BMC Nursing BioMed Central
ssResearch article Open Acce
Knowledge and behaviour of nurse/midwives in the prevention of 
vertical transmission of HIV in Owerri, Imo State, Nigeria: a 
cross-sectional study
Chizoma M Ndikom*1 and Adenike Onibokun2
Address: 1School of Occupational Health Nursing, University College Hospital, Ibadan, Oyo State, Nigeria and 2Department of Nursing, University 
of Ibadan, Oyo State, Nigeria
Email: Chizoma M Ndikom* - chizondikom2002@yahoo.com; Adenike Onibokun - nike1955@yahoo.com
* Corresponding author    
Published: 9 October 2007 Received: 7 February 2007
Accepted: 9 October 2007
BMC Nursing 2007, 6:9 doi:10.1186/1472-6955-6-9
This article is available from: http://www.biomedcentral.com/1472-6955/6/9
© 2007 Ndikom and Onibokun; licensee BioMed Central Ltd. 
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), 
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: Mother-to-Child Transmission (MTCT) of HIV remains the main mode of
acquisition of HIV in children. Transmission of HIV may occur during pregnancy, delivery or
breastfeeding. Studies have shown that some specific interventions help to reduce the transmission
of the virus to the baby. In order to target safe, rational and effective intervention to reduce MTCT
of HIV, it is necessary to ensure that the nurse/midwife has knowledge of the strategies for the
prevention of vertical transmission of HIV.
Method: The cross-sectional design was utilized to determine the knowledge and behaviour of
nurse/midwives in the prevention of vertical transmission of HIV in Owerri, Imo State, Nigeria. The
study sample consisted of 155 nurse/midwives drawn from three selected hospitals through
stratified random sampling method. Official permission was obtained from the institutions and
consent from participants. Data was collected through the use of a self administered questionnaire.
Information sought included respondents' demographic characteristics, knowledge about and
behaviour of prevention of vertical transmission as well as factors influencing behaviour.
Results: Findings revealed that nurse/midwives had moderate level of knowledge with mean score
of 51.4%. The mean score on behaviour was 52.5%, major factors that influence behaviour in these
settings were mainly fear of getting infected, irregular supply of resources like gloves, goggles, sharp
boxes, and water supply was not regular also. Hypotheses tested revealed that there is a positive
relationship between knowledge and behaviour (r = 0.583, p = 0.00). Knowledge level of nurse/
midwives who had educational exposure was not different from those who did not (t = 1.439, p =
0.152). There was a significant difference in the knowledge of nurse/midwives who had experience
in managing pregnant women living with HIV/AIDS and those who did not (t = 2.142, p = 0.03).
Also, there was a significant relationship between behaviour and availability of resources (r = 0.318,
p = 0.000).
Conclusion: The study revealed that the nurse/midwives though moderately knowledgeable still
had gaps in certain areas. Their behaviours were fairly appropriate. There is need for improved
knowledge through structured educational intervention. Resources needed for practice should
always be made available and the environment should be much more conducive for practice.
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BMC Nursing 2007, 6:9 http://www.biomedcentral.com/1472-6955/6/9Background of information acquired by the nurse/midwife in relation
Vertical transmission remains the main mode of acquisi- to vertical transmission of HIV/AIDS. On the other hand
tion of HIV infection in children. A total of 700,000 chil- Practice refers to direct goal oriented actions taken by the
dren were newly infected in 2003, mainly through nurse/midwife in order to prevent the transmission of
mother-to-child transmission of HIV [1]. Transmission is HIV from mother to child in the course of her professional
rare during early pregnancy and relatively frequent in late duty as a nurse. Behaviour operationally refers to, the
pregnancy [2]. According to Musoke and Mmiro [3], "the actions or reactions of the nurse/midwife, usually in rela-
number of children living with HIV infection is estimated tion to HIV/AIDS prevention and the working environ-
at 13 million with 33.8 million deaths since the epidemic ment. Issues relating to HIV/AIDS have generated a lot of
began, each year, approximately 2.4 million infected fear in the mind of health workers especially nurses and
women give birth and 1800 infants acquire HIV infection midwives. Some act inappropriately towards HIV seropos-
every day". WHO [4], stated that "without preventive itive clients. This makes one wonder if they had adequate
treatment, up to 40% of children born to HIV-positive knowledge about mode of transmission of HIV and ade-
women will be infected, majority through MTCT". It is quate knowledge and skill to prevent it. Some studies had
believed that the two-thirds are infected during and already been carried out to determine nurse/midwives
around time of delivery and one-third are infected knowledge.
through breastfeeding." Newell [2], opined, "risk factors
of vertical transmission include maternal progression of Study by Grellier, on midwives' knowledge of HIV virus
infection, measured as the peripheral blood viral load, or and its implication for their attitude and practice revealed
by clinical immunological markers". Premature infants that, "though training may provide midwives with techni-
are more likely to be infected than full term infants and cal knowledge, it does not necessarily equip them to deal
the risk increases with the duration of membrane rupture. with many of the underlying issues, which in turn reflect
on midwifery practice, It is important for practical knowl-
Thus, there is need for more effort to be made to prevent edge to be placed within a broader context" [8]. On the
transmission of HIV in order to ensure their survival. New other hand, a study carried out in Lagos State, Nigeria on
survey underscores the disproportionate impact of the attitudes of health care providers to persons living with
AIDS epidemic on women especially in Africa [5]. In HIV/AIDS by Adebajo, Bamgbala and Oyediran, revealed
2005, estimated 38.6 million people worldwide were liv- that "most of the respondents (96.3%) had moderate to
ing with HIV [6]. 24.5 million were in Sub-Saharan good knowledge of HIV/AIDS but the attitude of the
Africa[5]. Nigeria had 2,900,000 people living with HIV, nurses towards people living with HIV/AIDS was poor"
out of which 1,600,000 were women aged more than 15 [9]. Also findings from a study carried out by Mbanga,
years, 240,000 were children aged less than 15 years, Sebade, Kegne, Minkuolau and Awah, to assess knowl-
while 1,000,000 were men [7]. The rate of new infections edge and practices of nurses with regards to HIV/AIDS
will also affect the rate of heterosexual transmission and revealed that 70.1% of the nurses who responded scored
transmission from mother-to-child. highly in the knowledge section compared to 50.5% in
the attitude and practice section [10].
As the number of children infected during the HIV epi-
demic increase, the nurse/midwife has an important role These studies indicate that knowledge of HIV/AIDS has
to play in ensuring that mother-to-child transmission is improved to some extent, though their knowledge did not
reduced to the least possible level. The prevention of correlate with their attitude and behaviours. The nurse/
mother-to-child transmission of HIV could be reduced midwife has a vital role to play in the achievement of the
most effectively if all available intervention approaches millennium goals of reduction of child mortality, improv-
were considered. The major approaches for prevention ing maternal health and combating HIV/AIDS [11]. The
include, primary prevention of infection among parents nurse/midwives are open systems that receive input, proc-
to be, preventing unwanted pregnancy among women liv- ess them to give output, and the feedback returns to her as
ing with HIV and preventing transmission from HIV-pos- input [12]. Systems theory is one method of conceptualis-
itive women to their offspring, then providing care for ing the relationship of individuals, their environment and
HIV-infected mothers and their infants [4]. health (Sherwen, Scoloveno and Weignerten, 13). The
theory provides a way to understand the many influences
The nurse/midwives' knowledge of HIV is important on the nurse/midwife, and the possible impact of change
because it is the basis on which positive changes in behav- of any part on the whole. On the other hand Role theory
iour occur because it brings awareness, which in turn leads explains behaviour in terms of the roles, role expectation
to action. Knowledge, training and experience in every and demand, role set and reference group operating on
aspect of one's profession are very important. Knowledge the participants in the set of behaviours or function asso-
is operationally defined in the study as the level or degree ciated with particular position within a particular social
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BMC Nursing 2007, 6:9 http://www.biomedcentral.com/1472-6955/6/9context (Wightman and Deux, 14). The nurse/midwife is The target population comprised of all registered nurse/
expected to put her knowledge into practice when she per- midwives in Imo state. The study population includes all
ceives the importance of her role in reducing MTCT of nurse/midwives in the selected units in Federal Medical
HIV. Centre Owerri, General Hospital Owerri and Holy Rosary
Hospital, Emekuku-Owerri. The total number of these
Many tertiary institutions like Federal Medical Centre, nurse/midwives in the units was 310.
Owerri have developed formal pattern of incorporating
Voluntary Confidential Counselling and Test (VCCT) into The sampling technique employed was the stratified ran-
the antenatal services. Effort has been made to train nurse/ dom sampling technique. The selected hospitals formed
midwives but not all have had this training. Many second- the first stratum. The cadres formed the second stratum to
ary and primary health institutions in Nigeria are yet to ensure that every group is represented. A sample of 155
commence this training programme. In some of these Nurse/Midwives was selected using stratified random
institutions, women do not always receive voluntary con- sampling. Since the sampling population was not very
fidential counselling before HIV test. Many are stigma- large, 50% of respondents from each setting and each
tised after the test, if found positive. There is need to cadre were selected. They were selected from all the wards
explore reasons for this. Nurse/Midwives have a lot of role in the obstetric and gynaecology and paediatric units of
to play in prevention of vertical transmission of HIV, thus, the three selected hospitals. This gave rise to 65 from FMC
there is need to assess their current state of knowledge and Owerri, 55 from GH Owerri and 35 from Holy Rosary
behaviour. The main aim of the study was to determine hospital Emekuku. The total sample was 155 Nurse/Mid-
the knowledge and behaviour of nurse/midwives in the wives. The sample size was inflated by 10% to accommo-
prevention of vertical transmission of HIV in selected hos- date refusal and incompletely filled questionnaires and
pitals in Owerri, Imo State. those that may not meet the criterion.
Methods Tabular presentation of participants
The study utilised a cross-sectional design to elicit infor- Total no of personnel: 310
mation on knowledge and behaviour of nurse/midwives
in the prevention of vertical transmission HIV. 155 nurse/ The randomized no: 180
midwives were drawn from three selected hospitals
namely Federal Medical Centre (FMC), General Hospital The total no of respondents: 155
(GH), Holy Rosary Hospital (HRH), all in Owerri, who
have worked for a year in maternity and paediatric units The no of personnel who refused: 25
of the hospitals using stratified random sampling
method. All cadres were represented. About 50% of The final number as a percentage of total personnel: 50%
respondents from each setting were selected for represent-
ativeness. The instrument for data collection was a self adminis-
tered questionnaire developed by the researcher from
The settings were in Owerri, the capital of Imo state. It is reviewed literature. Information sought included
in the South East geopolitical zone of Nigeria. The mater- respondents' demographic characteristics, knowledge
nity and paediatric units consist of the following: Antena- about and behaviour of vertical transmission of HIV pre-
tal Clinic, Prenatal Ward, Gynaecology Ward, Labour vention, as well as factors that influence behaviour. The
Room, Postnatal Ward, Paediatrics Wards. The Federal tool was divided into four sections.
Medical Centre was founded in 1995. The total number of
nurse/midwives in the Obstetrics and gynaecology and Section A contained the demographic variables of the sub-
paediatric units in FMC was 130. General hospital Owerri jects and consists of ten items.
was founded in 1902. There were 111 working in the
maternity and paediatric units. Holy Rosary Hospital Section B consisted of items on knowledge of vertical
Emekuku was established in 1933 by Catholic missionar- transmission of HIV. There were twenty items. Thirteen
ies. There were 69 nurses in the maternity and paediatric items utilised Yes or No response, six utilised multiple
unit. Purposive sampling of three hospitals in Owerri was choice options and one was open ended question which
done. These hospitals have all the cadres of nurses work- dealt with full meaning of HIV.
ing in them and are utilised by the populace. They were
the three largest hospitals in the town that serve as referral Section C composed of items on behaviour of prevention
hospitals for others. Thus, they were found suitable for the of mother-to-child transmission of HIV. There were ten
study. major items used to elicit level of behaviour of prevention
of HIV vertical transmission by nurse/midwives in Owerri.
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BMC Nursing 2007, 6:9 http://www.biomedcentral.com/1472-6955/6/9Likert's three point scale option, that is always, some- The selected respondents were given the questionnaire,
times, never was used in 5 questions; Yes or No response trained research assistants helped in the distribution of
was used for 5 items. questionnaires. A period of one month was used for dis-
tribution and retrieval of the questionnaires.
Section D contained items on factors that influence
behaviour of mother to child transmission of HIV preven- Procedure for data analysis
tion. The section contained ten questions and had Yes or Filled questionnaires were analysed using Statistical Pack-
No or don't know responses. age for Social Sciences (SPSS) software. Descriptive statis-
tics were presented as graphs and tables to show frequency
The maximum point for a positive response was 3 while distribution of scores as well as their percentages. Cross
the negative response score was 1. There were a total of 50 tabulations and chi square statistics were used to deter-
items. mine the relationship between behaviour and demo-
graphic variables since they formed categories. The items
Validity of instrument on knowledge and behaviour were coded and scores were
The instrument was presented to other experts in this field given. Coded scores of 1 to 3 were used and were later
of study and was modified where necessary. The instru- converted to percentages. The scale of measurement was
ment was pre-tested before final data collection. interval as there was no 0 point. Thus Pearson Correlation
and students't-test were found suitable for the statistical
Reliability analysis. Four null hypotheses were stated at the com-
Test re-test of the research instrument was done before the mencement of the study and they were tested using Pear-
actual administration of the questionnaire for reliability. son Correlation to measure relationships while student t
The test-retest at a three week interval period yielded a test was used to compare the differences between two
Pearson correlation coefficient of 0.81. The test confirmed means.
that the instrument was suitable for the study.
Results
Ethical consideration Demographic characteristics of respondents
An introductory letter from the Department of Nursing, The study was carried out in Owerri with 155 respond-
University of Ibadan and an application letter for permis- ents, 65 (42%) were from FMC, 55 (35%) were from GH
sion, stating the nature of study was presented to the hos- and 35 (23%) were from HRH. Majority (24%) of the
pital authorities in the selected setting in order to obtain respondents had a mean age of 37.3 years and were mar-
permission. ried (76.8%), with diploma as their highest educational
qualification (81%). Also, they were mainly registered
The letters were then presented to their ethical committees nurse/midwives only (84%) and had 14.5 years as mean
who reviewed the research instrument before a written post qualification experience (27.7%) and 5 years as
permission was given. mean of their experience in obstetrics and gynaecology
unit; their first source of information on HIV/AIDS was
Consent of participants was sought and their right to par- workshops/seminars (60.3%), 41% received lectures on
ticipate or not to participate was respected. They were HIV as students while 42.2% have ever managed pregnant
informed that they had the right to withdraw from the women living with HIV as presented on table 1.
exercise if they wish to. The questionnaire also had an
informed consent form on the front page which they had Respondents' knowledge of vertical transmission of HIV
to sign first before filling the questionnaire. Majority (91%) of respondents were aware of vertical
transmission of HIV. Also, majority (67%) had knowl-
Procedure for data collection edge of the full meaning of HIV. Majority (89%) identi-
The data was collected by the researcher with the assist- fied the class of the virus as retrovirus, and had affinity for
ance of ward managers and research assistants. The ques- CD4 receptors (78.7%). On the other hand, (36.8%) of
tionnaire was given to the respondents to fill after the respondents could not correctly identify reverse tran-
obtaining informed consent. The respondents were scriptase as the enzyme used to copy RNA to DNA. Also,
assured of anonymity and confidentiality of information. (45.8%) of the respondents did not know the normal
The first stage of data collection was to compile the list of CD4 count. Only 19% of the respondents identified the
all the nurses on the wards in the maternity and children's confirmatory test as western blot as seen on table 2.
ward. Stratified random sampling method was used to
select respondents. The respondents demonstrated knowledge of strategies
for prevention of HIV as they agreed on the use of antiret-
roviral drugs (60%), exclusive formula feeding (58.7%),
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BMC Nursing 2007, 6:9 http://www.biomedcentral.com/1472-6955/6/9Table 1: Demographic characteristic of respondents
Variable frequency (%)  mean (SD)
Age(years) 37.3(8.7)
Marital status married 119(76.8)
Professional qualification RNM only 130(84)
RNMPH 16(10)
RNM others 9(6)
Educational qualification Diploma 125(81)
Designation Nursing Officer 46(29.7)
Post qualification years of experience (years) 14.5(9.3)
Year of experience in maternity unit(years) 05(6.6)
First source of information on HIV Workshop/Seminar 85(60.3)
Received lecture as a student on HIV 64(41.0)
Managed a pregnant woman living with HIV 67(42.2)
voluntary counselling and testing (58.7%), caesarean sec- with behaviour on tables 4 and 5. Majority (47%) had
tion option (52.3%). Also, 88.4% of respondents agreed moderate score on behaviour while 35.5% had low score
that universal precautions should be used with all the on behaviour. Mean score on behaviour was 52.5%.
patients, at all times regardless of diagnosis. Mean score
on knowledge was 51.4%. Majority of the respondents Factors that influence behaviour of MTCT of HIV 
(51%) had moderate level of knowledge that is between prevention
48 and 59 while 34.2% had low level of knowledge that is The study revealed that 36.1% agreed that time constraint
47 and below as measured by this knowledge test. did influence their behaviour. Other factors include will-
ingness of women to be tested (80.6%), confidence in
Respondents' behaviour of MTCT prevention strategies educating clients (90.3%), fear of contagion experience
Majority of the respondents, 78.1% always educate while caring of pregnant women living with HIV (76.8%),
women on HIV/AIDS, only (37.4%) offer VCT to clients, resources needed like gloves were not always available
while 76.8% always counsel women on safe infant feed- (62.6%), water supply not regular (43.9%), support from
ing practices and majority (81.3%) use aprons, gloves and clients' husband (45.8%) and support from professional
masks during delivery as seen on Table 3. colleagues (80%) – Table 5. Other resources like goggles
were not available in some hospitals; sharp boxes were
Generally, behaviour was seen as fairly appropriate. Cross not available in the institutions at the time of the study.
tabulations showed that age and post qualification years
of experience of respondents had significant relationship
Table 2: Individual items and respective scores assessing knowledge of HIV with percentage of correct responses
Items Correct answer Score Frequency (%)
Name of the virus Human Immunodeficiency Virus 3 44(28.4)
Class of virus Retrovirus 3 138(89)
Virus affinity CD4 receptors 3 122(78.7)
Enzyme used to copy RNA to DNA Reverse transcriptase 3 41(26.5)
Normal CD4 count 500 – 1200 cells/mm 3 64(41.3)
Drug commonly use in PMTCT Nevirapine 3 98(63.2)
Risk factors in MTCT:
Artificial rupture of membranes yes 3 57(36.8)
Caesarean section no 3 40(25.8)
Perineal trauma yes 3 89(57.4)
Vaginal delivery yes 3 92(59.4)
Strategies for PMTCT:
Use of antiretroviral drugs yes 3 93(60)
Exclusive formula feeding yes 3 91(58.7)
Voluntary counselling and testing yes 3 91(58.7)
Caesarean section option yes 3 81(52.3)
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BMC Nursing 2007, 6:9 http://www.biomedcentral.com/1472-6955/6/9Table 3: Respondents' behaviour of MTCT prevention strategies
Item Positive response Score Frequency (%)
How often do you educate women on HIV/AIDS? always 3 121 (78.1)
How often do you offer voluntary counselling and testing (VCT) to pregnant women? always 3 58 (37.4)
How often do you obtain consent before testing? always 3 87(56.1)
Are the regnant women usually Counselled with their husbands? always 3 55(35.5)
How often are women counselled on safe infant feeding? always 3 119(76.8)
Do you use aprons, gloves and masks during delivery? yes 3 126(81.3)
Do you encourage mothers living HIV to feed baby exclusively with formula? yes 3 139(89.7)
Do you gloves when checking soiled sanitary pad? yes 3 147(94.4)
In case of accidental exposure to contaminant during Delivery :
Do you wash under running water? yes 3 126(81.3)
Do you report the incident? yes 3 131(84.5)
Hypotheses testing added to nursing curriculum in the 1990s, thus informa-
Tables 6, 7, 8, to 9 showed the results of tested the tion on HIV was passed on mainly through seminars and
Hypotheses. The first Hypothesis showed a significant workshops. This was supported by UNAIDS, report on a
relationship between knowledge and behaviour of pre- study carried out in University of Witwatersrand in South
vention of vertical transmission of HIV among the Africa, which revealed that many nurses qualified before
respondents (r = 0.538, p = 0.000). The second showed HIV/AIDS was in the curriculum [16]. Despite this, the
that there is no significant difference between the knowl- study revealed that a significant proportion of the
edge of respondents that had educational exposure on respondents had moderate level of knowledge as meas-
HIV and those who did not (t = 1.439, p = 0.152). ured by the knowledge test with mean score of 51.4%.
Hypothesis three showed a significant difference between However, there existed many gaps in the knowledge of
the level of knowledge of those who had experience in the HIV as over 50% of respondents could not correctly
care of pregnant women living with HIV and those who answer the items on pathophysiology, diagnostic tests,
did not (t = -2.142, p = 0.03). Availability of resources for and factors that influence vertical transmission. In line
HIV prevention had a significant relationship with behav- with this finding, Adebajo et al [9], noted from a study of
iour as seen in the result of the fourth hypothesis (r = nurses in Lagos State, that "significant proportion, 96.5%
0.318, p = 0.003), Table 10. of the respondents had appreciable (moderate to high)
scores, however, in spite of this, there existed many gaps
Discussion in their knowledge of HIV, they had many misconcep-
The general objective of this study was to examine the tions regarding how HIV/AIDS can be transmitted". The
knowledge and behaviour of prevention of vertical trans- result is consistent with the study carried out by Mbanga
mission among nurse/midwives and to determine if their et al [10], to assess knowledge and practice of nurses in
behaviour is related to knowledge or influenced by other regard to HIV/AIDS in Cameroon which revealed that
factors. It is interesting to note that they are aware of ver- 70% of the nurses scored highly on the knowledge of HIV.
tical transmission of HIV and majority (60.3%) became
aware through workshop/seminar attendance for the first The hypothesis on knowledge and educational exposure
time and only 41% received lectures as students. HIV/ (t = -1.439, p = 0.152) showed that there is no significant
AIDS as a disease was documented in the 1980s and was difference between those that had educational exposure
Table 4: Relationship between demographic variables and behaviour Chi-square test of relationship between respondents' age and 
behaviour only
Age
Behaviour 20–25 26–30 31–35 36–40 41–45 46–50 50+ Total χ2 P < 0.05
≤ 47 4 10 3 8 15 9 6 55 244.65 0.002
48–59 5 18 6 15 18 8 3 73
≥ 60 3 10 3 5 3 1 2 27
Total 12 38 12 28 36 18 11 155
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Table 5: Chi-square test of relationship between respondents' years of post qualification experience and behaviour
Years of post qualification experience
Behaviour 1–5 6–10 11–15 16–20 21–25 26–30 30+ Total χ2 P < 0.05
≤ 47% 15 6 3 6 11 13 1 55 192.36 0.005
48 – 59% 19 6 14 18 9 6 1 73
≥ 60 9 7 2 1 3 5 - 27
Total 43 19 25 23 24 24 2 155
Table 6: Respondents' opinion on factors that influence behaviour
Factors Yes
Are the women willing to be tested in your hospital? 125 (80.6%)
Are you sometimes unable to give care desired because of time constraint? 56 (36.1%)
Do you feel confident educating clients on issues relating to HIV/AIDS? 140 (90.3%)
Do you experience fear of contagion when caring for pregnant women living with HIV? 119 (76.8%)
Do you receive regular supply of gloves in your unit? 97 (62.6%)
Do you have regular supply of water in your unit? 68 (43.9%)
Are the clients' husbands willing to give support to their wives during treatment? 71 (45.8%)
Do other professional colleagues give their support? 124 (80.0%)
Table 7: Hypothesis 1. Relationship between knowledge and 
behaviour
Variables N Mean r P < 0.05 Remark
Knowledge 155 51.4 0.00 Significant
Behaviour 155 52.5 0.538
Table 8: Hypothesis 2. Knowledge and exposure to information on HIV
95% confidence interval of the difference
Seminar/workshop N Mean SD Lower Upper t df P < 0.05 Remark
Knowledge Yes 85 51.7 6.28 -3.23 0.51 -1.439 150 0.152 Not significant
No 70 50.4 5.32
Table 9: Hypothesis 3. Knowledge and experience of managing pregnant women living with HIV
95% confidence interval of the difference
Ever Managed a N Mean SD Lower Upper t df P < 0.05 Remark
pregnant woman
Knowledge Yes 64 52.6 5.60 -3.23 0.51 -2.142 150 0.03 significant
No 88 49.3 5.84
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BMC Nursing 2007, 6:9 http://www.biomedcentral.com/1472-6955/6/9Table 10: Hypothesis 4. Behaviour and availability of resources contributes to stigmatization and negative attitude. The
fear of being infected at workplace, educational institu-
Variables N r P < 0.05 Remark
tions and in community has led to irrational discrimina-
Behaviour 155 0.318 0.00 Significant tory treatment of people living with HIV/AIDS [9].
Resources 155
The researcher observed that the nurses found it difficult
to practice in some cases due to insufficient supply of
through workshop and seminar and those who did not. gloves, which makes the use of a pair of gloves longer than
The findings were supported by Bennet and Weale [17] necessary. Also, face masks, goggles, sharp boxes were not
which revealed that "awareness training programme did always available. Every institution is required to have gog-
not make any significant difference in the knowledge and gles and sharp boxes, but these were conspicuously absent
attitude between those that attended the programme and in some of the institutions, even gloves were not supplied
those who did not". They suggested the need to review in large quantities, which made the practitioners to re-use
HIV related training for midwives. The hypothesis on dif- gloves. Water supply was not regular. The nurse/midwife
ference between knowledge of those who had experience continues to practice in fear since she cannot protect her-
in the management of pregnant women living with HIV self adequately. Needles were being recapped since there
and those who did not (t = -2.142, p = 0.03) on table 9 were no sharp boxes. Thus the practice of prevention of
showed a significant difference in their level of knowl- vertical transmission is being influenced by limited sup-
edge. This shows that majority acquired their knowledge ply of resources. Standard for infection control has to be
when they managed such clients. The experience of man- met for behaviour to be appropriate.
aging the clients enabled them to understand the condi-
tion better. Clinical experience is still very important in Conclusion
nursing as experience had lasting impact on the knowl- The study revealed that the Participants answered approx-
edge of the nurse/midwives. imately 50% of the items correctly on the HIV knowledge
test. Knowledge was acquired as an input from the envi-
The relationship between knowledge and behaviour was ronment, through lectures, workshops, seminars and
tested as hypothesis 1 using Pearson correlation, on table experience. Major factors that influenced behaviour in
7, revealed a significant positive relationship (r = 0.538, p these settings were mainly fear of contagion, irregular sup-
= 0.000). This indicates that there is a strong positive rela- ply of resources like gloves, goggles, sharp boxes and
tionship between knowledge and behaviour. Training water. The practice of VCT was not very good as only
improved midwives knowledge and this in turn improved 56.1% of respondents reported that they always obtained
their understanding of HIV testing policy and offering of consent before VCT. This is not a very good practice
testing to all pregnant women [18]. Though many factors because testing women without their permission is
could make a difference between what is known and what unethical. Also fear of contagion results in stigmatization.
is done [10], yet the respondents with higher level of
knowledge also scored better in area of behaviour since Correct input in the right environment will ensure correct
one cannot carry out what she does not know. output and effective behaviour. Thus, it can be deduced
that the nurse/midwives were partially effective in the
A significant positive relationship existed between availa- practice of prevention of vertical transmission of HIV,
bility of resources and behaviour of nurse/midwives in since they had moderate level of knowledge and resources
vertical transmission prevention (r = 0.318, p = 0.00), for role performance were not always available. There is
Table 10. The respondents were sometimes unable to need for improved knowledge through structured educa-
practice what they knew because what they require for tional intervention. Resources needed for practice should
practice was not available. This was supported by cham- always be made available and the environment should be
bers et al [19], as they discovered that, "multiple reasons made more conducive for practice. More elaborate studies
were offered for current practice, including perceived should be carried out in this field in other parts of Nigeria
reluctance by women to be tested, lack of time, skills, in order to ensure improvement in knowledge and behav-
knowledge and support services". The study revealed that iour.
majority – 119 (76.8%) experience fear when rendering
care, 81 (52.3%) said supply of water was not regular. Abbreviations
These two factors could also negatively affect behaviour. AIDS: Acquired Immune Deficiency Syndrome.
Fear of contagion was a major factor affecting behaviour.
The nurses feel their life is at risk and the resources needed DNA: Deoxyribonucleic acid
to protect themselves were not always available. Fear is the
most obvious factor influencing behaviour negatively. It FMC: Federal Medical Centre
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BMC Nursing 2007, 6:9 http://www.biomedcentral.com/1472-6955/6/9FMOH: Federal Ministry of Health vider know about human immune deficiency virus/acquired
immune deficiency syndrome.  International Nursing Review 2001,
48(4):241-249.
GH: General Hospital 11. United Nations: Millennium Development Goals.  Status 2004
[http://www.un.org/]. United Nations Department for Public Informa-
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and practice.  Orland: Grune and Stratton Inc; 1983. 
HRH: Holy Rosary Hospital 13. Sherwen LN, Scoloveno MA, Weingerten CT: Nursing Care of the
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14. Wrightman LS, Deux K: Social Psychology in the 80s.  3rd edition.
MTCT: Mother-to-Child transmission California Brooks/Cole Publishing Company; 1981. 
15. Webber RA: Management: Basic elements of managing
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RNA: Ribonucleic acid 16. UNAIDS: Nursing and Midwifery Champions in HIV/AIDS
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UN: United Nation of short training programme for Midwives.  Journal of Advanced
Nursing 1997, 26(2):273-282.
VCCT: Voluntary Confidential Counselling and Testing 18. Kaufman T: Feedback on HIV Antenatal Testing.  RCM MidwivesJournal 2001, 4(7):216-217.
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WHO: World Health Organisation
Pre-publication history
Competing interests The pre-publication history for this paper can be accessed
The author(s) declared that they have no competing inter- here:
ests.
http://www.biomedcentral.com/1472-6955/6/9/prepub
Authors' contributions
CN did the study under the supervision of AO. Both
authors have read and approved the final version of the
manuscript.
Acknowledgements
We wish to acknowledge the support and contributions of Dr Abimbola 
Oluwatosin, Department of Nursing, University of Ibadan,. Also, Dr O. 
Olaomi of Department of Statistics, University of Ibadan, who did the sta-
tistical analysis and Dr B. Brown of the Department of Paediatrics, Univer-
sity of Ibadan Oyo State. Nigeria.
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