Evaluating the benefits of incorporating traditional birth attendants in HIV Prevention of Mother to Child Transmission service delivery in Lilongwe, Malawi

Gloria Hamela, Charity Kabondo, Tapiwa Tembo, Chifundo Zimba, Esmie Kamanga, Innocent Mofolo, Bertha Bulla, Christopher Sellers, R. C. Nakanga, Clara Lee, Francis Martinson, Irving Hoffman, Charles van der Horst, Mina C. Hosseinipour

Abstract

The objective of our intervention was to examine the benefits of incorporating traditional birth attendants (TBA) in HIV

Prevention of Mother to Child Transmission (PMTCT) service delivery. We developed a training curriculum for TBAs related to PMTCT and current TBA roles in Malawi. Fourteen TBAs and seven TBA assistants serving 4 urban health centre catchment areas were assessed, trained and supervised. Focus group discussions with the TBAs were conducted after implementation of the program. From March 2008 to August 2009, a total of 4017 pregnant women visited TBAs, out of which 2133 (53.1%) were directly referred to health facilities and 1,884 (46.9%) women delivered at TBAs and subsequently referred. 168 HIV positive women were identified by TBAs. Of these, 86/168 (51.2%) women received nevirapine and 46/168 (27.4%) HIV exposed infants received nevirapine. The challenges in providing PMTCT services included lack of transportation for referrals and absence of a reporting system to confirm the woman’s arrival at the health center. Non-disclosure of HIV status by patients to the TBAs resulted in inability to assist nevirapine uptake. TBAs, when trained and well-supervised, can supplement efforts to provide PMTCT services in communities. (Afr J Reprod Health 2014; 18[1]: 27-34).

 

Keywords: Traditional Birth Attendants, PMTCT, Malawi 

 

Résumé

 

L'objectif de notre intervention était d'examiner les avantages de l'intégration des accoucheuses traditionnelles (AT) dans la prestation de service de la prévention de la transmission du VIH de la mère à  l’enfant (PTME). Nous avons élaboré un programme de formation pour les accoucheuses traditionnelles liées à la PTME et les rôles actuels des ATs  au Malawi. Quatorze accoucheuses traditionnelles et sept assistantes des ATs desservant 4 zones urbaines desservies par les centres de santé ont été évalués, formés et surveillées.  Nous avons mené des discussions en groupes cible avec les accoucheuses traditionnelles après la mise en œuvre du programme. Au total, 4017 femmes enceintes ont visité les accoucheuses traditionnelles du mois de mars 2008 au mois  d’août 2009,  dont 2133 (53,1%) ont été directement orientées vers les  établissements de santé et 1884 (46,9 %) des femmes ont accouché chez  des accoucheuses traditionnelles avant d’être orientées par la suite. 168 femmes séropositives ont été identifiées par les accoucheuses traditionnelles. Parmi celles-ci, 86/168 (51,2%), des femmes ont reçu la névirapine et 46/168 (27,4%) nourrissons exposés au VIH ont  reçu de la névirapine. Les défis dans la prestation de services de PTME comprennent le manque de transport pour les femmes orientées et l'absence d'un système de déclaration pour confirmer l'arrivée de la femme au centre de santé. La non - divulgation de la séropositivité par les patientes aux accoucheuses traditionnelles a entraîné l'impossibilité d'aider la promotion de la névirapine. Si les accoucheuses traditionnelles sont bien formées et bien surveillées, elles peuvent complémenter les efforts vers la prestation des services de PTME dans les communautés. (Afr J Reprod Health 2014; 18[1]: 27-34).

Mots-clés: accoucheuses traditionnelles,  PTME,  Malawi 


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