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Constructive integration : changes in uptake and outcomes of reproductive health services during the scaling up of ART and PMTCT in Thyolo District, Malawi
Includes bibliographical references
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| Main Author: | |
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| Other Authors: | |
| Format: | Thesis |
| Language: | English |
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Department of Paediatrics and Child Health
2015
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| _version_ | 1867613533835886592 |
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| access_status_str | Open Access |
| author | Van den Akker, Thomas |
| author2 | Shea, Jawaya |
| author_browse | Shea, Jawaya Van den Akker, Thomas |
| author_facet | Shea, Jawaya Van den Akker, Thomas |
| author_sort | Van den Akker, Thomas |
| collection | Thesis |
| description | Includes bibliographical references |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/12621 |
| institution | University of Cape Town (South Africa) |
| language | eng |
| last_indexed | 2026-06-10T12:37:40.192Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2015 |
| publishDateRange | 2015 |
| publishDateSort | 2015 |
| publisher | Department of Paediatrics and Child Health |
| publisherStr | Department of Paediatrics and Child Health |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/12621 Constructive integration : changes in uptake and outcomes of reproductive health services during the scaling up of ART and PMTCT in Thyolo District, Malawi Van den Akker, Thomas Shea, Jawaya Maternal and Child Health Includes bibliographical references Background: In recent years there has been increasing debate about the impact of scaled-up ART and PMTCT programmes on the uptake and outcomes of reproductive health services, in particular the potential detrimental effects of HIV-care on the overall capacity of fragile health systems. The objective of this study was to evaluate changes in the uptake of reproductive health services as well as the main pregnancy outcomes during the scaling up of ART and PMTCT in Thyolo District, Malawi. Methods : Study design: retrospective descriptive district-wide cohort analysis for the period 2005 to 2009. Setting: Thyolo District, an area with around 600,000 inhabitants, an adult HIV-prevalence of 21% and a Total Fertility Rate of 5.7 in 2004. HIV-care including ART and PMTCT was scaled up since 2004 in Thyolo District to reach district-wide coverage in 2007. HIV-care is provided at district hospital, health centre and community health post levels. Outcomes: uptake of antenatal, intrapartum and postpartum care, family planning and treatment of sexually transmitted infections; infrastructural changes, and changes in maternal and perinatal pregnancy outcome. Data collection and analysis: data were collected from facility antenatal, intrapartum and postpartum records, as well as from MoH and MSF databases maintained for routine programme monitoring. Chisquare tests were performed comparing the baseline year (2005) with the year of study end (2009). Results: Uptake of peripartum care had improved markedly by the end of the five-year study period: the percentages of pregnant women who took up antenatal, intrapartum and postpartum care increased by 30%, 25% and 20% respectively. The number of family planning consultations increased by almost 50% and the number of women treated for sexually transmitted infections more than doubled. Interactions between HIV-care and general reproductive health care had positive effects on key health system components, including governance, health financing, human resources and drug supply. Reliable pregnancy outcome indicators for the entire observation period were difficult to obtain due to likely under-reporting of facility-based maternal and perinatal mortality. However, previously documented results from Thyolo show a reduction of facility-based severe maternal complications, including uterine rupture, between 2007 and 2009. Conclusions: Uptake of reproductive health services and facility-based maternal outcomes increased markedly during the period of HIV scale–up. This implies that the scale up of HIV-care did not inhibit, and likely increased, uptake of reproductive health services, while quality improvements in perinatal care could still be successfully implemented. The finding that ART and PMTCT care may be successfully integrated into broader reproductive health services with satisfying outcomes is a strong argument for continued scale up of ART and PMTCT in similar settings. 2015-03-16T10:53:06Z 2015-03-16T10:53:06Z 2011 Master Thesis Masters MPhil http://hdl.handle.net/11427/12621 eng application/pdf Department of Paediatrics and Child Health Faculty of Health Sciences University of Cape Town |
| spellingShingle | Maternal and Child Health Van den Akker, Thomas Constructive integration : changes in uptake and outcomes of reproductive health services during the scaling up of ART and PMTCT in Thyolo District, Malawi |
| thesis_degree_str | Master's |
| title | Constructive integration : changes in uptake and outcomes of reproductive health services during the scaling up of ART and PMTCT in Thyolo District, Malawi |
| title_full | Constructive integration : changes in uptake and outcomes of reproductive health services during the scaling up of ART and PMTCT in Thyolo District, Malawi |
| title_fullStr | Constructive integration : changes in uptake and outcomes of reproductive health services during the scaling up of ART and PMTCT in Thyolo District, Malawi |
| title_full_unstemmed | Constructive integration : changes in uptake and outcomes of reproductive health services during the scaling up of ART and PMTCT in Thyolo District, Malawi |
| title_short | Constructive integration : changes in uptake and outcomes of reproductive health services during the scaling up of ART and PMTCT in Thyolo District, Malawi |
| title_sort | constructive integration changes in uptake and outcomes of reproductive health services during the scaling up of art and pmtct in thyolo district malawi |
| topic | Maternal and Child Health |
| url | http://hdl.handle.net/11427/12621 |
| work_keys_str_mv | AT vandenakkerthomas constructiveintegrationchangesinuptakeandoutcomesofreproductivehealthservicesduringthescalingupofartandpmtctinthyolodistrictmalawi |