Midwives’ experiences regarding the implementation of prevention of mother to child transmission (PMTCT) guidelines in Mopani District of Limpopo Province, South Africa

Abstract

Background: Midwives are responsible for provision of prevention of mother-to-child transmission (PMTCT) services. These involve a wide variety of tasks, ranging from HIV diagnosis, prescription of anti-retroviral therapy, ensuring safe obstetrics during delivery, counselling on infant feeding and management of opportunistic infections. The aim of this study was to explore midwives’ experiences regarding implementation of PMTCT guidelines in Mopani District. Methods: A qualitative approach which is exploratory and descriptive in nature was used. The study was conducted in primary healthcare facilities under Greater Giyani sub-District. The population comprised of all midwives working in the primary health care facilities under the Greater Giyani sub-District. A non-probability, purposive sampling method was used to select 35 midwives with at least 2 years of experience in implementing PMTCT guidelines, and the same method was used to select primary healthcare facilities. Data was collected from through in-depth face-to-face interviews using a semi-structured interview guide. Data was collected from 17 participants. The researcher made use of a voice recorder to capture the interviews with the consent of the participants. Trustworthiness was ensured by using the model of Lincoln and Guba that looks at credibility, dependability, confirmability and transferability. Ethical principles, such as anonymity, confidentiality and informed consent were strictly adhered to. Data was analyzed through an interpretive phenomenological analysis (IPA). Results: There were challenges experienced during implementation of PMTCT in primary healthcare facilities, despite this, the findings of the study revealed that there is a certain degree of progress on the implementation of PMTCT guidelines by midwives. There are now fewer cases of PCR positive that are being reported, improved midwives’ attitude towards HIV positive patients and introduction of mentor mothers. Participants reported employer as well as patient-related challenges affecting implementation of PMTCT guidelines. Lack of training, shortage of midwives and a lot of paper work was one of employer-related challenges, Poor quality care provision by midwives was also reported as a factor which is negatively affecting implementation of PMTCT guidelines in primary healthcare facilities. Recommendations: The study recommended that universities and colleges train students for PMTCT and NIMART so that they have the required knowledge before completing their courses. Training of more midwives to promote provision of PMTCT services, consolidation of PMTCT registers and provision of gadgets for filling patient’s records in order to reduce workload were some of the recommendations.