title: The implications of policy changes on the uptake of a PMTCT programme in rural Malawi: first three years of experience.
abstract: OBJECTIVE
  To study the implications of policy changes on the demand for antenatal care (ANC), HIV testing and hospital delivery among pregnant women in rural Malawi.
  
  
  METHODS
  Retrospective analysis of monthly reports.
  
  
  METHODS
  Malamulo SDA hospital in Thyolo district, Makwasa, Malawi.
  
  
  METHODS
  Three hospital-based registers were analysed from 2005 to 2007. These were general ANC, delivery and Prevention of Mother to Child Transmission (PMTCT) registers. Observations were documented regarding the introduction of specific policies and when changes were effected. Descriptive analytical methods were used.
  
  
  RESULTS
  The ANC programme reached 4,528 pregnant mothers during the study period. HIV testing among the ANC attendees increased from 52.6 to 98.8% after the introduction of routine (opt-out) HIV testing and 15.6% of them tested positive. After the introduction of free maternity services, ANC attendance increased by 42% and the ratio of hospital deliveries to ANC attendees increased from 0.50:1 to 0.66:1. Of the HIV-tested ANC attendees, 52.6% who tested positive delivered in the hospital and got nevirapine at the time of delivery.
  
  
  CONCLUSIONS
  Increasing maternity service availability and uptake can increase the coverage of PMTCT programmes. Barriers such as economic constraints that prevent women in poor communities from accessing services can be removed by making maternity services free. However, it is likely, particularly in resource-poor settings, that significant increases in PMTCT coverage among those at risk can only be achieved by substantially increasing uptake of general ANC and delivery services.
authors.affiliation: Malamulo SDA Hospital, Makwasa, Malawi.
authors.forename: Fyson
authors.initials: F
authors.lastname: Kasenga
authors.forename: Peter
authors.initials: P
authors.lastname: Byass
authors.forename: Maria
authors.initials: M
authors.lastname: Emmelin
authors.forename: Anna-Karin
authors.initials: AK
authors.lastname: Hurtig