KNOWLEDGE AND PRACTICE OF TRADITONAL BIRTH ATTENDANTS ON THE PREVENTION OF MOTHER-TO-CHILD HIV TRANSMISSION IN IBADAN METROPOLIS, OYO STATE, NIGERIA

Abstract

Prevention of Mother-to-Child Transmission (PMTCT) a strategy to reduce HIV infection during pregnancy, delivery and breastfeeding. Traditional birth attendants (TBAs) take significant numbers of deliveries in Nigeria. However few studies have focused on knowledge and practices or PMTCT amongst TBAs. This study was designed to assess TBAs’ knowledge or HIV Modes of Transmission (HMOT), Universal Safety Precautions (USP), and practices related to PMTCT in selected Local Government Areas (LGAs) in Ibadan. The study was cross-sectional in design. A total sampling method was used to recruit 234 registered and 127 unregistered TBAs in three randomly selected LGAs (Ibadan North, Ibadan North-West, and Ibadan South-East) in Ibadan metropolis. The pre-tested interviewer administered questionnaire was used to elicit information on socio-demographic characteristics, knowledge of HMOT, USP and PMTCT. It also included sections on practice of USP and PMTCT services such as HIV counselling, referral to health centres and infant feeding counselling. Knowledge on HMOT, USP and PMTCT were assessed with maximum scales or I0. 18 and 24 points respectively. Knowledge scores ≤5, ≤ 9 and ≤l2 were considered poor on HMOT, USP and PMTCT respectively. Practice of USP and PMTCT were measured on a 30 and 12 point scale respectively. Respondents with scores ≤15 and ≤ 6 were referred to as poor USP and PMTCT practices respectively. Data were analysed using descriptive statistics, Chi-square and logistic regression tests at a significant level of p <0.05. Respondents’ mean age and work experience were 45.4 ± 1 l.5 and 2.9 ± 0.8 years respectively. Most (91.7%) were females and 56.0% had secondary education. Respondents with poor knowledge of HMOT, USP and PMTCT were 16.9%, 5.0%, and 60.7% respectively. Overall poor practice of USP and PMTCT were 9.7% and 12.5% respectively. Most (85.9%) respondents reported keeping records of their activities. Most (56.8%) had been trained on safe delivery practices. The predominant USP practices were use of gloves (65.9%), wearing of protective clothing (58.4%), and sterilization of instruments in hot water (55.1%). Respondents' practice of PMTCT included HIV counselling (81.7%) and patients' referral for IUV testing at health centres (78.9%). A third (32.4%) of the respondents had attended to a patient living with HIV a year preceeding the study. Of these, 29.9% did not counsel patients on PMTCT, 70.9% did not render counselling services for infant feeding, 9.5% took HIV patients' delivery without any special precautions and 12.0% treated them with herbal concoctions. Significantly, unregistered TBAs (68.5%) had poor knowledge of PMTCT than registered TBAs (97.9%). Respondents with poor knowledge of PMTCT practices were less likely to engage in good practice (OR: 0.3%, 95% CI: 0.11 - 0.81). Registered TBAs were more likely to practice PMTCT (OR: 2.5, 95% CI: 1.27 - 4.9). Knowledge of prevention of mother-to-child transmission of HIV was poor among the traditional birth attendants in Ibadan metropolis. Periodic training and improved advocacy for the registration of traditional birth attendants is therefore recommended.