Adherence to universal precautions with reference to HIV infection among midwives and trained traditional birth attendants during home and health centre deliveries in Siavonga and Mazabuka Districts

Abstract

A cross sectional study was undertaken in both Siavonga and Mazabuka Districts. The general objective of the study was to determine if Universal Precautions were adhered to, and the reason for non-adherence among midwives, nurses who perform deliveries in the health centres and trained traditional birth attendants who perform deliveries in homes. It was hypothised that trained traditional birth attendants (TB ) and midwives adhere to Universal Precautions (UPS) during deliveries performed at home and health centres. A convenient sampling method was used. A total number of 63 midwives including nurses and 64 trained traditional birth attendants were interviewed for the study. Data was collected using two semi-structured questionnaires during a face-to-face interview. Questionnaire one was for the practicing midwives and nurses, while questionnaire two was for the practicing tTBAs. Two Focus Group Discussions (FGDs) were held; one for the midwives and nurses and the other for the trained traditional birth attendants. A checklist was used to observe routine deliveries for the midwives and nurses as well as tTBAs, although it was not possible to observe any routine deliveries for tTBAs because of poor communication and transport to the delivery sites. Epi-info 6 and SPSS were used to analyze data. The Chi-square was used to measure association between qualitative factors, and the cut off point for statistical significance was set at 5 percent. Regression analysis was also done to determine the value of the independent variables, which are the factors associated with adherence to Universal Precautions. The study findings revealed that the proportion of midwives and nurses adhering to Universal Precautions was 63.5%, while that of the trained traditional birth attendants was 67.2%.The most significant factors related to adherence for the midwives and nurses were the availability of medical supplies and the inclusion of UPS in their training. Respondents who were trained in UPS were 24.89 (95% CI 1.63, 380.59) times more likely to have adhered to UPS. Respondents who received weekly medical supplies were 11.86 (95% CI 2.10, 67.03) times more likely to adhere to UPS compared to respondents who received monthly supplies. Trained traditional birth attendants who had heard of

Universal Precautions were 5.61 (95% CI 1.90,16.55) times more likely to have adhered to Universal Precautions. Focus Group Discussions conducted among midwives and nurses revealed that they had knowledge of the standard Universal Precautions (UPS) through their training, but could not apply that knowledge because of the unavailability of medical supplies. Focus Group Discussions conducted among trained traditional birth attendants revealed that they have heard of Universal Precautions through their training, but they needed more knowledge through workshops, and, refresher courses. Adequate medical supplies and refresher courses would enhance adherence to Universal Precautions. Observations of routine deliveries for the midwives and nurses showed that 63.9% adhered to Universal Precautions. This confirms the responses made through the use of the questionnaire.