Knowledge on mother to child transmission of HIV among newly registered antenatal mothers in MOH area Ragama

Sri Lanka has remained a low prevalent country for HIV for past three decades . One important aspect of maintaining this low prevalence is preventing mother to child transmission (MTCT) of HIV. As highly effective strategies are now available to reduce the risk ofMTCT, early diagnosis of HIV in antenatal mother is important. Good knowledge about HIV and MTCT will promote mothers to take up HIV testing. Though mothers in this study population had a reasonably good education their knowledge about MTCT of HIV was poor.


Introduction
For past three decades Sri Lanka has remained a low prevalence country for HIV With the introduction of highly active antiretroviral treatment (HAART) during pregnancy risk of MTCT is reduced by 98%.Early introduction of ART during pregnancy minimises the risk 2 .Therefore, early detection of HIV positive antenatal mothers is important. Good knowledge about HIV and MTCT wi 11 motivate antenatal mothers to take up HIV testing. Antenatal clinics are a good opportunity to provide this knowledge. Having an idea about knowledge of antenatal mothers on HIV and MTCT will help to identify areas that need strengthening in future interventional programs. This study was conducted in the MOH area Ragama to assess the knowledge about HIV and MTCT among newly registered antenatal mothers .

Study setting
Sri Lanka is divided in to 25 administrative districts. According to the department of Census and Statistics, in 2009 Gampaha district had a population of2,066,096 which is about 12% of the total Sri Lankan population. Accordingly Gampaha is the second most populous district in Sri Lanka. With regard to socio-economic standards, Gampaha District is only second to Colombo District 3 .GampahaDistrict is divided into 16 MOH areas out of which Ragama is the smallest, with a land area of26 Km 2 and a population of81244. Ragama MOH area consists of socio-economically mixed population. This is divided in to sixteen public health midwife (PHM) areas. Four antenatal clinics, Batuwathha, Jayasrigama, Horape and Ragama are conducted every week in the area. Total of1427 antenatal mothers were registered in these clinics in 2008 4 . In addition to clinical examination and investigations, antenatal mothers receive health education, and food supplements.

Study design
A descriptive cross sectional study was carried out over a period of six months from September 2008 to February 2009.

Sample size and sampling method
According to the Lwanga and Lemeshow formula sample size of 384 was required for this study. One 'Consultant Venereologist, District General Hospital Kalutara , ' Consu ltant Venereologist, National STD/A IDS Control Programme, 3 SeniorLecturer in Paediatrics, 'Professor of Public Health, Faculty of Medicine, Ragama -Corresponding author: Perera HP, Paper hundred newly registered ante natal mothers were recrnited from each clinic on all inclusive consecutive basis . Informed written consent was obtained from mothers and none refused to consent.

Data collection
Data was collected using a pretested and validated interviewer administered questionnaire. Data collection was canied out by two pre-intern doctors supervised by the principal investigator. Data analysis was carried out using statistical package SPSS version 16.

Results
The majority (38%) of the mothers were in the age category of25 -29 years, followed by 25% in 20 -24 years category. More than 60% mothers had passed . GCE ordinary level, whi le 26% had passed GCE advanced level. Out of 400 mothers only 14% were employed. Forty seven percent had family income between Rsl 0,000 and Rs 20,000.Some of the sociodemographic characteristics of the study population are given in table 1  100 mothers knew about specific methods to reduce the risk of transmission. Only one mother knew all four possible modes of transmission. Table 3 gives the frequency distribution of knowledge of mothers on modes of HIV transmission. changing partners could transmit the virus. Table 4 gives the frequency distribution of knowledge on risky sexual behaviours for HIV transmission (N=390) At present general public use television to obtain information than any other media. However time dedicated in television channels to HIV is minimal. Using television with paid advertisements is also very expensive. Social networks like face book, twitter have become very popular among youth. The possibility of using these social networks to disseminate knowledge about HIV and other STis should be explored.

Conclusions
Though Sri Lankan antenatal mothers are well educated, their knowledge about MTCT of HIV is poor. Tailor-made educational programmes are needed to achieve this.