COMMUNITY BASED SITUATIONAL ANALYSIS Maternal and ...

SECTION 3: HEALTH SEEKING BEHAVIOUR OF HIV-POSITIVE AND HIV-NEGATIVE
WOMEN
Utilisation by HIV Status
There was no statistical difference (at alpha 0.10) in any of the utilisation variables, mean
utilisation score, or percent with a utilisation score of >=5 between mothers who were HIVpositive
and HIV-negative. There were also no differences in mean number of postpartum
visits (4 vs. 3, p=0.17) as shown in Appendix A18.
Complete immunisation of children for age was similar across HIV-positive and HIV-negative
women in Paarl and Rietvlei but significantly lower in children of HIV-positive women in Umlazi
(19% vs. 82%, p=0.0003). This latter finding is concerning, and further investigation to confirm
these results should be considered. (Appendix A19).
Quality of Care by HIV Status
HIV-positive and HIV-negative women reported a similar quality of care rendered by both the
clinic and hospital. However, staff was more likely to discuss HIV and AIDS with HIV-positive
women. However, HIV-positive women perception was that they received less privacy during
ANC than HIV-negative women. Staff was more likely to ask HIV-positive women to attend
post-partum care after birth (Appendix A 20).
Disclosure was substantially covered in the Good Start Cohort Study, and only 2 of the women
with unknown HIV status in this study were willing to discuss HIV with the interviewers. From
the cohort study 69% of women in Paarl, 30% of women in Rietvlei and 48% of women in
Umlazi had disclosed their HIV status to someone by the time of the initial interview. 9
SECTION 4: FAMILY INVOLVEMENT IN PREGNANCY, BIRTH AND CARE OF INFANT
Finally we examined family involvement during pregnancy, birth and care of infant. Appendices
A21 - A26 summarise results from both the mother and household member questionnaires that
related to family involvement. The extended family members did seem to be involved in
pregnancy and infant care. Fewer were involved in birth, but many women and family
members desired more participation during labour and birth, particularly in Paarl (Appendices
A22 - A24). Encouragement and responsibility of family members to make sure a woman gets
to ANC were very high (Appendix A 21 and A 23) and as noted above being advised by family
members to attend ANC was a significant predictor of overall utilisation (Appendix A4). Overall,
it appeared that Paarl had the highest level of family participation across the three sites. This
correlated with earlier data which showed a higher reliance compared with the other two sites
on family and friends for health information.
SECTION 5: DISCUSSION AND CONCLUSION
There were some similarities and differences across the three study sites. As seen in other
studies, Rietvlei represented the most poorly resourced area, and except for family planning,
had lower utilisation for the majority of indicators. However, with regard to health knowledge,
Paarl scored the lowest. Paarl also showed a higher reliance on family and friends for health
information than the other two sites, although across all three sites health workers were both
the major source of health information and the source considered to give the best advice for
making health decisions. Despite Paarl women having lower knowledge, it is clear that rural
under-resourced sites like Rietvlei are in a more critical need of support from National and
Community Based Situation Analysis: Maternal & Neonatal Follow-up Care 16