alexa
Reach Us +441414719275
Elimination of Mother-To-Child Transmission of HIV in Nigeria: The Roles, Preparedness and Determinants of Successful Involvement of Traditional Birth Attendants
ISSN 2155-6113
Journal of AIDS & Clinical Research

Like us on:

Make the best use of Scientific Research and information from our 700+ peer reviewed, Open Access Journals that operates with the help of 50,000+ Editorial Board Members and esteemed reviewers and 1000+ Scientific associations in Medical, Clinical, Pharmaceutical, Engineering, Technology and Management Fields.
Meet Inspiring Speakers and Experts at our 3000+ Global Conferenceseries Events with over 600+ Conferences, 1200+ Symposiums and 1200+ Workshops on
Medical, Pharma, Engineering, Science, Technology and Business

Elimination of Mother-To-Child Transmission of HIV in Nigeria: The Roles, Preparedness and Determinants of Successful Involvement of Traditional Birth Attendants

Olumide Abiodun1*, John Sotunsa2, Franklin Ani2, Atinuke Olaleye2 and Agboola Taiwo3

1Department of Community Medicine, Babcock University, Ilishan, Nigeria

2Department of Obstetrics and Gynaecology, Babcock University, Ilishan, Nigeria

3Orthopaedic Unit, Department of Surgery, Babcock University, Ilishan, Nigeria

*Corresponding Author:
Olumide Abiodun
Department of Community Medicine
Babcock University, Ilishan, Nigeria
Tel: +234-703 856 9725
E-mail: [email protected]

Received date: May 10, 2014; Accepted date: June 30, 2015; Published date: July 11, 2015

Citation: Abiodun O, Sotunsa J, Ani F, Olaleye A, Taiwo A (2015) Elimination of Mother-To-Child Transmission of HIV in Nigeria: The Roles, Preparedness and Determinants of Successful Involvement of Traditional Birth Attendants. J AIDS Clin Res 6:481. doi:10.4172/2155-6113.1000481

Copyright: © 2015 Abiodun O, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Visit for more related articles at Journal of AIDS & Clinical Research

Abstract

Background: Prevention of mother to child transmission of HIV plays a major role in reducing the number of children being infected with HIV. This study provides baseline information about the knowledge, practice and factors that affect PMTCT service provision by traditional birth attendants.

Methods: A cross-sectional study of 142 traditional birth attendants in Ogun State, Nigeria carried out between January and March, 2014. Sample selection was by two-staged probability sampling technique. Data collection employed structured pre-tested questionnaires. Data were analysed using SPSS software for Windows (version 18). Uni-variate, bi-variate and multivariate analyses were done.

Results: Participants were universally aware of HIV. Participants’ ability to correctly identify temporal mode of MTCT of HIV varied from 69.0% for ante-partum; and 76.1% during labour and delivery to 60.6% during breastfeeding. Most of them (81.7%) knew that MTCT of HIV is preventable. Most of them knew that knowledge of HIV status (94.4%); and HCT (98.6%) were important for pregnant women. The mean score for knowledge of MTCT and PMTCT of HIV was 16.89 ± 1.89. Participants with secondary education or more (AOR = 3.020, 95%, CI = 1.362-6.697) were likely to know more about MTCT and PMTCT of HIV. Majority (88.7%) of the TBAs always offer HCT to pregnant women; 122 (85.9%) always refer HIV-positive women to treatment centres; and 126 (88.7%) always provide referral support for patients. The mean score for PMTCT care practice for the participants was high (45.85 ± 9.48).

Conclusion: TBAs have a role to play in the e-MTCT of HIV in Nigeria and are poised to do so. They have some knowledge and good practices as it relates to MTCT and PMTCT of HIV. Some misconceptions and bad practices exist especially as it relates to infant feeding practices. These need to be comprehensively addressed.

Keywords

Elimination; Care practices; Knowledge; Mother-to-child transmission of HIV/AIDS; Traditional birth attendants

Abbreviations

ANC: Antenatal Care; ART: Antiretroviral Treatment; ARV: Antiretroviral; FMoH: Federal Ministry of Health; HCT: HIV Counselling and Testing; HIV: Human Immunodeficiency Virus; HIV/AIDS: Human Immunodeficiency virus and Acquired Immunodeficiency Syndrome; MTCT: Elimination of Mother to Child Transmission; MTCT: Mother to Child Transmission; NANTMP: National Association of Nigerian Traditional Medicine Practitioners; PMTCT: Prevention of Mother to Child Transmission; SBA: Skilled Birth Attendants; SPSS: Statistical Package for Social Science; TBA: Traditional Birth Attendants

Introduction

Mother-to-child transmission (MTCT), or vertical transmission of HIV infection, is the transmission of the virus from an infected mother to her child during pregnancy, labour, delivery or breastfeeding [1,2]. Greater than 90% of HIV infections among children occur through MTCT; with 90% of MTCT occurring in sub-Saharan Africa. In the absence of appropriate treatment, about half of these children die before their second birthday [3]. The cumulative risk of exposed children acquiring the virus is 20-45% without any intervention if breastfeeding is prolonged to 2 years [4]. The rate of MTCT is dependent on factors which include viral load, mode of delivery, prolonged rupture of membranes, prematurity and breastfeeding [5].

MTCT rates of less than 2% have been reported in high income countries owing to provider-initiated HIV counselling and testing (HCT), accessibility to antiretroviral (ARV) prophylaxis and safe use of breast milk substitutes [6,7]. This differs significantly from what obtains in sub-Saharan Africa, Nigeria inclusive. HCT and ARV prophylaxis access rates are low (11.7% and 17.1%, respectively) whereas, transmission through breastfeeding is high [3,8,9].

Nigeria accounts for about 30% of the global burden of MTCT; with a MTCT rate of about 32% and about 75,000 new infant HIV infections per annum. The ARV coverage for PMTCT is 22% among the estimated 210,000 annual HIV infections among pregnant women [10-13].

In countries that are rapidly scaling-up PMTCT services, the main challenges are; to offer more effective PMTCT, including provision of antiretroviral treatment (ART) for pregnant women, prophylactic ARV for infants; and to demonstrate the impact of these interventions by decreased paediatric infections, increased HIV-free survival and improved maternal and child health [2,14].

In Nigeria, PMTCT services are still largely concentrated in health facilities, with less than desirable collaboration with community support services [15]. Whereas, 58% of pregnant women attend antenatal clinic (ANC) at least once, only 35% of births occur in health facilities. In Nigeria, only 39% of deliveries are attended by skilled birth attendants (SBA). Between 49% and 93% of births in different parts of Nigeria occur in the home of traditional birth attendants (TBA) [16]. Ogun State, Nigeria has the highest HIV prevalence rate (3.1%) in south west Nigeria after Lagos. TBA utilization rate in the state is also high (63.6%). It is therefore important to assess the knowledge and practices of TBAs in Ogun State as it relates to MTCT and PMTCT of HIV [17]. The WHO defines TBA as a person who assists the mother during childbirth and who initially acquired her skills by delivering babies herself or through an apprenticeship to other TBA [18]. Despite the role of TBA, they have not been accorded a defined role in the Nigerian health system. They are often perceived as major contributors to the high maternal mortality rate in Nigeria as many of their practices have been found to adversely affect the health of mothers [16]. However, recently, various governmental and nongovernmental agencies have engaged TBA in trainings in PMTCT. The proposed roles of TBA in PMTCT are highlighted in Table 1.

Preconception Health education and counselling on safe HIV and PMTCT practices, HIV counselling and testing, prompt referral of HIV positive individuals for treatment, adherence counselling and treatment support, bridging the gap of unmet needs for family planning, identification and prompt referral of STIs, promotion of consistent and correct condom use
Prenatal HIV counselling and testing, prompt referral of HIV positive mothers for treatment, adherence counselling and treatment support for mothers, Mobilization of pregnant women for appropriate ANC attendance, Health and Nutrition education. Partner counselling and testing
Perinatal Safe delivery practices, prompt referral of HIV positive mothers in labour and babies for nevirapine therapy
Postnatal Adherence counselling, treatment support for mothers and infant prophylaxis, mother and infant follow-up, Nutritional education and support for mother and infant, bridging the gap of unmet needs for family planning

Table 1: The role of TBAs in the prevention of mother to child transmission of HIV.

Nigeria endorses the global plan for the elimination of MTCT of HIV infection (e-MTCT) which targets the reduction of paediatric HIV by 90% and reduction of MTCT rate to less than 5%. Nigeria has a commitment to fully implement new scale up plan by 2015; to reduce HIV incidence among women of reproductive age, reduce unmet needs for family planning by 100% and reach 90% of HIV infected women and infants with ARV and ARV prophylaxis [19].

Prevention of mother to child transmission of HIV plays a major role in reducing the number of children being infected with HIV. This study provides baseline information about the knowledge, practice and factors that affect PMTCT service provision by TBA. It should help to identify PMTCT training needs; facilitate quality and efficient health care services to reduce MTCT of HIV infection.

Methods

Study design, area and period

A cross-sectional study was conducted in Ogun State, one of the 36 states in Nigeria between January and March 2014. All duly registered TBA were included in the study. The unregistered TBAS were excluded from the study.

Sampling

The sample was drawn from a sampling frame of all duly registered TBA in Ogun State, Nigeria. Sample Size was determined using the single population proportion formula. The aim was to achieve results at 95% confidence interval, confer 80% power and a desired degree of accuracy of 0.05. The estimated proportion was taken as 8.6% which was the proportion of TBA with the correct knowledge of HIV transmission from mother-to-child in Lagos State, Nigeria [20]. A sample size of 121 was derived. An allowance of 20% was made for non response making a sample size of 145. TBAs are registered in four zones (Egba, Ijebu, Remo and Yewa) in Ogun State, Nigeria. Two (Ijebu and Remo) of the four zones were selected by simple random sampling via balloting. Proportional allocation was used to assign sample size to the zones based on the number of duly registered TBA in the selected zones (Ijebu- 65, Remo 80). Systematic random sampling was then used to select participants from a list of all duly registered TBA in the zones.

Data collection

The data collection instrument was adapted from a similar study among nurses in Nigeria [21]. Three Reproductive Health Specialists were requested to vet the instrument and establish content validity. The specialists made various suggestions which were taken into account, and necessary corrections were made. The specialists agreed that the instrument was suitable for use in the study context. The questionnaire was translated into Yoruba (the local language) and back into English. Questionnaire administration was done both in Yoruba and English language which were the languages the TBA were conversant with. The questionnaire was then pretested among 15 TBA in the Yewa health zone of Ogun State. Necessary adjustments were made. Questionnaire administration was carried out by trained research assistants at the various TBA facilities. Data was collected between January and March, 2014 over a 13 week period.

The survey consisted of the following sections: demographics; knowledge questions related to MTCT and PMTCT; and a practice scale related to PMTCT care practice. The MTCT and PMTCT knowledge scale consisted of 20 items related to MTCT and its prevention. The items were rated 0 (wrong) and 1 (correct) based on participant’s responses. The least and highest possible scores were 0 and 20 respectively. Participants were grouped into having above average knowledge or below average knowledge of MTCT and PMTCT based on whether their total scores were higher or lower than the mean score. The PMTCT practice scale consisted of 14 items related to practices associated with the prevention of maternal to child transmission. The items were rated from 0 (never) to 4 (always) based on how often the TBA engaged in the practice. The scale included evidence-based practices related to newborn care, infant feeding practices, maternal prenatal laboratory testing and screening; maternal adherence to treatment before and after delivery, and availability and use of protective equipment for universal precautions. The least and highest possible scores were 0 and 56 respectively. Participants were classified into having above or below average PMTCT care practices based on whether their total scores were higher or lower than the mean score. Cronbach alpha for the scale was 0.712, consistent with other HIV knowledge scales [20,21].

Data quality control

One day training was given to ten research assistant about the objectives and procedures of the data collection by the investigators. The investigators checked the data for completeness and consistency. Data cleaning and editing took place.

Data analysis

Data were entered, coded and analysed using SPSS version 18. Relevant descriptive statistics were used to summarize the findings. Associations between dependent and independent variables were assessed by using bi-variate analysis. Multiple logistic regression models were then constructed for variables that were statistically significant. To measure internal consistency, reliability analysis was done. P-values less than 0.05 were considered statistically significant in all cases.

Ethical consideration

Ethical clearance was obtained from the Babcock University Health Research Ethics Committee. Permission and cooperation was obtained from the National Association of Nigerian Traditional Medicine Practitioners (NANTMP), which is the umbrella body for all The TBA and Faith Based Organizations providing health care in Nigeria. Informed consent was obtained from the selected TBA. Only TBAs who gave their consent were interviewed. 142 TBAs consented to the study, giving a response rate of 97.9%.

Results

Socio-demographic and practice characteristics (Tables 2)

One hundred and forty two TBAs consented to the study, giving a response rate of 97.9%. There were 60 (42.3%) males and 82 (57.7%) females. Most (45.1%) of the participants were within the age group of 45-59 years; while 31.0% were aged between 25 and 44 years. The mean age of the participants was 49.56 ± 12.66 years. The majority, 132 (93.0%), of the participants were married at the time of the survey, while 140 (98.6%) of them were Yoruba by ethnicity. Seventy two (50.7%) participants were Muslims, while 50 (35.2%) were Christians. About one-third, 46 (32.4%), had completed primary, 74 (52.1%) secondary, 16 (11.3%) tertiary education; however, 6 (4.2%) had no formal education. About half (47.9%) of the participants had between 1 and 10 years of practice as TBA; 31.0% had practiced for between 11 and 20 years; 16.9% had practiced for between 21 and 30 years while only 4.2% had more than years of practice as TBA. The mean duration of practice was 13.25 ± 8.78 years. Majority (57.7%) of the participants had their basic TBA trainings by relatives while 42.3% were trained by non relatives. The duration of training was between 1 and 10 years for 83.1% of the participants while 16.9% of them underwent training for more than 10 years. Most (91.5%) participants offer services other than antenatal and delivery services. The services include treatment of infertility (43.7%), family planning (40.8%), and circumcision (38.0%).

Demographic characteristics Frequency (n= 142 ) %
Age in years    
25-44 44 31.0
45-59 64 45.1
≥ 60 34 23.9
Sex    
Male 60 42.3
Female 82 57.7
Educational status    
None 6 4.2
Primary 46 32.4
Secondary 74 52.1
Tertiary 16 11.3
Religion    
Christianity 50 35.2
Islam 72 50.7
Traditional African 20 14.1
Ethnicity    
Yoruba 140 98.6
Others 2 1.4
Years of Practice    
1 to 10 years 68 47.9
11-20 years 44 31.0
21-30 years 24 16.9
> 30 years 6 4.2
Source of basic training    
Relatives 82 57.7
Non relatives 60 42.3
Duration of basic training    
1 to 10 years 118 83.1
> 10 years 24 16.9
Average number of deliveries attended per month    
1-5 94 66.2
6-10 26 18.3
>10 22 15.5
Engagement in other work activities    
Yes 130 91.5
No 12 8.5
Other work activities*    
Family Planning 58 40.8
Scarification/incisions 4 2.8
Circumcision 54 38.0
Infertility treatment 62 43.7

Table 2: Socio-demographic and occupational characteristics of TBAs in Ogun State, Nigeria March 2014.

Knowledge of MTCT and PMTCT of HIV infection among TBA (Figure 1)

The current study assessed the knowledge of TBA on MTCT of HIV. All of the participants were aware of HIV/AIDS. The major sources of awareness of HIV/AIDS were other health workers (38.1%), the media (31.0%), and workshop/seminars (25.4%). Most (90.8%) of the participants knew about transmission of HIV from infected mother to her child. Participants who could correctly identify the temporal mode of MTCT of HIV varied from 69.0% for ante-partum; 76.1% during labour and delivery to 60.6% during breastfeeding. There were misconceptions that infants could contract HIV through infant formulae feeding (15.5%), herbal concoctions (8.5%) and through demonic attacks (7.0%).

aids-clinical-research-knowledge

Figure 1: MTCT and PMTCT of HIV knowledge scores among TBAs in Nigeria, March 2014.

The current study also assessed the knowledge on PMTCT of HIV/ AIDS of TBA. Majority of them (81.7%) knew that MTCT of HIV is preventable. Majority of the participants knew that knowledge of HIV status (94.4%); and HCT (98.6%) were important for pregnant women. Almost all of them (98.6%) knew a referral centre for care of HIV positive pregnant women. Ninety four (66.2%) of them knew that ART drugs use by HIV-positive pregnant mothers could reduce the risk of HIV transmission. Majority of the participants, 138 (97.2%), knew that a child from HIV-positive mother need follow-up at ART clinic. Among these participants, 32 (22.5%), said that a child need follow-up for six months, 4 (2.8%) for one year and 106 (74.6%) until proven HIV negative. All the participants knew that the observance of universal precautions during labour and delivery is pertinent to PMTCT of HIV.

More than half (52.1%) thought that discouraging breastfeeding in all HIV positive mothers irrespective of whether they were on drugs or not is the ideal infant feeding option. A few of the participants thought that herbal concoctions, scarification and traditional rituals would are effective in PMTCT of HIV.

The mean knowledge score for MTCT and PMTCT of HIV among the TBAs was 16.89 ± 1.89 with lowest and highest scores of 12 and 20. Figure 1 shows the distribution of the knowledge scores. Eighty six (60.6%) and 56 (39.4%) of the participants had above and below average knowledge of MTCT and PMTCT scores respectively.

Association between TBA characteristics and knowledge of MTCT and PMTCT of HIV infection (Table 3)

The bi-variate analysis revealed that sex, religion, source and duration of training, years of experience and the average monthly deliveries attended by the participants did not have significant association with knowledge of MTCT and PMTCT of HIV (p>0.05). However, age (χ2 = 3.950, p = 0.047) and educational status (χ2 = 11.448, p = 0.001) were associated with knowledge of MTCT and PMTCT of HIV. On multivariate analysis, age was not significantly associated (AOR = 1.290, 95% CI = 0.538-3.094) while participants with at least secondary school education (AOR = 3.020, 95% CI = 1.362-6.697) were like average knowledge of MTCT and PMTCT of HIV.

Characteristics Above average knowledge of MTCT X2 (p value) AOR (95% CI)
  Yes No    
Age in years        
Less than  45 32 (72.7) 12 (27.3) 3.950 (0.047)* 1.290 (0.538-3.094)
45 or more 54 (55.1) 44 (44.9)    
Sex        
Male 34 (56.7) 26 (43.3) 0.661 (0.416)  
Female 52 (63.4) 30 (36.6)   1.286 (0.555-2.981)
Educational status        
Primary school or less 22 (42.3) 30 (57.7) 11.448 (0.001)*  
Secondary or more 64 (71.1) 26 (28.9)   3.020 (1.362-6.697)*
Religion        
Christianity 36 (72.0) 14 (28.0) 4.429 (0.109) 2.486 (0.731-8.334)
Islam 40 (55.6) 32 (44.4)   1.057 (0.314-3.552)
Traditional 10 (50.0) 10 (50.0)    
Years of Practice        
10 years or less 40 (58.8) 28 (41.2) 0.165 (0.684) 0.448 (0.188-1.069)
More than 10 years 46 (62.2) 28 (37.8)    
Source of basic training        
Relatives 52 (63.4) 30 (36.6) 0.661 (0.416) 1.883 (0.851-4.166)
Non relatives 34 (56.7) 26 (43.3)    
Duration of basic training        
1 to 10 years 72 (61.0) 46 (39.0) 0.060 (0.806) 1.856 (0.634-5.436)
> 10 years 14 (58.3) 10 (41.7)    
Average number of deliveries attended per month        
5 or less 58 (61.7) 36 (38.3) 0.151 (0.698)  
More than 5 28 (58.3) 20 (41.7)   0.895 (0.387-2.068)

Table 3: Factors related to good knowledge of MTCT and PMTCT of HIV infection among TBAs in Ogun State, Nigeria, March 2014.

Practices of PMTCT of HIV infection among TBA (Figure 2)

Prevention of mother-to-child transmission and factors affecting its practice among the TBA were assessed using the different explanatory variables. One hundred and twenty six (88.7%) of the TBA always offer HCT services to all pregnant women. Majority of them, 122 (85.9%) always refer HIV positive women to treatment centres, while, 126 (88.7%) of them always provide referral support for patients (for any indication).

aids-clinical-research-nigeria

Figure 2: PMTCT care practice scores among TBAs in Nigeria, March 2014.

More than half of the TBA (57.7%) encourage all HIV positive mothers to breastfeed their newborns irrespective of whether they on ART or not. However, 114 (80.3%) of the participants encourage and support HIV positive mothers on ART to breastfeed their infants. One hundred and ten (77.5%) participants encourage and support HIV positive pregnant women; mothers and their infants on ART drugs to comply with their medication; while, 18.3%, 12.3% and 8.7% offer herbal concoctions, scarification and traditional rituals respectively for treatment of HIV positive women. Eighteen participants give babies born to HIV positive mothers herbal concoctions to prevent HIV infection.

Most of the participants always observe universal precautions when caring for pregnant women. Ninety three percent of them always use sterile instruments; 128 (90.1%) always use new razor to cut every umbilical cord and, 138 (97.2%) always use a new pair of sterile glove for each new procedure.

The mean PMTCT care practice score for the participants was 45.85 ± 9.48 with lowest and highest scores of 0 and 56. Figure 2 shows the frequency distribution of the scores. One hundred and four (73.2%) and 38 (26.8%) of the participants had above and below average PMTCT care practice scores respectively.

Association between TBA characteristics and practices of PMTCT of HIV/AIDS (Table 4)

The bi-variate analysis revealed that age, sex, religion, source and duration of training, years of experience and the average monthly deliveries attended by the participants did not have significant association with PMTCT care practice. Knowledge of MTCT and PMTCT of HIV was also not significantly associated with PMTCT care practice. Educational status (χ2 = 5.417, p = 0.020) was associated with PMTCT care practice. Logistic regression analysis revealed that TBA who had primary school education or none at all were more likely (AOR = 2.750, 95% CI = 1.150-6.574) to have above average PMTCT care practices than those who had secondary school or higher education.

Characteristics Above average PMTCT care practice X2 (p value)
  Yes No  
Age in years      
Less than  45 28 (63.6) 16 (36.4) 3.000 (0.083)
45 or more 76 (77.6) 22 (22.4)  
Sex      
Male 42 (70.0) 18 (30.0) 0.556 (0.456)
Female 62 (75.6) 20 (4.4)  
Educational status      
Primary school or less 44 (84.6) 8 (15.4) 5.417 (0.020)*
Secondary or more 60 (66.7) 30 (33.3)  
Religion      
Christianity 32 (64.0) 18 (36.0) 4.251 (0.119)
Islam 58 (80.6) 14 (19.4)  
Traditional 14 (70.0) 6 (30.0)  
Years of Practice      
10 years or less 48 (70.6) 20 (29.4) 0.468 (0.494)
More than 10 years 56 (75.7) 18 (2.3)  
Source of basic training      
Relatives 60 (73.2) 22 (26.8) 0.000 (0.983)
Non relatives 44 (73.3) 16 (26.7)  
Duration of basic training      
1 to 10 years 88 (74.6) 30 (25.4) 0.637 (0.425)
> 10 years 16 (66.7) 8 (33.3)  
Average number of deliveries attended per month      
5 or less 70 (74.5) 24 (25.5) 0.214 (0.644)
More than 5 34 (70.8) 14 (29.2)  
Knowledge of MTCT and PMTCT of HIV      
Above average 68 (79.1) 18 (20.9) 3.782 (0.052)
Below average 36 (64.3) 20 (35.7)  

Table 4: Factors related to good practice of PMTCT of HIV infection among TBAs in Ogun State, Nigeria, March 2014.

Discussion

The global goal of eliminating MTCT (e-MTCT) of HIV is most relevant to sub-Saharan Africa where majority of vertical transmission of HIV occur. In Nigeria, where most deliveries and high proportions of antenatal care are attended by TBA, it is important to create awareness and enhance PMTCT care practices among this category of health workers.

This current study assessed the knowledge and practices of TBAs in Nigeria as it relates to PMTCT of HIV. The study revealed that while more than 90% of TBAs were aware of MTCT of HIV, three out of every five of them had good knowledge of MTCT and PMTCT of HIV. Misconceptions about the modes of MTCT of HIV and feeding of HIV exposed infants were found to be in existence. While age and level of education completed by the TBAS were related to their knowledge of MTCT and PMTCT of HIV; their knowledge was only predicted by higher level of education. Majority of the TBAs offered HCT, referral and referral support services. Universal precaution was also widely practiced. Breastfeeding and ART adherence support were however not as good. Some of the TBAs give herbal concoctions, scarification marks and perform traditional rituals in order to prevent HIV transmission. Almost three-quarters of the TBAs were found to have good PMTCT practices. PMTCT care practice was predicted by lower level of education.

This study shown that all the TBA are twenty five years or older; they are predominantly married, females with at least primary school education. These socio-demographic findings match the criteria put forward by Federal Ministry of Health for selecting TBA for training in Nigeria [21]. There was universal awareness of HIV/AIDS among the participants. The awareness of MTCT and PMTCT of HIV were not universal. This is similar to findings among TBA and indeed pre and postnatal women in Nigeria and other parts of Africa [2,20,22,23]. However, the level of awareness of MTCT of HIV was higher than that found in Lagos, Nigeria by Balogun et al in 2010 [20]. The sources of information about HIV found in the current study represents a significant shift from what Balogun et al found in 2010 when more than 75% of TBA got information from health workers. Our findings probably reflect the increased interest in the subject with the involvement of the media in the campaign coupled with trainings and workshops for various cadres of health workers including TBA. This may also account for the significantly better knowledge of TBA about MTCT and PMTCT of HIV compared to earlier findings, despite that the level of awareness of PMTCT remained essentially the same [20]. Misconceptions about feeding of HIV exposed infants, use of herbal concoctions and scarification, and the importance of demons and traditional rituals to MTCT of HIV and its prevention still persist. Similar findings have been reported by previous studies [2,20,24]. The knowledge of TBAs about MTCT and PMTCT of HIV is predicted by their level of education. Those with at least secondary school education were likely to have better knowledge of the subject. This is similar to findings in Ethiopia in 2013. Previous studies implied that improvement in women’s educational status enables them to have better knowledge on PMTCT that decreases infant mortality and improve their health [2,25-27]. This would seem to lend credence the FMoH’s suggested selection criteria of a minimum of secondary education for training of TBA in PMTCT of HIV [21]. However, considering that between one-third and half of TBA have less than secondary school education, excluding them may amount to loss of a huge proportion of the already inadequate human resources for the e-MTCT of HIV.

The PMTCT care practices of the TBA are good when compared with findings from earlier studies in Nigeria [28-30]. These studies however precede the 2010 launching of the national scale up plan towards e-MTCT of HIV in Nigeria by the FMoH. The findings are similar to that of Abajobir and Zeleke in Ethiopia in 2013 [2]. Universal precautions are largely observed; HCT services are offered to pregnant women with prompt referrals of HIV positive women by majority of the TBA. However, breastfeeding practices and support for patients on ART to ensure compliance are less than desirable. Harmful and unhelpful traditional practices which are erroneously thought to help in PMTCT of HIV still persist among the TBA. These deficiencies and malpractices by the TBA may encourage the spread of HIV while giving a false impression of protection instead of the TBAs employing more valid means of PMTCT of HIV. There is a need to address these deficiencies. The discrepancy in the association level of education predictors with knowledge and practice of PMTCT is surprising. However, this may underscore the known fact that knowledge and practice are not necessarily associated and may be predicted by different factors [31-33].

Certain limitations of this study should be taken into account when interpreting the findings. The study was cross-sectional in design; hence, causality cannot be established. The use of self-reported data is prone to a number of biases that could affect the reliability and validity of the findings. There could be recall biases and self-presentation or confidentiality concerns. This was, however, mitigated by assuring the TBA of full confidentiality and conducting the survey in a private environment. A particular strength of the current study is that the sample of TBA is representative and the findings can be generalised to all TBA in Nigeria. The findings can be scaled up nationally towards the eMTCT of HIV in Nigeria.

Conclusion

TBAs have a definite role to play in the e-MTCT of HIV in Nigeria and are poised to do so. They have access to a sizeable proportion of pregnant women before, during and after delivery. They have some knowledge and good practices as it relates to MTCT and PMTCT of HIV. It is however, imperative to set up a campaign towards universal awareness of MTCT and PMTCT of HIV among TBA; and to improve their knowledge of the subject through campaigns that use multiple, integrated methods of health education. Misconceptions about MTCT and PMTCT of HIV need to be specifically targeted for an effective engagement of TBA in the e-MTCT of HIV. Innovative health education methods that are focused on those with lower levels of education need to be researched and employed to bridge the knowledge gap that seems to exist as a result of the educational status of the TBA. It is important to clarify the policy guideline as it relate to feeding practices in HIV exposed infants and to support the TBA to adopt and fully integrate the strategies into their practice. Harmful and unhelpful traditional practices need to be discouraged. Interactions with TBA that are best on due recognition may aid in the drive to end these practices.

Competing Interests

The authors declare that they have no any competing interests.

Acknowledgements

We are grateful to all data collectors, supervisors and research participants who took part in the study.

References

Select your language of interest to view the total content in your interested language
Post your comment

Share This Article

Recommended Conferences

Article Usage

  • Total views: 14709
  • [From(publication date):
    July-2015 - Dec 19, 2018]
  • Breakdown by view type
  • HTML page views : 10659
  • PDF downloads : 4050
 

Post your comment

captcha   Reload  Can't read the image? click here to refresh

Peer Reviewed Journals
 
Make the best use of Scientific Research and information from our 700 + peer reviewed, Open Access Journals
International Conferences 2018-19
 
Meet Inspiring Speakers and Experts at our 3000+ Global Annual Meetings

Contact Us

Agri and Aquaculture Journals

Dr. Krish

[email protected]

+1-702-714-7001Extn: 9040

Biochemistry Journals

Datta A

[email protected]

1-702-714-7001Extn: 9037

Business & Management Journals

Ronald

[email protected]

1-702-714-7001Extn: 9042

Chemistry Journals

Gabriel Shaw

[email protected]

1-702-714-7001Extn: 9040

Clinical Journals

Datta A

[email protected]

1-702-714-7001Extn: 9037

Engineering Journals

James Franklin

[email protected]

1-702-714-7001Extn: 9042

Food & Nutrition Journals

Katie Wilson

[email protected]

1-702-714-7001Extn: 9042

General Science

Andrea Jason

[email protected]

1-702-714-7001Extn: 9043

Genetics & Molecular Biology Journals

Anna Melissa

[email protected]

1-702-714-7001Extn: 9006

Immunology & Microbiology Journals

David Gorantl

[email protected]

1-702-714-7001Extn: 9014

Materials Science Journals

Rachle Green

[email protected]

1-702-714-7001Extn: 9039

Nursing & Health Care Journals

Stephanie Skinner

[email protected]

1-702-714-7001Extn: 9039

Medical Journals

Nimmi Anna

[email protected]

1-702-714-7001Extn: 9038

Neuroscience & Psychology Journals

Nathan T

[email protected]

1-702-714-7001Extn: 9041

Pharmaceutical Sciences Journals

Ann Jose

[email protected]

1-702-714-7001Extn: 9007

Social & Political Science Journals

Steve Harry

streamtajm

[email protected]

1-702-714-7001Extn: 9042

 
© 2008- 2018 OMICS International - Open Access Publisher. Best viewed in Mozilla Firefox | Google Chrome | Above IE 7.0 version