SCHOOL OF PUBLIC HEALTH

COLLEGE OF MEDICINE AND HEALTH SCIENCES

SITY of recarch PROPOSAL SUBMITED TO

SCHOOL OF PUBLIC HEALTH, COLLEGE OF
MEDICINE AND HEALTH SCIENCES,
UNIVERSITY OF GONDAR

Name of investigator

Name of advisor Professor YIGZAW KEBEDE (MD.MPH)

Full title of the project KAP towards PMTCT of HIV among Antenatal care
mothers in Adigrat District, Tigray
Duration of the project October-November, 2012 G.C

Study area ADIGRAT DISTRICT, TIGRAY

Total cost of the project 11,589.90 ETB.

Address of investigator Adigrat District, Tigray

Postal address:- 73
Tele:+251-34-445-23-22 (Office)
Mobile:+251-91472-31-01

E-mail -gtesfayb@yahoo.com

1
Research Proposal on Assessment
Knowledge, Attitude and Practice towards
PMTCT Of HIV among Antenatal care
mothers in Adigrat District, Tigray.

INVESTIGATOR
TESFAYE GEBRU BAHTA (BSc.)

ADVISOR
Professor Yigzaw Kebede (MD, MPH)

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 TABLE OF CONTENT
Acronyms ……………………………………………………… II
Summary ………………………………………………………. III
1. Introduction …………………………………………………. 1
1.1 Statement of the problem ………………………………… 1
1.2 Literature review …………………………………………… 3
1.3 Justification of the study ………………………………….. 6
2. Objectives ……………………………………………………. 7
3. Methodology …………………………………………………. 8
3.1 Study design………………………………………………… 8
3.2 Study area ………………………………………………….. 8
3.3 Study population …………………………………………… 8
3.4 Sample size & sampling procedures …………………….. 9
3.5 Variables of the study ……………………………………… 10
3.6 Operational definitions …………………………………….. 11
3.7 Data collection procedures ……………………………….. 12
3.7 Data processing and analysis …………………………….. 13
4. Ethical consideration ………………………………………… 14
5. Dissemination of results …………………………………….. 14
6. Work plan ……………………………………………………… 15
7. Reference ……………………………………………………… 16
8. Cost of the project …………………………………………….. 18
9. Annex…………………………………………………………….
Annex 1. English Questionnaire …………………………………
Annex 2. Dummy table ……………………………………………

3
 Acronyms
AIDS Acquired immune deficiency syndrome
ANC Antenatal care
ARV Anti-retroviral
BSS Behavioral surveillance system
EDHS Ethiopian Demographic and Health Survey
EPHA Ethiopian Public Health Association
ETB Ethiopian Birr
FHI Family Health International
FMOH Federal Ministry of Health
HAPCO HIV/AIDS Prevention and Control Office
HC Health Centre
FMOH Federal Ministry of Health
HIV Human Immunodeficiency Virus
HMIS Health Management Information System
KAP Knowledge, attitude and practice
Km Kilo-meter
MCH Maternal and child health
MTCT Mother to child transmission
OR Odds ratio
PLWHA People living with HIV/AIDS
PMTCT Prevention of mother to child transmission
SPSS Statically package for social science
TRHB Tigray regional health bureau
UNAIDS United Nations for AIDS program
WHO World health organization
VCT Voluntary counseling and testing

II

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SUMMARY
Introduction: Human Immune Deficiency or AIDS is currently a major public health
problem in Ethiopia and mother to child transmission (MTCT) is by far the largest
source of infection in children below the age of 15 years. The transmission of HIV from
infected mothers to babies could occur during pregnancy (intrauterine), during labor
and delivery (intrapartum), or after delivery through breast feeding (postpartum).
Prevention of mother to child transmission is the most effective when under taken not
as an isolated activity, but rather as part of the continuum of HIV/AIDS interventions,
which ranges from primary prevention to care and support for people living with
HIV/AIDS.
Objectives:
Objectives: This study attempts to assess pregnant women’s knowledge, attitude and
practice of prevention of MTCT of HIV/AIDS who attend antenatal care services.
Methods: A cross sectional institution based study will be conducted to assess KAP
towards prevention of MTCT on antenatal mothers in one hospital and three health
centers in Adigrat District, government health institutions. Proportional distribution of
samples will be carried out to attain the required sample size i.e. 461 pregnant women.
A structured, pre-tested questionnaire will be used for quantitative data collection. Data
will be entered into a computer using Epi info version 6 and SPSS 11 will be used for
data analysis. Frequency distribution and cross tabulation will be made for the
variables; odds ratio and 95% confidence interval will be used to calculate significant
difference among proportions of categorical variables.
Work plan: The study will be done among pregnant mother attending ANC in Adigrat
hospital and three health centers in Adigrat District from October to November 2007
G.C.
Budget: The total cost required for the project will be 11,589.90 ETB.

III

5
1. INTRODUCTION
1.1 STATEMENT OF THE PROBLEM
The Human immunodeficiency virus (HIV) Pandemic is one of the most serious health
crises the world faces today. AIDS has killed more than 25 million people since 1981
and an estimated 38.6 million people are now living with HIV, about 2.3 million of
who are children. [1]
Mother –to-child transmission (MTCT) of HIV remains a major public health problem
world wide, especially in resource-constrained countries, home to more than 95% of all
people living with HIV/AIDS. Heterosexual intercourse is the most common mode of
transmission in resource-constrained countries, which results in large numbers of
infected women in these settings who then transmit the virus to their babies [2].
The risk of acquiring the virus from an infected mother to a baby ranges from 15% to
25% in industrialized countries compared to 25-35% in developing countries largely
due to breast-feeding practice [3].
Sub-Saharan African remains by far the worst affected region, with 23.8 million to 28.9
million people living with HIV at the end of 2005. The proportion of women being
affected by the epidemic continues to increase. In 2005, 16.2-19.3 million women were
living with HIV, one million more than in 2003. Just under two thirds (64%) of all
people living with HIV are in sub-Saharan Africa, as are more than three quarters
(77%) of all women living with HIV [4].
According to the 2005 AIDS in Ethiopian, sixth report cumulative number of people
living with HIV/AIDS by the year 2005 was 1,320,000. The prevalence of HIV was
higher in women than in men (4% female and 3% male) in 2005 the distribution of HIV
prevalence between urban and rural population was 10.5% and 1.9% respectively. In
Tigray 7.767 HIV positive pregnancies were estimated and 2.256 HIV positive births
were projected to occur in 2012[5].
HIV counseling and testing has been shown to have a role in both HIV prevention and
for people with HIV infections; as an entry point to care.

6
VCT provides people with an opportunity to learn and practice about their serostatus in
confidential environmental. Pregnant women who are aware of their status can prevent
transmission to their infant (MTCT) [6].
In Ethiopia only 3.03% of HIV positive pregnant women receiving a complete course
of antiretroviral prophylaxis to reduce the risk of mother to child transmission of HIV
[7].

1.3 JUSTIFICATION OF THE STUDY

Mother to child transmission (MTCT) is by far the largest source of HIV infection in
children below the age of 15 years. The risk HIV transmission from an infected mother
to her child can be reduced by 50% by giving ARV drug during pregnancy and labor
and avoiding breast-feeding.
PMTCT has been recognized as an effective and pivotal strategy by nations in general
and considered as one of the essential prevention interventions to curb the epidemic.
PMTCT service includes primary HIV prevention; prevent unintended pregnancy,
prevention of mother to child transmission in late pregnancy, during labor and breast-
feeding and care & support.
Even though there is high knowledge regarding HIV/AIDS in the study area only one in
ten pregnant women was used the services for preventing mother to child transmission
of HIV.
Assessing and understanding socio-demographic and service delivery factors that
influence PMTCT is needed to improve use of service, hence its impact on the long run,
among the health institution and the public is vital and timely activity to facilitate HIV
prevention effort in the country in general and in shire District in particular.
However, there is lack of such studies in the district. Therefore, this study will
conducted to assess socio-demographic and KAP about PMTCT which may be useful
in maximizing use of PMTCT services and a women know benefit from these
interventions and other advantages.

7
1.2 LITERATURE REVIEW
A disproportionate burden has been placed on women and children, who in many
settings continue to experience high rates of new HIV related illness and death. In 2005
alone, an estimated 540,000 children were newly infected with HIV, with about 90% of
these infections occurring in sub-Saharan Africa. [8].
Most children living with HIV acquire the infection through Mother to child
transmission which can occur during pregnancy, labour and delivery or during breast
feeding. In the absence of any intervention the risk of such transmission is 15-30% in
non breast feeding populations. Breast feeding by an infected mother increases the risk
by 5-20% to a total of 20-45%. [9].
Rate of transmission of HIV from mothers to children have carried in different parts of
the world. Most studies in the United States and Europe have documented transmission
rates in the untreated women to be between 12-30%. In contrast, transmission rates in
Africa and Haiti were reported to be higher (25-52%) [10].
In some places HIV prevalence among pregnant women has shown a decline. The
prevalence of HIV among pregnant women is high in most Africa countries even if it
seems to decline in some parts of the region in Addis Ababa prevalence has fallen from
a peak of 24% in 1995 to 11% in 2003 [11].
In study investigating knowledge and awareness of HIV/AIDS among pregnant women
in Maharashtra state (India) about 81% of the 269 study subjects heard about sickness
called HIV/AIDS. When asked ways of spread 54% reported they did nor know, 39%
reported that sexual contact, 18% mentioned through injection, and 8% through blood,
4% mentioned commercial sex workers and only one person said from mother to child.
The study reported that education played the most important role on the knowledge
about HIV/AIDS [12].

8
Among antenatal care attending Ghanaian pregnant women at two polyclinics in Accra,
less than 3% of them spontaneously mentioned MTCT as an HIV transmission route,
when prompted. Majority of mothers agreed that the virus could be transmitted during
pregnancy (49%), delivery (91%), and breast-feeding (86%). About 40% of the
participants indicated that MTCT could not prevent and another 14% did not know how
to curtail MTCT [13].
In developed countries combination of antiretroviral during dramatically reduce the risk
of MTCT of HIV. These regimens are expensive and complicated to administer, and as
a result, access to these drugs in minimal in developing countries. However, more
recent trials have shown encouraging results with less expensive short course regimens.
Following those trials, many developing countries have set up pilot projects, which give
HIV-positive women access to ARV to prevent MTCT of HIV during pregnancy, labor
and delivery. Access to VCT is there fore a prerequisite for PMTCT [14].
In Zimbabwe 186 women attending an ANC were offered VCT as part of their
antenatal care, although most women endorsed the multiple benefit of VCT, up take
was low, with only 23% of women consenting to VCT [15].
The finding of the behavioral survey surveillance (BSS) Ethiopia 2002 about
knowledge of mode of transmission of HIV, majority of the study participants
mentioned unprotected sex and contaminated sharps. Only few youth participants
mentioned mother-to-child transmission during pregnancy and breast-feeding [16].
Another study revealed that a small proportion of mothers in Jimma town had sufficient
knowledge about MTCT (38.8%) and PMTCT of HIV (41.8%). In the same study area,
84% of mothers visited health institutions for antenatal care out of which 35.7% used
VCT services during their last pregnancy. The same study showed that 62.4% of
pregnant and lactating mothers had good attitude towards VCT [17].
A community based study on knowledge, attitude and practice (KAP) on HIV/AIDS in
Gambella town, Western Ethiopia, indicated only 4.5% of the participants reported that
they did not heard of HIV/AIDS. The commonly Reported ways of transmission were
unprotected sex (79.8%) and unsafe blood transfusion (64.2%) and less than 1%
reported that they know that HIV transmitted from mother to child [18].

9
Ethiopian demographic and health survey (EDHS) revealed that from 919 women in
Tigray, 97% of women have heard of AIDS and 86.5% believes there is a way to avoid
HIV/AIDS. [19].
The prevalence of HIV/AIDS in Tigray in 2005 estimated to be 4.7% and 5.7% among
pregnant mothers. More than 1230 under treatment in Mekelle hospital, 340 in kahsay
Abera hospital humera, 138 in St.Mary hospital Axum and 62 in Adigrat hospital. This
gives us about 10% of those who need treatment having free access to treatment with
ARV [20].
Disclosure of HIV positive result to a partner can make it easier for a woman to access
the complete package of PMTCT services and follow programme recommendations.
However in a Nairobi study, Kenyan, respondents were asked about disclosure of their
HIV status to their partner. Their experience was negative as it brought about partner
abuse and break up of their relation ship on disclosing the results. In the same study,
89% of HIV positive women were less likely to disclose to the someone. HIV positive
women were less likely to disclose their test results than HIV negative women were
(69% and 92% respectively) [21].

10
2. OBJECTIVES
2.1 General objective:
To assess the knowledge, attitude and practice of prevention of mother to child
transmission of HIV/AIDS among pregnant women who attend antenatal care services.
2.2 specific objectives:
2.2.1 To describe socio-demographic and other factors associated PMTCT.

2.2.2 To assess the knowledge, attitude and practice towards PMTCT among pregnant
women.

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3. METHODES
3.1 STUDY DESING
A cross sectional study design using quantitative method will be used to assess the knowledge,
attitude and practice of antenatal mothers towards PMTCT in mothers attending ANC in health
services found in Adigrat District.
3.2 STUDY AREA
The study will be conducted in Adigrat district 903 k.m north of Addis Ababa; in Tigray
administrative region. The district covers an area of 549.66 Km 2 with a total population of
about 192,186 with (98,014 females & 94,172 males). In Adigrat district there are one hospital,
three health centre and sixteen health post [22]. In 2006, the health service coverage of the
study area was 68% and the antenatal coverage 86%. A total of 2490 pregnant women visited
antenatal care clinics in the same year. There are six VCT and four PMTCT centers. There are
three health institutions starting antiretroviral therapy (ART) for HIV/AIDS patients and four
ART for PMTCT (in one hospital and three health centers) in the study area [23].
3.3 STUDY POPUATION
The study subjects will be pregnant women attending the health institution for ANC for
their current pregnancy.
Inclusion criteria
Pregnant women attending Antenatal care service and volunteer for interview.
Exclusion criteria
Any pregnant women who is involuntary (inability to communicate) for interview.
3.4 SAMPLE SIZE AND SAMPLING PROCEDURE
Sample size will be calculated using soft ware Epi-info stat calc. Sample size will be worked
out using the 70% proportion (70% of respondent for BSS 2002) in Tigray knew that an HIV
infected mothers can transmit the virus to her baby through breast-feeding (16).
To determine the sample size for this study, single population proportion formula will be used
the following assumption will be made to obtain the minimum sample size required for the
study [24].

12
Formula n = z2p (1-p)
d2
Where n = the required sample size
p = the estimated prevalence rate (0.7)
z (1-alpha) = the value of standard normal distribution corresponding to a
significant level of alpha. (1.96)
d = Margin of error (0.04)
The absolute precision was 4% and will 95% confidence interval. Since the study
population (N=2490) was less than 10,000, we reduced the sample size by calculating
n= (n/1+n/N). The calculated sample size will be 419. Non-response rate in this study
will be estimated to be 10% i.e. 42, and hence an overall sample size of 461 pregnant
women will be taken.
3.5 SAMPLING PROCEDURE
Selection of health institutions will be based on the number of clients they serve. We
assumed the usual trend of antenatal care client flow the health institutions does not
fluctuate for every month. Based on the number of customers who visited each health
institution of the last year, proportional distribution of samples will be carried out to
attain the required sample size. Finally, the determined sample for each health
institution will be achieve through exit interview for continued period until the
optimum level will be reached. Every antenatal care attendee will be approach to
participate and those who showed willingness will be interview.

13
Sampling frame for: - KAP of pregnant women towards PMTCT attends
antenatal care in, Adigrat District, Tigray.

Total number of antenatal visitors in the study area

Health institutions (n=2490)

ADIGRAT ADIGRAT BIZET MUGULAT

HOSPITAL Health Center Health Center Health Center
N = 56 n = 179 n = 83 n = 143

Proportionally 461 pregnant women

Will be interview

3.5 VARIABLES OF THE STUDY

Dependent variable
Knowledge about MTCT and PMTCT of HIV/AIDS
Attitudes towards VCT for PMTCT of HIV/AIDS
Practice towards VCT for PMTCT of HIV/AIDS
Independent variable
 Socio-demographic factors like age, ethnic group, religion, educational status,
occupation of pregnant women, marital status, monthly family income, number
of pregnancies, number of antenatal care visits and occupation of her
husband/partner.
 Risk perception of HIV.

14
3.6 OPERATIONAL DEFINTIONS
Knowledge: - information stored in the memory related to HIV/AIDS and prevention of
mother to child transmission.
Knowledgeable: - those study participants who scored points equal to and more than
80% items of 15 knowledge questions.
Not knowledgeable: - those study participants who scored less than 80% items of 15
knowledge questions.
Attitude: - Predisposition to respond in favorable or unfavorable manner towards
HIV/AIDS, VCT and PMTCT.
Good attitude to wards PMTCT: - When the respondent pregnant women who scored
points equal to and more than 80% items of reported accepting attitude to all of 6
prepared statement of favorable attitude towards PMTCT.
Negative attitude to wards PMTCT: - When the respondent pregnant women who
scored less than 80% items of reported NOT accepting attitude to all of 6 prepared
statement of favorable attitude towards PMTCT.
Practice: - do something repeatedly or habitually.
Good Practice:
Practice: -those study participants who scored points equal to and more than
80% items of 13 practice questions.
Not Good Practice:
Practice: - those study participants who scored less than 80% items of 13
practice questions.
Voluntary HIV testing: - a process of voluntary HIV is testing after informed consent.
MTCT: - transmission of HIV from an HIV infected women to her child during
pregnancy, childbirth or breast-feeding.
Antenatal care: - care of a pregnant women and her un born child or foetus before
delivery.
VCT: - is the process by which an individual undergoes counseling enabling him/her to
make an informed choice about being tested for HIV.
AIDS: - is commonly identified as cd4 cell count below 200/mm3 and /or certain
opportunistic conditions, common with advanced immune deficiency, are present.

15
Antiretroviral: - long-term use of antiretroviral drugs to treat maternal HIV/AIDS and
prevent PMTCT.
Prevalence: - the percentage of a population i.e. affected with a particular disease at a
given time.

3.7 Data Collection Procedures

The questionnaire will be consisted of the basic socio-demographic characteristics and
questions related to the knowledge, attitude and practice of the study population
towards PMTCT and the like.
Closed and open-ended questions will be developed in English and then translated to
local language (Tigrinya) and then back to English to check for its consistency. Eight
individuals who completed high-school data collectors will be trained for to days by the
principal investigator and two diplomas or above health professionals will be recruited
for supervising.
After the training, pretesting of the questionnaire will be undertaken in similar health
institution before the actual data collection took place and modifications will be done
accordingly.
Data collection will be done at one corner of the MCH unit after a women has
completed the antenatal follow up examination. The over all activity will be
coordinated by the principal investigator of the study.
3.8 Data processing and analysis
Quantitative data will be entered in to a computer using EPI info version 6 and SPSS
version 11. To assess quality of data entry the principal investigator will enter ten
percent of the data twice. Data will be cleaned during analysis. Data will be summarize
or transform into concise form for subsequent analysis. Analysis including frequencies,
percentages, odds ratio for categorical variables and adjusted odds ratio will be
computed when they are appropriate. P-values less than 0.05 will be considered
significant.

16
4. ETHICAL CONSIDERATIONS
Ethical clearance will be obtained from university of Gonder, research and publication
office. After getting ethical clearance, permission will be obtained from the Tigray
regional health bureau, Adigrat district health office and health institutions. The
purpose of the study explained for the study participants in order to get informed verbal
consent. A written consent form will be read to each respondent to obtain her
agreement (see annex--).
The study subjects will be told clearly about the benefits and harms of participating in
the study through a two-way communication. Consent of subjects will be secured
before the initiation of data collection and subjects are assure about the confidentiality
of the information they give. To maintain confidentiality of the names of subjects will
not be register on the questionnaire.
Information about the available services in the health institution will be offered in detail
for individual respondents if they inquired to know about it.

5. Dissemination Of Results
Results of the study will be submitted to the University of Gonder, College of Medicine
and health Sciences, school of public health, Tigray regional health bureau, Adigrat
District health office, Adigrat hospital and health centers and other organizations when
deemed necessary. The findings of this study will be presented in the annual Student
and staff scientific conference, Ethiopia public health association (EPHA), National and
Regional conferences and it will be published in reputable journals.

17
 6. WORK PLAN
October November
Phase Activities 1st 2nd 3rd 4th 5th 6th 7th 8th
Week Week Week Week Week Week Week Week
1 Submission of Final proposal X

2 Ethical clearance X

3 Securing fund for research X

Recruiting and training of data

4 X
collectors and supervisors

5 Pre-testing X

Revision and duplication of

6 X X
questionnaires

7 Data collection X

8 Data entry and cleaning X X

9 Data analysis X

10 Write up X X

11 Submission of draft report X

12 Submission of final report X

Note- X indicates week of month.

18
7. REFERENCE
1. UNAIDS. ReportontheglobalHIV/AIDSEpidemic. Geneva, 2006
http://www.unaids.org/en/HIV-data/2006GlobalReport/default.asp, Accessed 12
July 2006.
2. FHI. Reducing MTCT of HIV. http://www.fhi.org.accessed on 2006-05-03.
3. MOH. National Guideline on prevention of Mother-to-child Transmission of HIV in
Ethiopia, Nov 2001, Addis Ababa.
4. UNAIDS.“AIDSepidemicupdate”,2005. http://www.unauds.org./epi/2005/doc/EPI
update 2005-pdf-en/. accessed on 2006-05-03
5. FMOH. AIDS in Ethiopia, 6th report, FMOH /National HIV/AIDS Prevention and
control office, June 2006, Addis Ababa. Ethiopia.
6. UNAIDS. Prevention of HIV Transmission from Mother to child “Strategic option:,
1999, Geneva.
7. FDRE. Report on progress towards implementation of the declaration of
commitment on HIV/AIDS. HAPCO, February, 2006, Addis Ababa. Ethiopia.
8. De Cock Km et al. Prevention of mother to child HIV transmission in Resource
poor countries: translating research into policy and practice. Journal of the
American Medical Association, 2000, 283(9):1175-1182.
9. Dorenbaum A et al. Two-dose intrapartum/new born nevirapine and standard ART
therapy to reduce Perinatal HIV transmission a Randomized trial. Journal of
American Medical Association, 2002, 288(2):189-198.
10. Yogev R and Chadwick E G. acquired immune Deficiency syndrome, nelson text
book of pediatrics, 17th Edition: pp 1109-1112.
11. UNAIDS. Report on the global AIDS epidemics, July 2004, Geneva.
12. Maria Tallish and Anna Nilsson. Awareness, Attitude, and prevention of HIV
among pregnant women. No 14, 2002. Goteborg University, India.
13. Yi Kyoung Lee, Ms, Graces Marquis, Anna Lartey, Knowledge and attitude about
MTCT and prenatal VCT among Ghanaian pregnant women. No 17, 2003.
University of Ghana, Accra.

19
14. UNAIDS. HIV voluntary counseling and testing case study. UNAIDS June 2002.
Genera, Switzerland.
15. UNAIDS. The impact of VCT, A global review of the benefits and challenges, 2001
pp55, Geneva.
16. MOH and HAPCO. HIV/AIDS Behavioral Surveillance survey (BSS) Ethiopia,
2002, Addis Ababa.
17. Hailu.C. Assessment of knowledge attitude and practice among mothers: about
VCT and feeding of infants to HIV positive women in Jimma town: Addis Ababa
University Master thesis, 2005, Addis Ababa, Ethiopia.
18. Yayeh Negash, Betemaria Gebre, Dani Bential, Mebrahtu Bejiga. A community
vased study on knowledge attitude and practiced ON HIV/AIDS in Gambella town,
Western Ethiopia. Ethiop.j.Health Dev 2003; 17(3):202-213.
19. EDHS. Central statistical Agency Addis Ababa Ethiopia. November 2005.
20. TRHB. Regional Health profile of 2006. HMIS, Tigray.
21. Barakari.JP, MCKenna S, Myrick A, Mwinga K, Bhat GJ, Allen S. rapid VCT for
HIV acceptability and feasibility in Zambia antenatal care clients. Ann NY
Acad.Sci. Nov 2000; 918:67-76.
22. Eastern Zonal Health Bureau. Eastern zonal health profile of 2006. Adigrat, Tigray.
23. Adigrat District Health office. Annual report of 2006, Adigrat, Tigray.
24. Getu Da. Lecture note on Biostatistics for master of public Health. University of
Gonder, College of Medicine and Health Sciences, 2006.

20
 8. COST OF THE PROJECT
Qualification/ Duration of Total
S.no Description Quantity Rate/Birr
Unit work (in days) cost/Birr
I Personal cost
Data collector High school
1 8 35.00 8x15x35 4200.00
completed
2 Supervisor Diploma nurse 2 58.00 2x15x58 1740.00
Training of data collectors
High school 8x35birr/day
3 & Supervisors (including 10 2 days 792.00
completed/diploma +2x58birr/day
day of pre-testing)
Entertainment for 5birr/day
4 14 2 days 140.00
participants participants
5 Driver 1 58birr/day 15 days 870.00
Sub total 7742.00
II Equipment and supplies
1 Printing paper Pack 3 40.00 120.00
2 Duplicating paper Pack 6 30.00 180.00
3 Duplicating ink Tube 4 40.00 160.00
4 Stencil Rim 1 89.00 89.00
5 Note book Pieces 10 10.00 100.00
6 Pen Pieces 15 1.20 18.00
7 Pencil Pieces 20 0.30 6.00
8 Eraser Pieces 12 2.00 24.00
9 Sharper Pieces 12 2.00 24.00
10 Toner Pieces 1 800.00 800.00
11 Diskette Pieces 10 5.00 50.00
12 Bag Pieces 1 50.00 50.00
13 Clip board Pieces 10 20.00 200.00
14 Staples Pack 5 5.00 25.00
15 Binding ring Pieces 5 8.00 40.00
16 Binding cover Pieces 10 2.00 20.00
Sub total 1906.00
III Transport
1 Fuel Lit. 200lit. 5.85 birr/lit - 1170.00
Sub total 1170.00
IV Other
1 Communication & E-mail 220.00 220.00
Sub total 220.00
Grand total 11,038.00
v Contingency 5% 551.90
Total cost 11,589.90

21
9. ANNEXES
Annex I English Questionnaire
001 - Date ____/____/________
002 Questionnaire Identification Number ______________________
003 Name of Health institution ______________________________
004 ADIGRAT DISTRICT,
Introduction
Hello! My name is __________________. I am working as data collector in the survey
conducted by University of Gonder, College Medicine and Health Sciences, School of
public Health. We are interviewing pregnant women here about knowledge, attitude and
practice to wards prevention of mother to child transmission of HIV. This study is designed
to generate information for program expansion and designing strategies for PMTCT in the
District and else where with similar characteristics. To attain this purpose, your honest and
genuine participation by responding to the question prepared is very important.
Confidentiality and consent
We would like you to answer some personal questions. Your answers are completely
confidential. Your name will not be written on this form. The nurses, doctors and other
health workers will not be told what you have said in relation to your name. You can
refuses to answer a single question, to the extent to stop the interview at any step if you are
not comfortable. We appreciate your kindness to be part of the study. The interview will
take about 15-25 minutes. Are you willing to participate?
If the answer is Yes Continue
No Stop
Name of Data collector _______________________
Signature ______________________
Signature of the interviewee certified that respondent has given informed consent verbally.
Name of supervisor _______________________
Signature ______________________
Date ______________________

22
 Section I: Sociodemographic characteristics
Sr.No Question Coding categories Skip Code
101 How old are you? ____________ Years old
 Tigire 1
To which ethnic group/tribe do you  Amahara 2
102
belong?  Oromo 3
 Other 4
 Orthodox 1
 Muslim 2
103 What religion are you?  Catholic 3
 Protestant 4
 Other (specify) 5
 Yes 1 105
104 Hove you ever attended School?
 No 2
 Literate (read & write) 1
What is the highest level of school  Primary 2
105
you completed?  Secondary 3
 Tertiary (above 12) 4
 Government employee 1
 Private employee 2
106 What is your occupation?  Un employed 3
 Student 4
 Other 5
-------------------------- ETB.
107 Family income per month
 Single 1
 Married 2
If other than
108 Marital status  Separated 3
marries skip to 110
 Divorced 4
 Widowed 5
If married are you currently living  Yes 1
109
with your partner?  No 2
Number of pregnancy including the
110 -----------------------
current one?
The number of antenatal care visit
111 -----------------------
you made in the current pregnancy?
 Government employee 1
 Private employee 2
What is the profession of your
112  Merchant 3
husband?
 Un employee 4
 Other (specify) 5

23
 Section II: knowledge towards HIV, MTCT and PMTCT.
Sr.No Question Coding categories Skip Code
 Yes 1
Hove you ever heard of HIV or  No 2
201
disease called AIDS?  I don’t know 88
 No response 99
 Yes 1 203
Do you know how HIV is  No 2 204
202
transmitted?  I don’t know 88
 No response 99
 Sexual intercourse 1
If the answer is yes to question  Infected blood 2
number 202 mention the route of  By sharing sharps 3
203
transmission? (More than one  Mother to child 4
answer is possible)  Injection with unsterile needle 5
 Other (specify) 6
 Yes 1
 No 2
204 Can HIV/AIDS be Cured?
 I don’t know 88
 No response 99
 Yes 1
Can pregnant woman with HIV or
 No 2
205 AIDS transmit the virus to her
 I don’t know 88
Unborn baby?
 No response 99
 Yes 1
Can an HIV infected woman
 No 2
206 transmit to her child during
 I don’t know 88
pregnancy?
 No response 99

24
Sr.No Question Coding categories Skip Code
 Yes 1
Can an HIV infected woman
 No 2
207 transmit to her child during
 I don’t know 88
child birth?
 No response 99
Can a woman with HIV or  Yes 1
AIDS transmit the virus to her  No 2
208
new born child through breast  I don’t know 88
feeding?  No response 99
 Yes 1
If a woman is infected with the
 No 2
209 AIDS virus, is there any way to
 I don’t know 88
avoid transmission to the baby?
 No response 99
Do you know the existence of  Yes 1
intervention which reduce  No 2
210
mother to child transmission of  I don’t know 88
HIV?  No response 99
 Use antiretroviral drug 1
 A void breast feeding 2
What can a woman do to reduce
211  Other (specify) 3
transmission of the HIV virus?
 I don’t know 88
 No response 99
 Yes 1
Have you ever heard of
 No 2
212 voluntary HIV counseling and
 I don’t know 88
testing for PMTCT?
 No response 99
 Mass media (Radio, TV, etc) 1
What is the source of  Health work /health institution 2
213 information, if the answer is  Neighbours 3
yes?  School 4
 Other (specify) 5
 Yes 1
Do you think voluntary HIV
 No 2
214 counseling and testing is
 I don’t know 88
important for pregnant women?
 No response 99
 Mother alone 1
 Baby alone 2
To whom do you think that the
 Mother and baby 3
215 test is of benefited during
 Health workers 4
pregnancy?
 Other (specify) 5
 No response 99

25
 SECTION III: - Attitude to words PMTCT, VCT
Sr.No Question Coding categories Skip Code
 Yes 1 302
Do you think you can get  No 2 304
301
the virus?  I don’t know 88
 No response 99
 Very high 1
 High 2
What are your chances of  Moderate 3
302  Low 4
getting infected with HIV?
 Very low 5
 I don’t know 88
 No response 99
 I had multiple sexual partners 1
 I had sexual contact without condom 2
 I had injection with unsterile needle 3
If the answer is moderate or
303  I had sexual contact with HIV positive person 4
high, what are the reasons?
 Other (specify) 5
 I don’t know 88
 No response 99
 I trust my sexual partner 1
If your response is NO to  No injection with unsterile needle 2
304 question number (301), what  I always use condom 3
are the reasons?  I don’t know 88
 No response 99
Do you need to be tested if  Yes 1
 No 2
305 you know the existence of
 I don’t know 88
PMTCT intervention?  No response 99
 Male 1
Which sex is accepted to be
306  Female 2
a counselor for PMTCT?
 Both can be 3

26
 SECTION IV: - PRACTICE TOWARDS PMTCT, VCT.
Sr.No Question Coding categories Skip Code
I don’t want to know the result  Yes 1
401 but have you ever had
 No 2 410
voluntary counseling and
testing for PMTCT?
 To protect my child from HIV 1
What is the reason for testing?
 To protect my partner 2
If the answer to question  To know my status 3
402  To take necessary protective measure (future life) 4
number (401) is yes. (multiple
 Other (specify) 5
answers are allowed)  I don’t know 88
 No response 99
 With in ONE month 1
When did you have your most  With in TWO month 2
403  With in THREE month 3
recent HIV test?
 After THREE month 4
 I don’t remember 88
 Yes 1
Would you talk your partner
404  No 2
before having HIV test?
 No response 99
 Yes 1
Do you receive counseling  No 2
405
before testing?  I don’t know 88
 No response 99
 Yes 1
Were you satisfied with HIV
406  No 2
counseling you received?
 No response 99
Don’t tell me the result; do  Yes 1
 No 2
407 you know the result of your
 I don’t know 88
test?  No response 99
Would you tell your partner  Yes 1
 No 2
408 the test result of an HIV/AIDS
 I don’t know 88
test?  No response 99

27
Sr.No Question Coding categories Skip Code
Did you receive  Yes 1
409 counseling after getting  No 2
your result (post test  I don’t know 88
counseling)?  No response 99
By whom do you prefer to  Doctor 1
 Nurse /mid wifery 2
410 get voluntary counseling  Trained counselor 3
and testing?  HIV patient 4
 Other (specify) 5
 Face to face (verbally) 1
 Secretive letter 2
Which way do you prefer  Through relative/family 3
411  Through my partner 4
to obtain HIV test result?
 Through telephone 5
 Other (specify) 6
 No response 99
 Inability to deal with stress of being positive 1
What are some of the
 Fear of rejection by the community 2
reasons you think for  Fear of rejection by partner 3
412  Non respect of confidentiality 4
refusal of voluntary HIV
 Other (specify) 5
testing for PMTCT?  I don’t know 88
 No response 99

If you tell to your partner/husband what reaction do you expect?

412
Possible reaction Yes No I Do Not Know No Response
412.1 Insult me 1 2 88 99
412.2 Psychological harassment 1 2 88 99
412.3 Physical violence 1 2 88 99
412.4 Marriage disruption 1 2 88 99
412.5 Accept it as his problem 1 2 88 99
412.6 Stop financial support to me 1 2 88 99
412.7 Others 1 2 88 99

This is the end of our questionnaire thank you very much for taking your time to answer
those questions; I appreciate your cooperation.
cooperation

28
 Thank You!

Annex II Dummy tables

Section I Socio demographic characteristics.
Variables NO (%)
Age
15-19
20-24
25-29
30-34
35-39
40-44
45-50
Ethnic group
Tigray
Amahara
Oromo
Other
Religion
Orthodox
Muslim
Catholic
Protestant
Other
Attend school
Yes
No
School completed
Literate (read & write)
Primary
Secondary
Tertiary (above 12)
Occupation
Government employee
Private employee
Un employee
Student
Other

29
Family income  
< 200ETB.  
201-400 ETB.  
401-600 ETB.  
>601 ETB.  
Marital status  
Single  
Married  
Separated  
Divorced  
Widowed  
Currently living with your partner  
Yes  
No  
Number of pregnancy  
1  
2  
3  
4  
> 5  
Number of ANC visit  
First visit  
Two to three visits  
More than four visits  
Profession of your husband  
Government employee  
Private employee  
Merchant  
Un employee  
Other  

30
Section II: knowledge towards HIV, MTCT and PMTCT
Variables NO (%)
Ever heard of HIV/AIDS  
Yes  
No  
I don’t know  
No response  
Mode of HIV transmitted  
Yes  
No  
I don’t know  
No response  
Route of HIV transmission  
Sexual intercourse  
Infected blood  
By sharing sharps  
Mother to child  
Injection with un sterile needle  
Other (specify) __________  
HIV/AIDS be cured  
Yes  
No  
I don’t know  
No response  
Pregnant women with HIV/AIDS transmit the
virus to her un born baby  
Yes  
No  
I don’t know  
No response  
HIV infected woman transmit to her child
during pregnancy  
Yes  
No  
I don’t know  
No response
 

HIV infected woman transmit to her child

during child birth  
Yes  

31
No  
I don’t know  
No response  
HIV infected woman transmit to her child new
born child through breast feeding
 
Yes  
No  
I don’t know  
No response  
Woman infected with HIV/AIDS is there any
way to avoid transmission to the baby
 
Yes  
No  
I don’t know  
No response  
Existence of intervention which reduce MTCT
of HIV  
Yes  
No  
I don’t know  
No response  
What can a Woman do to reduce MTCT of
HIV  
Use ARV drug  
Avoid breast feeding  
Other  
I don’t know  
No response  

Have you ever heard of voluntary HIV

counseling and testing for PMTCT?
Yes  
No  
I don’t know  

32
No response  
What is the source of information, if the
answer is yes?
Mass media (Radio, TV, etc)
Health work /health institution
Neighbours
School
Other (specify)
Do you think voluntary HIV counseling
and testing is important for pregnant
women?
Yes  
No  
I don’t know  
No response  
To whom do you think that the test is of
benefited during pregnancy?
Mother alone
Baby alone
Mother and baby
Health workers
Other (specify)
No response

SECTION III: - Attitude to words PMTCT, VCT

Variables No (%)
 
Do you think you can get the virus  

33
 Yes  
No  
I don’t know
 
No response
   
Chance of getting infected with HIV    
Very high    
High    
Moderate    
Low    
Very Low    
I don’t know    
No response
   
What are the reasons for High or Moderate    
I had multiple sexual partners    
I had sexual contact without condom
   
I had injection with unsterile needle
   
I had sexual contact with HIV positive person
   
Other specify
   
I don’t know
   
No response
   
If your response is NO to question number (301), what are
thereasons?
I trust my sexual partner

No injection with unsterile needle

I always use condom

I don’t know
No response

Do you need to be tested if you know the existence of PMTCT

intervention?
Yes
No
I don’t know

34
No response
Which sex is accepted to be a counselor for PMTCT?
Male
Female
Both can be

SECTION IV: PRACTICE TOWARDS PMTCT, VCT.

Variables No (%)
I don’t want to know the result but have you ever had
voluntary counseling and testing for PMTCT?
Yes
No
What is the reason for testing? If the answer is yes.
To protect my child from HIV
To protect my partner
To know my status
To take necessary protective measure (future life)
Other (specify)
I don’t know
No response
When did you have your most recent HIV test?
With in ONE month
With in TWO month
With in THREE month
After THREE month
I don’t remember
Would you talk your partner before having HIV test?
Yes
No
No response
Do you receive counseling before testing?
Yes
No
I don’t know
No response
Were you satisfied with HIV counseling you received?
Yes
No
No response

35
Do you receive counseling before testing?
Yes
No
No response
Were you satisfied with HIV counseling you received?
Yes
No
No response
Don’t tell me the result; do you know the result of your
test?
Yes
No
No response
Would you tell your partner the test result of an
HIV/AIDS test?
Yes
No
No response
Did you receive counseling after getting your result
(post test counseling)?
Yes
No
No response
By whom do you prefer to get voluntary counseling and
testing?
Doctor
Nurse /mid wifery
Trained counselor
HIV patient
Other (specify)
Which way do you prefer to obtain HIV test result?
Face to face (verbally)
Secretive letter
Through relative/family
Through my partner
Through telephone
Other (specify)
No response
What are some of the reasons you think for refusal of
voluntary HIV testing for PMTCT?
Inability to deal with stress of being positive
Fear of rejection by the community

36
Fear of rejection by partner
Non respect of confidentiality
Other (specify)
I don’t know
No response

If you tell positive test to your partner/ husband

what reaction do you expect? (Possible reaction)

Insult me
Yes
No
I don’t know
No response
Psychological harassment
Yes
No
I don’t know
No response
Physical violence
Yes
No
I don’t know
No response
Marriage disruption
Yes
No
I don’t know
No response

Accept it as his problem

Yes
No
I don’t know
No response
Stop financial support to me
Yes
No
I don’t know
No response

Others

37
Yes
No
I don’t know
No response

38