Original articles

Asessing missed opportunities for the prevention of mother-to-child HIV transmission in an Eastern Cape Local Service Area

Laetitia Charmaine Rispel, Karl Peltzer, Nancy Phaswana-Mafuya, Carol Ann Metcalf, Latasha Treger



The Kouga Local Service Area (LSA) located in the area surrounding the Nelson Mandela Bay Municipality (Port Elizabeth) in the Eastern Cape.


An assessment was conducted in 2007 before implementing technical support for PMTCT programme strengthening including: interviews with 20 PMTCT managers, 4 maternity staff and 27 other health workers on service provision, management, infrastructure, human resources and the health information system; 296 antenatal clinic users on their service perceptions; 70 HIV-positive women on HIV knowledge, infant feeding, coping, support and service perceptions; 8 representatives from community organisations and 101 traditional health practitioners (THPs). Observations were conducted during site visits to health facilities and the District Health Information System (DHIS) data was reviewed.


Staff had high levels of awareness of HIV policies and most had received some relevant training. Nevirapine uptake varied by clinic, with an average of 56%. There were many missed opportunities for PMTCT, with 67% of pregnant women tested for HIV and only 43% of antenatal care attendees tested during a previous pregnancy. Only 6% of HIV-positive women reported support group participation.


Reducing missed opportunities for PMTCT requires formal health sector strengthening, intersectoral liaison and enhancing community support. Priority areas for strengthening in the formal health sector include HIV counselling and testing; family planning and nutrition counselling; infant follow-up; human resources; and monitoring and evaluation.

Authors' affiliations

Laetitia Charmaine Rispel, Centre for Health Policy, School of Public Health, University of the Witwatersrand, JOHANNESBURG

Karl Peltzer, Social Aspects of HIV/AIDS and Health Programme, Human Sciences Research Council

Nancy Phaswana-Mafuya, Social Aspects of HIV/AIDS and Health Programme, Human Sciences Research Council

Carol Ann Metcalf, Social Aspects of HIV/AIDS and Health Research programme, Human Sciences Research Council

Latasha Treger, Global AIDS program, US Centers for Disease Control and Prevention (CDC)

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PMTCT; missed opportunities; health programme evaluation; service utilisation; Eastern cape; South Africa

Cite this article

South African Medical Journal 2009;99(3):174.

Article History

Date submitted: 2008-06-11
Date published: 2009-03-17

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