Public Health of Indonesia
E-ISSN: 2477-1570 | P-ISSN: 2528-1542
Original Research Factors associated with knowledge of mother-to-child transmission (MTCT) of HIV/AIDS among young adults in Indonesia: Analysis of IYARHS Maretalinia1* .
Erni Buston2.
Marlynda Happy Nurmalita Sari3.
Tating Nuraeni4.
Ni Komang Sulyastini5, and Siti Sholihat6 1 PhD Program in Demography.
Institute for Population and Social Research.
Mahidol University.
Thailand 2 Program Study of Nursing.
Health Polytechnic of Ministry of Health Bengkulu.
Indonesia 3 Program Study of Midwifery.
Health Polytechnic of Ministry of Health Semarang.
Indonesia 4 Department of Public Health.
Faculty of Public Health.
Universitas Wiralodra.
Indramayu.
Indonesia 5 Program Study of Midwifery.
Faculty of Medicine.
Ganesha University of Education.
Denpasar.
Bali.
Indonesia Program Study of Nursing.
Raflesia Institute of Health Science.
Depok.
Indonesia DOI: https://doi.
org/10.
36685/phi.
Received: 4 July 2023 | Revised: 5 August 2023 | Accepted: 1 September 2023 Corresponding author:
Maretalinia.
PhD (Candidat.
PhD Program in Demography.
Institute for Population and Social Research Mahidol University.
Nakhon Pathom, 73170 Thailand Email: mareta.
21@gmail.
Copyright: A 2023 the Author.
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium provided the original work is properly cited.
Abstract Background: The prevalence of mother-to-child transmission (MTCT) of HIV/AIDS is increasing, particularly in low- and middle-income countries.
Most previous studies focused on pregnant women in antenatal care, but this study examined the early phases of non-married women, which are young adults.
Objective: This study aimed to examine the factors associated with knowledge MTCT of HIV/AIDS among young adults in Indonesia.
Methods: This study used secondary data from the Special Indonesia Demographic Health Survey (IDHS), also known as the Indonesia Young Adult Reproductive Health Survey (IYARHS).
The unit of analysis in this study is a non-married young adult aged 14 to 24 from 34 provinces in Indonesia.
The final samples brought into the analysis were 9,600 women.
The univariate analysis, bivariate analysis using the Chi-Square test, and multivariate analysis using binary logistic regression were done using the STATA 17 version licensed by the Institute for Population and Social Research.
Mahidol University.
Results: This study revealed that 33.
75% of the respondents had poor knowledge of the MTCT of HIV/AIDS.
Moreover, the factors found to be significantly associated with knowledge of MTCT of HIV/AIDS were age .
to 24 years ol.
, residence in an urban area, graduation from junior high school, senior high school, academy, and university, and also those who talked about sexual matters with friends.
Conclusion: This study suggests supporting and encouraging related stakeholders in order to provide education about MTCT in the early years of adulthood so the prevention program can be applied more easily.
Keywords: Mother-to-child transmission (MTCT).
HIV/AIDS.
IYARHS.
IDHS.
Indonesia wreaking havoc on the human race at a rapid rate.
The results of investigations showed that in Nigeria.
Mali, and Lesotho, respectively, 7.
5%, 10.
3%, and Background The epidemic of HIV/AIDS, which uses a different method of transmission from mother to child, is Volume 9.
Issue 3.
July - September 2023 8 percent of women had a thorough understanding of MTCT prevention (Acharya et al.
Due to a lack of treatment, between 15 and 30 percent of kids born in Nepal with HIV .
uman immunodeficiency viru.
become infected during labor and delivery, and between 5 and 20 percent become infected during nursing (Acharya et al.
According to a study conducted in Uganda, 1% of pregnant women and 50% of newborns had HIV infections (Operto, 2.
In reality, more than 90% of newborns with HIV/AIDS were transmitted from their mothers during pregnancy, labor, delivery, and the postpartum period (Sekar et al.
, 2.
urban residency, exposure to media, and exposure to HIV/AIDS knowledge.
In order to prevent HIV MTCT during pregnancy, labor, and breastfeeding.
Prevention of Mother-toChild Transmission (PMTCT) programs offer a variety of services to women and infants, including counseling and testing, antiretroviral drug therapy, thorough antenatal care, safer delivery practices, and appropriate infant feeding.
By engaging in these activities, the risk of vertical HIV transmission can be cut to under 1%.
To begin antiretroviral medication (ART) and end HIV MTCT.
HIV testing is necessary both before and throughout pregnancy (Mudji et al.
The HIV-infected population is increasing globally, leading to public health concerns.
Housewives are not an exception because of the risk of being transmitted by their husbands.
Mother-to-child transmission (MTCT) is one of the most common routes for spreading HIV infection in pregnant Without treatment, one-third of children living with HIV die before the age of one year, and almost half of them by the age of two.
With the appropriate intervention, the risk rate of MTCT can be decreased by up to 2% (Acharya et al.
, 2.
Some interventions that can be done are antiretroviral (ARV) prophylaxis and screening.
However, those two prevention methods must be estimated together with the total number of pregnant women infected by HIV.
Women are the highest-risk population to be infected by HIV from husbands and partners.
Knowledge and awareness will be useful for them to protect themselves and the people around them from HIV infection and take HIV testing as a preventive measure.
Various studies have been done globally to examine the knowledge of MTCT among women, particularly among pregnant women on antenatal care and the general population of However, this study only focused on young adults as the initial description of young adult factors as early prevention.
Thus, to provide more comprehensive data, this study aimed to examine the factors associated with MTCT of HIV/AIDS among young adults aged 14 to 25 years old in Indonesia.
Low- and middle-income countries are the most risky for MTCT of HIV/AIDS.
One of the intervention methods established by the Indonesian government is providing HIV screening for pregnant women in primary health care.
However.
HIV screening is ineffective since coverage was only 13% in 2018.
Some factors have been found to define the low ARV screening and testing for HIV, such as lack of knowledge about HIV, unwillingness to get blood tests, poor perception of HIV settings, and not all health care centers providing HIV testing.
All the stakeholders tried to support the prevention program of MTCT so babies would be delivered free from HIV/AIDS.
Methods Study Design The IYARHS provided the secondary data for this investigation (Indonesia Young Adult Reproductive Health Surve.
IYARHS is a component of the Indonesia Demographic Health Survey (IDHS), also referred to as the Special IDHS.
IYARHS
concentrated on survey respondents who were young adults.
The Indonesian Demography and Health Survey (IDHS) 2017 secondary data are used in this cross-sectional research study.
A global survey that focuses on fertility, family planning, and mother and child health is called the Demographic and Health Survey (DHS).
In cooperation with the National Population and Family Planning Board (BKKBN) and the Indonesian Ministry of Health (MoH).
Statistics Indonesia (BPS) carried out the Indonesia Demographic and Health Survey (IDHS).
Several factors contributed to the high prevalence of MTCT of HIV/AIDS: facing at least one pregnancy, lack of awareness of HIV status, poor adherence to ART, lack of clinic-based HIV education and counseling, low educational level, poor wealth index.
Volume 9.
Issue 3.
July - September 2023 transmitted from mother to child during pregnancy, delivery, and breastfeeding.
If the respondents could answer AuyesAy to all those questions, it would be categorized as Augood,Ay but if they answered at least one Auno,Ay it would be categorized as Aupoor.
Ay The predictors in this study consist of age, place of residence, highest educational level, having talked about sexual matters with a friend, owning a mobile telephone, having ever used the internet, having ever had sexual intercourse, reading a newspaper or magazine at least once a week, listening to the radio, and watching television.
The poll, which ran from July 24 to September 30, 2017, was financed by the Indonesian government.
ICF provides technical support through the DHS Program, which is financed by the United States Agency for International Development (USAID) and provides financial support and technical support for demographic and health surveys in nations around the world (DHS, 2.
Setting The original survey (IYARSH) was a cross-sectional frame, which was done in 2017.
However, this current study using IDHS was downloaded, cleaned, and processed in July 2023.
The IYARSH has been done in 34 provinces in Indonesia, representing 100% of the Indonesian population.
The data were tested for univariate, bivariate (Chisquar.
, and multivariate .
inary logistic regressio.
by using the STATA 17 version licensed for the Institute for Population and Social Research.
Mahidol University.
Samples/Participants The IDHS 2017 used stratified cluster-random sampling to select the sample (DHS, 2.
The sample frame used in IDHS 2017 was the Master Sample of Census Blocks from the 2010 Population Census.
The sample of IDHS 2017 covered 1,970 census blocks in urban and rural areas and 49,250 This study only focuses on nevermarried women and young adults aged 15 to 24 years old.
The total number of eligible women was 11,032, but only 10,691 of them were eligible to be Finally, after data cleaning, 9,600 of them were brought into the analysis.
Ethical Considerations The IDHS 2017 obtained ethical clearance from the National Agency for Research and Health Development.
Ministry of Health.
Republic Indonesia.
The raw data is available on the website https://dhsprogram.
com/data/ and is free to download after registering and receiving approval by Results Table 1 provides general information about the It was shown that 33.
75% of the young adults had poor knowledge about HIV/AIDS motherto-child transmission.
In terms of age, more than half of them are aged 14 to 18 years old .
75%).
According to place of residence, the majority of them lived in the urban area .
23%).
The respondents of this study were predominantly those who graduated from senior high school .
16%), had a tendency to talk with friends about sexual matters .
26%), owned a mobile phone .
18%), and had ever used the internet .
46%).
In terms of their sexual intercourse experiences, most of them said never .
11%).
According to access to media, including newspapers and magazines, radio, and television, at least once a week they could access those media by 16.
29%, 15.
85%, and 81.
Instrument The instrument used by IDHS 2017 was the standardized questionnaire.
The variable of motherto-child transmission was derived from 3 questions:
HIV can be transmitted from mother to baby during pregnancy.
es/n.
HIV can be transmitted from mother to baby during delivery? .
es/n.
HIV can be transmitted from mother to baby during breastfeeding? .
es/n.
MTCT was categorized as good if the respondent answered .
to all three questions.
MTCT was categorized as poor if the respondent answered .
to at least one question.
Data Analysis The outcome variable of this study is the MTCT of HIV/AIDS transmission.
It combined three questions, including whether HIV/AIDS can be Volume 9.
Issue 3.
July - September 2023 Table 1 The general characteristics of the respondents Variables .
= 9,.
Knowledge about MTCT of HIV/AIDS Poor Good Age 14 to 18 years old 19 to 24 years old Place of residence Rural Urban Highest educational level Primary Junior high school Senior high school Academy University Talk about sexual matters with friends Yes Own a mobile telephone Yes Have ever used the internet Yes Have ever had sexual intercourse Yes At least once a week read a newspaper or magazine Yes At least once a week listen to the radio Yes At least once a week watch television Yes The predictors that were found to correlate with knowledge of mother-to-child transmission of HIV/AIDS are age, place of residence, educational level, talking about sexual matters with friends, owning a mobile phone, access to the internet, and access to a newspaper or magazine.
However, other variables, including having ever had sexual intercourse and having access to radio and television, showed no correlation with knowledge of mother-to-child HIV/AIDS transmission (Table .
Frequency Percentage 9,419 another independent variable.
In detail, respondents who were aged 19 to 24 years old were 1.
18 times more likely to have good knowledge of MTCT HIV/AIDS compared to young adults aged 14 to 18 years old.
According to place of residence, those who lived in urban areas were 1.
21 times more likely to have good MCTC knowledge than those who graduated from primary school.
In terms of the highest educational level, it was found that those who graduated from junior high school, senior high school, academy, and university were 1.
58, 2.
47, and 2.
91 times more likely to have good MCTC Moreover, those who mostly talked with friends about sexual matters were 1.
38 times more likely to have good MCTC knowledge compared to those who did not talk with friends.
Table 3 shows that variables significantly associated with knowledge of mother-to-child HIV/AIDS transmission included age, place of residence, highest educational level, and talking about sexual matters with friends after controlling for Volume 9.
Issue 3.
July - September 2023 Table 2 The bivariate analysis of each independent variable with the knowledge of MTCT Knowledge of MTCT of HIV/AIDS Poor (%) Good (%) Variables Age 14 to 18 years old 19 to 24 years old Place of residence Rural Urban Highest educational level Primary Junior high school Senior high school Academy University Talk about sexual matters with friends Yes Own a mobile telephone Yes Have ever used the internet Yes Have ever had sexual intercourse Yes At least once a week read a newspaper or magazine Yes At least once a week listen to the radio Yes At least once a week watch television Yes Total p-value <0.
<0.
<0.
<0.
<0.
5,262 .
It was also discovered that some variables do not have a correlation with MTCT knowledge, such as owning a mobile phone, having ever used the internet, having ever had sexual intercourse, reading a newspaper or magazine at least once a week, listening to the radio, and watching television.
HIV during pregnancy, delivery, and breastfeeding (Acharya et al.
, 2.
In Ethiopia, the knowledge of the prevention of MTCT for HIV/AIDS is only 30.
(Dina et al.
, 2.
Knowledge of HIV/AIDS transmission during breastfeeding can be one point to emphasize, like in the study in Uganda that reported more than 50% of MTCT was found during breastfeeding practice (Operto, 2.
In Congo, 4% of respondents knew MTCT as a route of HIV/AIDS transmission (Mudji et al.
, 2.
In the Indonesian context, the vertical transmission of HIV in Indonesia is still a major problem because of 2,101 new cases of perinatal HIV/AIDS in 2017 (Savitri et al.
, 2.
Discussion According to the study results above, the prevalence of poor MTCT for HIV was 33%.
Another study in Indonesia found that 37% of women did not know how to prevent MTCT (Mutiar et al.
, 2.
The study in Nepal reported similar results, with only 4% of respondents knowing the transmission of Volume 9.
Issue 3.
July - September 2023 Table 3 The multivariate analysis of factors associated with MTCT of HIV/AIDS Variables Age .
ef: 14 to 18 years ol.
19 to 24 years old Place of residence .
ef: rura.
Urban Highest educational level .
ef: primar.
Junior high school Senior high school Academy University Talk about sexual matters with friends .
ef: n.
Yes Own a mobile telephone .
ef: n.
Yes Have ever used the internet .
ef: n.
Yes Have ever had sexual intercourse .
ef: n.
Yes At least once a week read a newspaper or magazine .
ef: n.
Yes At least once a week listen to the radio .
ef: n.
Yes At least once a week watch television .
ef: n.
Yes
AOR
95% C.
p-value 07 Ae 1.
11 Ae 1.
<0.
08 Ae 2.
50 Ae 3.
93 Ae 6.
00 Ae 4.
<0.
<0.
<0.
26 Ae 1.
<0.
76 Ae 1.
80 Ae 1.
87 Ae 1.
96 Ae 1.
90 Ae 1.
84 Ae 1.
LR chi2 .
= 277.
86 | Prob > chi2 = 0.
000 | Pseudo R2 = 0.
0226 | Log likelihood = -5998.
Supporting the results of this study, some previous studies found that variables of educational level are correlated to MTCT knowledge.
In Ethiopia, other variables had significance for the MTCT of HIV/AIDS knowledge, such as wealth index, media exposure, and knowledge about HIV (Kebede et al.
The study in Ethiopia found that knowledge of the prevention of MTCT was higher among respondents aged less than 25 years (Dina et al.
In line with the findings of this study, the study in Congo found that older participants and those with higher educational levels tend to have higher knowledge of the MTCT of HIV/AIDS (Mudji et al.
As the general information about HIV, some findings showed that the factors of educational level and living in the urban area tend to have HIV knowledge, including MTCT knowledge (Sari et al.
(Ntombela et al.
, 2022.
Qiu & Wu, 2022.
Tibebu et , 2.
The highest educational level is related to the knowledge people get at the formal educational level, which positively increases the knowledge of MTCT of HIV/AIDS (Alemu et al.
, 2018.
Alwafi et al.
Worku et al.
, 2.
The variable of talking with friends about sexual matters might be related to sharing information with peers, which is related to knowledge about MTCT of HIV/AIDS (Ehiri et al.
Kumbani et al.
, 2023.
Letshwenyo-Maruatona & Gabaitiri, 2.
The media exposures in this study found no association with knowledge of MTCT of HIV/AIDS, which differs from several previous studies (Lakhe et al.
, 2020.
Pachuau et al.
, 2021.
Teshale et al.
, 2.
There is a correlation between knowledge and attitude toward the MTCT of HIV/AIDS, as found in the study in Nigeria (Ezenkiri et al.
, 2.
The study in Tanzania found HIV-infected women had significantly more comprehensive knowledge of HIV/AIDS and prevention of mother-to-child transmission of HIV than HIV-negative women, and comprehensive knowledge of prevention of motherto-child transmission of HIV was low among the study participants (Ngadaya et al.
, 2.
Another study examining the MTCT of HIV practice found In terms of the variable of age, older women might have good knowledge of MTCT because they might have more experience and get more information (Gebregziabher et al.
, 2023.
Olopha et al.
, 2021.
Yourkavitch et al.
, 2.
Regarding the place of residence, living in an urban area will have more tendency to easily access any information to enrich the knowledge, including MTCT of HIV/AIDS Volume 9.
Issue 3.
July - September 2023 that age, education, and attitude played a significant role (Sekar et al.
, 2.
Declaration Conflicting Interest The authors declared no competing interest.
In relation to MTCT, early screening can be carried out to obtain the initial diagnosis.
The significance of HIV testing for early HIV/AIDS prevention, particularly in the Eastern half of Indonesia, must also be emphasized (Ibrahim et al.
, 2.
Given that hospitals have hosted the majority of successful MTCT programs, primary health care should integrate MTCT prevention effectively (Indrawati & Setyani, 2.
It also highlighted research done in Indonesia showing that hospitals retained women more frequently than primary health institutions did (Lumbantoruan et al.
, 2.
Pregnant women can receive integrated ANC services, which also include HIV testing and counseling.
HIV diagnosis and antiretroviral therapy for pregnant women, safe delivery, planning for future pregnancies, management of infant and child feeding, administration of antiretroviral (ARV) prophylaxis and cotrimoxazole in children.
HIV diagnostic testing in children, and immunization (Witarini, 2.
Testing for syphilis, hepatitis B, and HIV/AIDS can all be done concurrently because they are all noncommunicable diseases (Wardiana et al.
, 2.
the local scope, the findings of this study can contribute to health promotion initiatives for public health centers (Pusat Kesehatan Masyarakat/ Puskesma.
, especially young adults, as the subject to prevent MTCT.
In the global scope, this study can give a clear situation of MTCT knowledge among young adults in Indonesia, which can be strong evidence to arrange the policy and health program for all stakeholders.
Funding None.
Acknowledgment The authors would like to thank IDHS of special (IYARSH) and the national government for allowing us to use the data for this study.
Author Contribution M.
EB, and MHNS obtained and analyzed the data and developed the topics.
NKS, and SS highly contributed to the conceptualization and design of the study.
All authors critically reviewed the manuscript and took part in the discussion part.
All authors read and approved the final manuscript.
Author Biography Maretalinia is a PhD candidate at the PhD Program in Demography.
Institute for Population and Social Research.
Mahidol University.
Thailand.
Erni Buston is a Government Lecturer from the Program Study of Nursing.
Health Polytechnic of the Ministry of Health Bengkulu.
She is interested in research related to the community.
Marlynda Happy Nurmalita Sari is a Government Lecturer from the Program Study of Midwifery.
Health Polytechnic of the Ministry of Health Semarang.
Tating Nuraeni is a Lecturer from the Department of Public Health.
Universitas Wiralodra.
Indramayu.
Indonesia.
Ni Komang Sulyastini is a Lecturer at Program Study of Midwifery.
Ganesha University of Education.
Bali.
Indonesia.
Siti Sholihat is a Lecturer at the Program Study of Nursing.
Raflesia Institute of Health Science.
Depok.
Indonesia.
References