HIV This Week

Perez F, Aung KD, Ndoro T, Engelsmann B, Dabis F. Participation of traditional birth attendants in prevention of mother-to-child transmission of HIV services in two rural districts in Zimbabwe: a feasibility study. BMC Public Health. 2008;8(1):401. [Epub ahead of print]

Prevention of mother-to-child transmission of HIV is among the key HIV prevention strategies in Zimbabwe. A decrease in use of antenatal care services with an increase in home deliveries is affecting the coverage of prevention of mother-to-child transmission interventions in a context of accelerated economic crisis. The main objective was to evaluate acceptability and feasibility of reinforcing the role of traditional birth attendants in family and child health services through their participation in prevention of mother-to-child transmission programmes in Zimbabwe. A community based cross-sectional survey was undertaken using multistage cluster sampling in two rural districts through interviews and focus group discussions among women who delivered at home with a traditional birth attendant, those who had an institutional delivery and traditional birth attendants. 45% of traditional birth attendants interviewed knew the principles of prevention of mother-to-child transmission and 8% delivered a woman with known HIV-positive status in previous year. Of the complete package of prevention of mother-to-child transmission services, more than 75% of traditional birth attendants agreed to participate in most activities with the exception of performing a blood test (17%), accompanying new-borns to closest health centre to receive medication (15%), and assisting health centres in documentation of the link between antenatal care and prevention of mother-to-child transmission services (18%). Women who delivered at home were less likely to have received more than one antenatal care service or have had contact with a health centre compared to women who delivered in a health centre (91.0% vs 72.6%; P<0.001). Also, 63.6% of the women who delivered in a health centre had the opportunity to choose the place of delivery compared to 39.4% of women who delivered at home (P<0.001). More than 85% of women agreed that traditional birth attendants could participate in all activities related to a prevention of mother-to-child transmission programme with the exception of performing a blood test for HIV. Concerns were highlighted regarding confidentiality of the HIV-serostatus of women. Although the long-term goal of antenatal care service delivery in Zimbabwe remains the provision of skilled delivery attendance, prevention of mother-to-child transmission programmes will benefit from complementary approaches to prevent missed opportunities. Traditional birth attendants are willing to expand their scope of work regarding activities related to prevention of mother-to-child transmission. There is a need to reinforce their knowledge on mother-to-child transmission prevention measures and better integrate them into the health system.

Editors’ note: When health professionals are not available, traditional birth attendants, usually elderly, married or widowed women with a minimum level of education, are a significant workforce in maternity care in high HIV prevalence settings. Legitimising and acknowledging their practice, training them to preserve confidentiality and support women in the process of disclosure to access HIV prevention and treatment programmes, integrating them into prevention of mother-to-child transmission programmes, and conducting operational research to assess their impact are key steps. Reaching the two-thirds of pregnant women with HIV infection who are not currently reached by prevention of mother-to-child transmission programmes is the objective and all able hands need to be on deck.