Are Public Antenatal Clinics in Blantyre, Malawi, Ready to Offer Services for the Prevention of Vertical Transmission of HIV?
),
(1)
Corresponding Author
Abstract
At least 10% of the adult population in Malawi is infected with HIV and vertical transmission is a major mode of transmission. Currently, there are plans to provide widespread antiretroviral therapy to prevent mother to child transmission of HIV. This study was conducted to describe the perceptions of midwives towards selected issues regarding prevention of mother to child transmission of HIV in eleven public health centres in Blantyre, Malawi. A cross-sectional study using a self-administered questionnaire incorporating both open-ended and closed-ended questions was used. Twenty seven midwives participated in the study. Less than half (40.7%), of them reported working at a baby friendly hospital initiative health facility, while 96.3% reported that they would advise an HIV infected woman to breastfeed her infant. HIV prevention messages were reportedly offered routinely by 77.8% of the respondents, but only 22.2% reported that their clinics offered condoms to pregnant women. Also, only 37.0% reported offering routine STI screening, while 37.0% of the midwives would support antenatal women being accompanied by their male partners. Majority (81.2%) said that women who know they are HIV infected should not become pregnant, while 37.0% reported that they would be uncomfortable to assist in the delivery of an HIV infected woman. There was lack of appropriate clinic space and sterile gloves for the proper delivery of maternity services. Midwives in Malawi need training, supervision and other support to provide adequate health care services to antenatal women. (Afr J Reprod Health 2004; 8[2]: 64-70)
Keywords: Malawi, vertical transmission, mother-to-child transmission, HIV
References
Ministry of Health and Population. Malawi National Health Plan 1999-2004, Lilongwe, Malawi, 1999.
Taha TE, Dallabetta GA, Hoover DR, Chiphangwi JD, Mtimavalye LA, Liomba GN, Kumwenda NI and Miotti PG. Trends of HIV-1 and sexually transmitted diseases among pregnant and postpartum women in urban Malawi. AIDS 1998; 12(2): 197-203.
Sherr L. Preventing HIV transmission during pregnancy and delivery: a review. AIDS STD Health PromotExch 1997; 4: 4-6.
Ndinya-achola JO, Plummer FA, Ronald AR and Piot P. Acquired immunodeficiency syndrome: epidemiology in Africa and its implications for health services. Afr J Sex Transm Dis 1986; 2(2): 77-80.
Bryson YJ. Perinatal HIV-1 transmission: recent advances and therapeutic interventions. AIDS 1996; 10(Suppl 3): S33-42.
Richardson BA, John-Stewart GC, Hughes JP, Nduati R, Mbori-Ngacha D, Overbaugh J and Kreiss JK. Breast milk infectivity in human immunodeficiency virus type 1-infected mothers. J Infect Dis 2003; 187(5): 736-740.
Akerele J, Abhulimen P and Okonofua F. Prevalence of asymptomatic genital infections among pregnant women in Benin City, Nigeria. Afr J Reprod Health 2002; 6(3): 93-97.
Latif AS, Bvumbe J, Muongerwe JP, Paraiwa E and Chikosa W. Sexually transmitted diseases in pregnant women in Harare, Zimbabwe. Afr J Sex Transm Dis 1984; 1(1): 21-23.
Semba RD. Mastitis and transmission of human immunodeficiency virus through breast milk. Ann NY AcadSci 2000; 918: 156-162.
Rousseau CM, Nduati RW, Richardson BA, Steele MS, John-Stewart GC, Mbori-Ngacha DA, Kreiss JK and Overbaugh J. Longitudinal analysis of human immunodeficiency virus type 1 RNA in breast milk and of its relationship to infant infection and maternal disease. J Infect Dis 2003; 187(5): 741-747.
Stephenson CB. Vitamin A, beta-carotene, and mother-to-child-transmission of HIV. Nutr Rev 2003; 61(8): 280-284.
Ononeze BO and Turner MJ. Acceptability of antenatal HIV testing in Ireland. Ir Med J 2003; 96(4): 107-109.
Kowalczyk J, Jolly P, Karita E, Nibarere JA, Vyankandondera J and Salihu H. Voluntary counseling and testing for HIV among pregnant women presenting in labor in Kigali, Rwanda. J Acquir Immune DeficSyndr 2002; 31(4): 408-415.
Cartoux M, Meda N, Van de Perre P, Newell ML, de Vincenzi I and Dabis F. Acceptability of voluntary HIV testing by pregnant women in developing countries: an international survey. Ghent International Working Group on Mother-to- Child Transmission of HIV. AIDS 1998; 12(18): 2489-93.
Poore P. The Global Fund to fight AIDS, tuberculosis and malaria (GFATM). Health Policy Plann 2004; 19: 52-53.
Braun ML, Giugliani ER, Soares ME, Giugliani C, de Oliveira AP and Danelon CM. Evaluation of the impact of the baby- friendly hospital initiative on rates of breastfeeding. Am J Public Health 2003; 93(8): 1277-79.
Yawman D. Reflections on the baby-friendly hospital initiative. Pediatr Ann 2003; 32: 360-361.
Naylor AJ. Baby-Friendly Hospital Initiative. Protecting, promoting, and supporting breastfeeding in the twenty first century. PediatrClin North Am 2001; 48(3): 475-483.
Bauni EK and Jarabi BO. The low acceptability and use of condoms within marriage: evidence from Nakuru district, Kenya. Afr Pop Stud 2003; 18(1): 51-65.
Sobti J, Mathur GP and Gupta A. WHO's proposed global strategy for infant and young child feeding: a viewpoint. J Ind Med Assoc 2002; 100(8): 502-504, 506.
Wlikinson D, Abdool Karim SS, Harrison A, Lurie M, Colvin M, Connolly C and Sturm AW. Unrecognised sexually transmitted infections in rural South African women: a hidden epidemic. Bull World Health Organ 1999; 77(1): 22- 28.
Blankart D, Muller O, Geresenguet G and Weis P. Sexually transmitted infections in pregnant women in Bangui, Central African Republic. Int J STD AIDS 1999; 10: 609-614.
Wilkinson D, Ndovela N, Harrison A, Lurie M, Connolly C and Sturm AW. Family planning services in developing countries: an opportunity to traet asymptomatic and unrecognized genital tract infections. Genitourin Med 1997; 73(6): 558-560.
Nduati R, Richardson BA, John G, Mbori-Ngacha D, Mwatha A, Ndinya-Achola J, Bwayo J, Onyango FE and Kreiss J. Effect of breastfeeding on mortality among HIV-1 infected women: a randomised trial. Lancet 2001; 357(9269): 1651-55.
Ernst A and Zetterstrom R. Vertical transmission of HIV-1 infection and dilemma of infant feeding. ActaPaediatr 2003; 92(9): 990-991.
National Statistical Office. Demographic and Health Survey 2000. National Statistical Office, Zomba, Malawi, 2001.
Family Planning Association of Kenya and Africa Operational Research Technical Assistance Project II (1995). Increasing male involvement in FPAK's Family Planning Program, Kenya.
Muula AS, Mfutso-Bengo JM, Makoza J and Chatipwa E. The ethics of developed nations recruiting nurses from developing countries: the case of Malawi. Nurs Ethics 2003; 10(4): 433-438.
Ostergaard L. Why do midwives leave the job in Malawi. MSc thesis, Liverpool School of Tropical Medicine, 2003.
Twahir A, Maggwa BN and Askew I. Integration of STI and HIV/AIDS services with MCH-FP services: a case study of the Mkomani Clinic Society in Mombasa, Kenya. Population Council, Nairobi, 1996.
Kulmala T, Vaahtera M, Rannikko J, Ndekha M, Cullinan T, Salin ML and Ashorn P. The relationship between antenatal risk characteristics, place of delivery and adverse delivery outcome in rural Malawi. ActaObstetGynecolScand 2000; 79: 984-990.
Walraven G. Involving traditional birth attendants in prevention of HIV transmission needs careful consideration. BMJ 2002; 324: 224-225
Article Metrics
Abstract View
: 403 timesDOC
Download : 324 times
Refbacks
- There are currently no refbacks.
