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Aust. J. Rural Health (2018) 26, 33–41

Original Research
Knowledge, perception, access and utilisation of HIV
counselling and testing among pregnant women in rural
communities of Osogbo town, Nigeria
Adekemi E. Olowokere, PhD, RN,1 Oluyemi A. Adelakun, BNSc, RN,2 and
Abiola O. Komolafe, MSc, RN1
1
Department of Nursing Science, Obafemi Awolowo University, Ile-Ife, and 2Dagbolu Primary Health
Care Centre, Osogbo, Osun State, Nigeria

Abstract cope with being positive’ and ‘absence of HIV counsel-

ling and testing centre’.
Objective: To assess knowledge, perception, access Conclusion: Many women selected from rural com-
and utilisation of HIV counselling and testing among munities demonstrated good knowledge and percep-
pregnant women from rural communities in Nigeria. tion of HIV counselling and testing. The majority of
Design: Descriptive cross-sectional survey. them also had access to HIV counselling and testing
Setting: Primary health care facilities in rural commu- and used it. However, some still have misconception
nities of Osogbo, Osun State, Nigeria. about mother-to-child transmission of HIV.
Participants: Three-hundred pregnant women attend-
ing antenatal clinics in primary health care facilities. KEY WORDS: health promotion, health services
Main outcome measures: Knowledge of HIV counsel- access, rural services planning, rural women’s
ling and testing, perception of HIV counselling and health, women’s health.
testing, utilisation of HIV counselling and testing and
barriers associated with HIV counselling and testing
utilisation.
Introduction
Results: Findings showed that 59.0% had good knowl- Mother-to-child transmission (MTCT) of HIV is the
edge, while 56.7% had good perception. Majority second-most common route of infection (after hetero-
(88.4%) of the 77.7% of respondents who reported the sexual sex) in Nigeria. It accounts for 10% of the total
availability of HIV counselling and testing services said infections in Nigeria1 and 90% of global paediatric
it was free and 61.3% of the respondents had HIV infections.2 Mother-to-child transmission is the trans-
counselling and testing done before. Majority (78.3%) mission of HIV virus from an infected woman to her
had one-on-one counselling, while a little above half unborn child during pregnancy, delivery and breast-
(55.4%) gave consent for testing. However, less than feeding.3 The rate of transmission of HIV differs across
half (36.3%) of the respondents were willing to have the three periods of MTCT. The estimated rate during
HIV counselling and testing done in the present preg- pregnancy is 5–10%, 10–15% during delivery and up
nancy. There is significant association between the level to 20% during the breast-feeding period. If there is no
of perception and utilisation of HIV counselling and intervention, the risk of a child getting infected by the
testing. A significant association is also found between HIV-positive mother is between 15% and 45% across
knowledge of HIV counselling and testing and utilisa- the three periods of potential for MTCT.4 Vertical
tion. Key barriers found to be associated with utilisation transmission of HIV occurs when an infected mother’s
of HIV counselling and testing include ‘fear of how to blood mixes with that of the baby during vaginal deliv-
ery.5 However, Pillitteri reported that MTCT that is
spread through the placenta is still the most common
Correspondence: Dr Adekemi E. Olowokere, Department of
Nursing Science, Obafemi Awolowo University, Ile-Ife, reason for childhood HIV infection, with the disorder
Osun State, Nigeria. Emails: [email protected], progressing more rapidly in such infants and children
[email protected]. who receive the virus through placental transmission if
Conflict of interest: The authors declare that they have no they do not receive treatment.6 These children are usu-
competing interests. ally HIV-positive by six months and develop clinical
Accepted for publication 8 May 2017. signs from one to three years of age.

© 2017 National Rural Health Alliance Inc. doi: 10.1111/ajr.12368

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34 A. E. OLOWOKERE ET AL.

What is already known on this subject: What this study adds:

● HIV counselling and testing is important for ● Women reported being tested without their
the prevention of mother-to-child transmis- consent in previous pregnancy.
sion of HIV. ● A notable proportion of the rural women
● HIV intervention programs are often who had done HIV counselling and testing
focused in the urban areas due to frequency before would not want to do it in the cur-
of events reported related to sex and sexual- rent pregnancy.
ity, such as clubbing, exposure to sexual ● Fear of how to cope with HIV-positive
activities through the media and internet, result and unavailability of testing facilities
drug use and violence against women. in the rural settings are key barriers to utili-
● Early detection of HIV through HIV coun- sation of HIV counselling and testing.
selling and testing is important for reduction ● Counselling needs to be focused on emo-
in sexual transmission of HIV. tional support to allay fear relating to posi-
tive result during pre-test counselling.

Prevention of mother-to-child transmission

(PMTCT) of HIV becomes imperative, considering the women to access ARV prophylaxis, enabling women
burden of the disease and the number of newly to make informed choices about future pregnancies
infected children. It is a strategy adopted globally to providing HIV-infected women with the opportunity
reduce the burden of MTCT. Nigeria, although one of to seek early medical care for HIV-related conditions
the countries with the highest burden, has low cover- (e.g. tuberculosis). In addition, it provides opportunity
age of PMTCT service and alone accounts for 30% of for referrals, early diagnosis, treatment and follow-up
the global PMTCT gap – the difference between esti- support for the exposed infant, enabling identified
mated number of HIV-positive pregnant women and HIV-infected women to adopt a positive lifestyle and
those reached with antiretroviral prophylaxis for empowering HIV-negative pregnant women to remain
PMTCT.3 Efforts to scale up PMTCT services in Nige- negative.9 Despite the benefits of HCT in the antenatal
ria are driven by a number of global guidelines, such setting, the coverage of antenatal screening for HIV is
as World Health Organization policy on PMTCT, the still as low as 13%,10 which is far from the national
Joint United Nations Program on HIV/AIDS for vir- targets. Therefore, information about knowledge, per-
tual elimination of paediatric HIV and universal access ception and access to HCT is needed to optimise
to counselling and treatment. Many of the current screening services. Many studies have assessed knowl-
interventions to prevent HIV/AIDS require people to edge and perception of HCT but there is a dearth of
know their status through HIV testing. In view of this, studies on the access and utilisation among pregnant
HIV counselling and testing (HCT) is considered a key women in rural settings. This is needed in order to
preventive strategy for all forms of HIV and AIDS pre- scale up services to prevent MTCT of HIV even in
vention and control interventions, including PMTCT, remote areas in Nigeria. Thus, this study assessed the
treatment, care and support programs.7 It is also a knowledge, perception, access and utilisation of HCT
vital point of entry into PMTCT through HIV testing among pregnant women in rural Nigeria.
of pregnant women attending antenatal care.8 HIV
counselling is the confidential dialogue between indi-
viduals and their health care providers to help clients
Methods
examine their risk of acquiring or transmitting HIV
Design and setting
infection and to make informed decisions based on
information available to them, while HIV testing is A cross-sectional survey of pregnant women attending
the process that determines whether a person is antenatal clinics in three rural communities in Olor-
infected with HIV or not.9 unda local government area (LGA) of Osun State in
HIV counselling and testing is of immense benefit to Nigeria (Fig. 1) was conducted. The communities in
those who test positive and those who test negative. It the LGA were stratified to urban and rural. All the
alleviates anxiety, promotes behavioural change and three rural communities (Ilie, Oba Ile and Oba Oke)
facilitates early referral to care and support, including and the five facilities available in the communities
access to antiretroviral (ARV) drug therapy.8 HCT as (two comprehensive health centres and three primary
a component of PMTCT in the antenatal setting, is of health centres (PHCs)) were selected for the study.
innumerable benefit, such as enabling HIV-infected ‘Oba Ile’ and ‘Oba Oke’ communities are located

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HCT ACCESS AND UTILISATION AMONG PREGNANT WOMEN 35

FIGURE 1: Map showing the study settings.

about 15 km north-west of Osogbo, while ‘Ilie’ is situ- communities, and the replies were translated back into
ated about 30 km north-east of Osogbo. Osogbo is English. The face, content validity and the reliability
the capital of Osun State in south-western Nigeria. of the instrument were established in a pilot study
prior to final administration for data collection and
the reliability coefficient using the test–retest method
Sampling selection
was 0.83. The questionnaire was administered directly
The sample size was determined using a standard for- to the pregnant women upon their consent to partici-
mula N = z2 P (1 P)/d2, where the prevalence of pate in the study. The questionnaire sought to elicit
MTCT was taken as 25%.11 Of the 300 participants, information on sociodemographic characteristics and
only 288 were eligible for the analysis. The total knowledge, perception, access and utilisation of the
number of pregnant women who attended each of HCT services.
the facilities was obtained and the sample was pro-
portionately allocated to the various PHC facilities.
Data analysis
Pregnant women who participated in the study from
each facility were selected by convenience sampling. Data on sociodemographic characteristics of the
respondents were analysed using descriptive statistics of
frequency and percentages. For the knowledge items,
Data collection method the ‘Yes’ answer was scored as 2 and ‘No’ was scored
A structured interviewer-administered questionnaire as 1. The median point was used to determine the level
was used to collect data. The questionnaire was of knowledge. A score above or below the median score
adapted from previous studies based on knowledge, (18) was categorised as good and poor knowledge of
perception, access and utilisation of HCT.8,12 The HCT, respectively. The perception of HCT was mea-
questionnaire was translated into the Yoruba lan- sured utilising the four-point Likert scale questionnaire.
guage, which is the language spoken in the rural The ‘strongly agree’ answer was scored as 4, ‘agree’

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36 A. E. OLOWOKERE ET AL.

was scored as 3, ‘disagree’ was scored as 2 and

‘strongly disagree’ was scored as 1. The median point
Results
was used to determine the level of perception. Thus, The sociodemographic characteristics of respondents
those who had scored above and below the score (19) are presented in Table 1. The mean age was
were considered to have good and poor perception, 30.59  7.01 years. Most of the respondents were
respectively. A v2-test was used to find an association between the age range of 15 and 24 years.
between barriers and utilisation of HCT. The level of Table 2 shows the knowledge of respondents on
significance was set at P < 0.05. Data were analysed HIV transmission and HCT for the PMTCT of HIV.
with IBM SPSS Statistics for Windows software version Generally, the majority of the women was well-versed
20 (IBM Corporation, Armonk, NY, USA). on most of the knowledge items, which included
knowing that HIV infection has no age barrier, can be
prevented and the fact that HCT is meant for every-
Ethical considerations body. Most of them also had an understanding of the
Ethical approval was obtained from the Health correct definition of HIV counselling and the possibil-
Research Ethics Committee of the Institute of Public ity of a child getting infected from the parents. Key
Health, Obafemi Awolowo University, Ile-Ife, Nigeria. observations from participant responses, however,
For those who could not read, the content of the form showed that close to half of the women (49.3%) felt
was read to them in the local language and clarifica- that HIV infection is a curse used by God to punish
tions were made before they thumb printed on the promiscuous people. Also, 52.0% and 33.3% were
form. Confidentiality with regard to respondents’ not aware that HIV can be transmitted during delivery
information was maintained at all times by ensuring and breast-feeding, respectively. In summary, the
that participants were not linked to the questionnaire. results showed that 40.30% of respondents had poor
Participation was voluntary and respondents were knowledge, while 59.7% had good knowledge of
informed of their right to withdraw at any time with- HCT.
out any penalty from the study. Table 3 presents the perception of respondents
towards HCT. Many of the respondents felt that par-
ticipating in HCT could cause anxiety after one has
been diagnosed as HIV-positive. About 60% (59.3%)
TABLE 1: Sociodemographic profile of respondents of the respondents felt that women would not go for
HCT for the fear of being refused care at the point of
Characteristics of population n = 300 %
need. Also, 59.4% and 75.7% of them felt that partic-
Age (years) ipating in HCT had been a problem because of the
15–24 180 60.0 fear of being stigmatised or losing one’s spouse,
25–34 91 30.3 respectively. The summary of these findings showed
35–44 29 9.7 that 56.7% of respondents had a good perception of
Marital status HIV counselling and testing, while the rest (43.30%)
Married 279 93.0 had poor perception.
Single 15 5.0 Access to HCT was measured by availability and
Divorced 4 1.3 affordability of the service. Table 4 presents the access
Widowed 2 0.7 and utilisation of HCT by the pregnant women. HCT
Ethnicity services were reported to be available and free of cost
Yoruba 280 93.3 by 77.7% and 88.4% of the respondents, respectively.
Igbo 12 4.0 The utilisation of HCT revealed that many of the
Hausa 6 2.0 respondents (61.3%) reported to have done HCT
Others 2 0.7 before in their previous pregnancies. Only about 56%
Religion (55.4%) of the respondents gave consent, while the
Christian 263 87.7 majority (78.3%) acknowledged one-on-one coun-
Islam 35 11.6 selling. However, less than half (36.3%) of the respon-
Others 2 0.7 dents were willing to have HCT done during the
Educational status present pregnancy.
No formal education 5 1.7 A v2 analysis of the association between the level
Primary 5 1.7 of perception and the utilisation of HCT is pre-
Secondary 274 91.0 sented in Table 5. There was significant association
Tertiary 16 5.6 between level of perception and respondents’ utilisa-
tion of HCT (v2 = 4.95; P = 0.02). Also, Table 6

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HCT ACCESS AND UTILISATION AMONG PREGNANT WOMEN 37

TABLE 2: Knowledge of respondents on HIV transmission and HIV counselling and testing

Yes No
Statement Correct response n (%) n (%)

HIV is a curse used by God to punish promiscuous people No 148 (49.3) 152 (50.7)
HIV can affect anybody at any age Yes 258 (86.0) 42 (14.0)
HIV infection is preventable Yes 292 (97.3) 8 (2.7)
HIV can be transmitted from a pregnant woman to her unborn baby Yes 283 (94.3) 17 (5.7)
HIV cannot be transmitted during delivery No 156 (52.0) 144 (48.0)
HIV cannot be transmitted during breast-feeding even if No 100 (33.3) 200 (66.7)
the viral load of the affected woman is high
HIV counselling and testing is for anybody either pregnant or not Yes 297 (99.0) 3 (1.0)
HIV counselling is the confidential dialogue between individuals Yes 293 (97.7) 7 (2.3)
and their health care providers to assist in taking informed decision
HIV counselling and testing empowers HIV-negative women to remain negative Yes 279 (93.0) 21 (7.0)
Participating in HIV counselling and testing is Yes 287 (95.7) 13 (4.3)
important for the prevention and management of HIV in pregnancy

TABLE 3: Respondents’ perception of HIV counselling and testing (HCT)

Strongly Strongly
agree Agree Disagree disagree Total
Statement n (%) n (%) n (%) n (%) n (%)

HIV counselling and testing is highly important in pregnancy 201 (67.0) 64 (21.3) 28 (9.3) 7 (2.3) 300 (100.0)
Women become anxious after knowing their status 173 (57.7) 86 (28.7) 34 (11.3) 7 (2.3) 300 (100.0)
Women do not go for HCT because they fear health 141 (47.0) 37 (12.3) 92 (30.7) 30 (10.0) 300 (100.0)
care providers might refuse to assist them during delivery
HCT can lead to stigmatisation and 128 (42.7) 50 (16.7) 89 (29.7) 33 (11.0) 300 (100.0)
isolation for the woman if positive
HCT can create disharmony among couples and family 119 (39.7) 108 (36.0) 37 (12.3) 36 (12.0) 300 (100.0)
Consent of the partner will increase HCT utilisation 135 (45.0) 56 (18.7) 44 (14.7) 65 (21.6) 300 (100.0)

shows association between barriers and utilisation of pregnancy-related care by the Federal Ministry of
HCT. There was significant association between both Health of Nigeria.9 However, most of the women
‘fear of how to cope with being positive’ completed secondary school education, as against pre-
(v2 = 14.90; P = 0.00) and ‘absence of counselling vious patterns obtained in a population-based study
centre’ (v2 = 8.19; P = 0.00) and utilisation of HCT. where only 10–12% of rural dwellers completed sec-
ondary education.13,14 This might not be connected
with the fact that the group of women sampled were
Discussion those who attended public health care facilities in the
Prevention of mother-to-child transmission of HIV is a selected communities. Having secondary school educa-
public health concern worldwide. Improved feto-maternal tion might have contributed to the utilisation of ortho-
outcomes of people affected is subject to early detec- dox health care facilities. Previous studies have linked
tion through HCT. Reaching out to women living in level of education of people to HCT utilisation
the rural and remote areas is important as their set- because they might have more understanding of the
tings are often underserved in terms of basic health benefits of such services and are more likely to
care facilities for health promotion, prevention and respond to health-promoting messages.15
curative services. The knowledge of HCT was good with the majority
Most of the participants in this study were young of the pregnant women. This result affirmed a previ-
women within the age range of 15–24 years. This age ous study in Nigeria on awareness and knowledge of
range corresponded with the reported age category of HCT.12 Over 90% of the women in this study had
women attending maternal and child health clinics for knowledge on the benefits of HCT. Most importantly,

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38 A. E. OLOWOKERE ET AL.

TABLE 4: Information on access and utilisation of HIV misconceptions about transmission of HIV, including
counselling and testing (HCT) in prevention of mother-to- lack of knowledge that HIV can be transmitted dur-
child transmission among respondents ing delivery and breast-feeding. Mother-to-child
transmission has been found to be responsible for
n % the majority of paediatric HIV infection;2 therefore,
the knowledge of pregnant women on MTCT of
Access to HCT
HIV is important in the prevention of the infection
Are HIV counselling and testing services available in your
in unborn child17 and pregnant women, especially
antenatal clinic?
those who are seropositive, should be educated on
Yes 233 77.7
MTCT of HIV in order to reduce the risk of infec-
No 67 22.3
tion in oncoming generation.18 Many participants
If Yes, is counselling and testing free?
believe that HIV infection is a punishment of
Yes 206 88.4
promiscuous people, which provides insight into why
No 27 11.6
stigmatisation and discrimination against people who
If your answer above is No, how much do you pay for it?
are infected still pervades the Nigerian society. These
<500 25 91.7
misconceptions could have serious implications on
>500 2 8.3
mothers’ decision regarding choice of delivery and
Do you think that the cost of HCT is affordable for you?
getting counselling on infant feeding practices.
Yes 16 63.3
In accordance with a previous study,19 in present
No 11 36.7
study more than half of the women in rural areas still
Utilisation of HCT
had good perception on the importance of HCT. The
Have you done HCT before (previous uptake)?
majority of the respondents perceived HCT as very
Yes 184 61.3
important during pregnancy. Of notable importance is
No 116 38.7
the respondents’ high perception of spousal consent/ap-
If Yes, did you do it with your consent?
proval as a strategy to improve the utilisation of HCT,
Yes 102 55.4
which was in line with the submission of Oyebode
No 82 44.6
et al.20 Thus, intervention aiming to increase utilisation
What kind of counselling did you receive then?
of HCT among rural women should target men to sup-
One-on-one 144 78.3
port and approve their wive’s utilisation of HCT.
Group counselling 40 21.7
Accessibility of rural communities to HCT during
If you have not had HCT in this pregnancy, will you be
pregnancy in this study was good. The HCT service
willing to do it? (intention for uptake in current
was available and free of cost for the majority of preg-
pregnancy)
nant women attending the antenatal clinic in the rural
Yes 109 36.3
areas. A previous study in a West African country,
No 191 63.7
however, had reported that women were not accessing
HCT services despite its availability.21 The difference
they were aware about its use in empowering HIV- could be in terms of the affordability of the cost, as
negative women to remain negative and in the preven- lack of financial empowerment could be an impedi-
tion and control of HIV in pregnancy. This was higher ment to accessing health-related services.22 Some of
than 35.0% reported in a household survey by Amu the women indicated payment was being collected for
and Ijadunola in the same settings and 58.4% HCT, which majority said was less than 500 naira
obtained in a household survey of residents in an (less than two dollars) and affordable to them. The
urban town in south-western Nigeria.12,16 issue of HCT payment is not about the amount but its
Although the women in the study demonstrated affordability. Although many of them claimed that it
good knowledge of HCT, there were still was affordable, women in rural Nigeria are typically

TABLE 5: Association between perception and utilisation of HIV counselling and testing

Utilisation

Perception No (%) Yes (%) Total (%) d.f. v2 P-value

Poor perception 56 (18.6) 65 (21.7) 121 (40.3) 1 4.95 0.020

Good perception 60 (20.0) 119 (39.7) 171 (59.7)

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HCT ACCESS AND UTILISATION AMONG PREGNANT WOMEN 39

TABLE 6: Chi-squared analyses of association between bar- captured in previous studies in Nigeria or Africa set-
riers and utilisation of HIV counselling and testing (HCT) tings. However, Perez et al. have linked refusal of
HCT to the husband’s/partner’s approval before being
Utilisation tested in rural districts of Zimbabwe.28 This could be
corroborated with the perception of majority of
Factors No (%) Yes (%) Total (%) v2, d.f., P-value women in this study that consent of partner will
increase HCT utilisation. Involving men in PMTCT
Lack of information on HCT
services might be useful in this regard as women per-
No 85 (28.3) 140 (46.7) 225 (75.0) v2 = 0.30
ceive spousal approval as a priority. Refusal to use
Yes 31 (10.3) 44 (14.7) 75 (25.0) d.f. = 1, P = 0.58
HCT in current pregnancy might also be due to the
Distance of service point
fear of receiving positive result or unavailability of
No 75 (25.0) 139 (46.3) 214 (71.3) v2 = 4.12
HCT services, as found in this study. Fear of coping
Yes 41 (13.7) 45 (15.0) 86 (28.7) d.f. = 1, P = 0.42
with positive result has also been reported in a previ-
Cost of the service
ous study as a barrier to utilisation.29 Thus, coun-
No 106 (35.3) 169 (56.3) 275 (91.7) v2 = 0.20
selling must be done in a way to explore and allay
Yes 10 (3.3) 15 (5.0) 25 (8.3) d.f. = 1, P = 0.88
people’s fear and offer necessary psychological support
Attitude of health workers
during pre- and post-test counselling to enhance emo-
No 86 (28.7) 131 (43.7) 217 (72.3) v2 = 0.308
tional stability even after receiving a positive result.
Yes 30 (10.0) 53 (17.7) 83 (27.7) d.f. = 1, P = 0.57
Also, there is need for continuous community-based
Fear of how to cope with being positive
education on the importance of testing regularly
No 80 (26.7) 85 (28.3) 165 (55.0) v2 = 14.90
throughout one’s lifespan as long as one is still having
Yes 36 (12.0) 99 (33.0) 135 (45.0) d.f. = 1, P = 0.00
sexual exposure or engaging in other risky behaviour.
Absence of counselling centre
People need to know that previous negative test result
No 88 (29.3) 110 (36.7) 198 (66.0) v2 = 8.19
does not guarantee immunity against HIV infection. It
Yes 28 (9.3) 74 (24.7) 102 (34.0) d.f. = 1, P = 0.00
might be important for subsequent research in this
area to explore reasons why people who have had
previous uptake of HCT would not want to have it.
of low socioeconomic status, with either little or no This could be better addressed in qualitative research.
education, as demonstrated in this study with majority The outcome of such research can help provide basis
of the women having secondary school education, for educational programs to promote continuous
which seems to place a limit on their economic power. uptake of HCT among women.
From the study, most women could afford the cost of Examining the technique of HCT in the study set-
HCT in places where payments are collected. Evidence tings, the majority reported that counselling was done
from previous studies has shown that cost is a serious one-on-one which was adjudged right, but almost half
barrier to service utilisation.23,24 Fotso et al.25 and of the women had HCT done without their consent.
Meehan et al.26 submitted that it is not only enough to HIV counselling and testing, is not mandatory and
increase the availability of health services, but also people tested must give informed consent for the test
make such services available to poor at affordable cost. to be voluntary.30 Informed consent is the central
The study shows that the most (61.3%) of the women theme of voluntary counselling and testing, which has
had used HCT during previous pregnancy. However, been described as a vital point of entry to PMTCT.8
this rate was lower than 71% uptake reported in Iba- Informed consent in care and service is ethical and, as
dan, an urban setting in south-western Nigeria.27 The such, health care providers should ensure informed
high uptake may also be linked to the scaling-up of the consent from clients prior to HIV counselling and test-
PMTCT services in the country, especially at the PHC ing, irrespective of setting – rural or urban – in order
level, by the Federal Ministry of Health and national to avoid legal issues.
and international non-governmental organisations, as It is important to state that this study has some
reported by Owoaje et al.27 Considering the impor- limitations. These findings were based on self-report
tance of partners’ consent in utilisation of HCT, com- of respondents in which bias might have been an
munity-based education should be strengthened by issue in cases that the women felt they needed to
public health nurses in all rural communities to create respond in a way that was expected. However, such
awareness of the importance of PMTC and HCT biases are less likely as the women received explana-
uptake in the prevention and management of HIV. tion of the benefit of their sincere response to help
The significance of this study is some women’s improve the health of women in the rural areas. The
reluctance to do HCT during the current pregnancy settings of the study (PHC facilities) did not capture
despite previous uptake. This finding has not been other women who might have been attending private

© 2017 National Rural Health Alliance Inc.

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40 A. E. OLOWOKERE ET AL.

health care facilities, missions’ homes, traditional 12 Jul 2016]. Available from URL: http://www.who.int/
birth attendant homes and other places. Thus, these hiv/topics/mtct/en/
findings might not provide a general picture of 5 Adogu PO, Nwabueze SA, Adinma ED, Ilika A, Ikechu-
what was obtained is in these settings. Also, women belu JI. Infant feeding choices and practices as risk fac-
tors of mother-to-child-transmission of HIV among
recruited in this study might not really be those who
exposed infants in Nnamdi Azikiwe University Teaching
have access issues in relation to maternity health care
Hospital, Nnewi. Afrimedic Journal 2013; 3: 7–12.
services, including MTCT. A household survey could 6 Pillitteri A. Maternal & Child Health Nursing: Care of
provide more representative findings of the variables the Childbearing & Childrearing Family, 6th edn. China:
of interest in subsequent research. The use of conve- Lippincott Williams, 2010.
nience sampling also limits the generalisation of the 7 Yahaya LA, Jimoh AGA, Balogun RO. Factors hindering
findings. acceptance of HIV/AIDS voluntary counseling and testing
(VCT) among youths in Kwara State, Nigeria. Journal of
AIDS and HIV Research 2010; 2: 138–143.
Conclusion 8 Mbamara SU, Obiechina NJA, Akabuike JC. Awareness
This study demonstrated that many of the rural and attitudes to voluntary counselling and testing (VCT)
for human immunodeficiency virus/acquired immune defi-
women showed good knowledge and perception of
ciency syndrome (HIV/AIDS) among law undergraduates
HCT. These findings suggest that most rural women
in tertiary institutions in Anambra State, Southeast, Nige-
have access to HCT and many of them used the ser- ria. International Journal of Medicine and Medical
vices. In this study, the need for adequate counselling, Sciences 2013; 5: 290–294.
continuous education to promote HCT utilisation and 9 Federal Ministry of Health (FMoH) of Nigeria. National
emotional support for those affected were expressed. Guidelines on PMTCT. Abuja, Nigeria: Federal Ministry
As there are still misconceptions about HIV/AIDS and of Health, 2010.
MTCT, these could lead to serious implications for 10 UNICEF. Prevention of Mother to Child Transmission
the transmission of HIV infection to the unborn child. (PMTCT) of HIV. A High School Educators’ Guide
(GRADE 9-12), 2012. [Cited 27 Jun 2015]. Available
from URL: www.humanrightsmalta.org/uploads/1/2/3/3/
Acknowledgements 12339284/_pmtct_final.pdf
11 Federal Ministry of Health Nigeria (FMoH). National
The authors would like to appreciate the nursing
HIV/AIDS and Reproductive Health and Serological Sur-
heads in the five facilities in the three communities vey, 2012 (NARHS Plus). Abuja, Nigeria: Federal Min-
and also the heads of the maternity units. istry of Health, 2013.
12 Amu EO, Ijadunola KT. Awareness and knowledge of
HIV counselling and testing among adults of reproduc-
Authors’ contribution
tive age in Osun State Nigeria. Trends in Medical
AEO and OAA conceptualised and designed the study. Research 2011; 6: 265–272.
AEO, OAA and AOK analysed and interpreted the 13 Demographic and Health Survey 2013. [Cited 26 Jan
data. AEO, OAA and AOK prepared the manuscript. 2017]. Available from URL: https://dhsprogram.com/pub
All authors edited and reviewed the manuscript. s/pdf/FR293/FR293.pdf
14 Busari AO. Expanding access to voluntary HIV coun-
selling and testing in the rural communities of Oyo State,
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