrapartem