Prevention of mother-to-child transmission

Prevention of mother-to-child transmission

Traditional birth attendants lack basic information on HIV and safe delivery practices in rural Mysore, India.

Madhivanan P, Kumar BN, Adamson P, Krupp K. BMC Public Health. 2010;10(1):570.

There is little research on HIV awareness and practices of traditional birth attendants in India. This study investigated knowledge and attitudes among rural traditional birth attendants in Karnataka as part of a project examining how traditional birth attendants could be integrated into prevention-of-mother-to-child transmission of HIV programs in India. A cross-sectional survey was conducted between March 2008 and January 2009 among traditional birth attendants in 144 villages in Mysore Taluk, Karnataka. Following informed consent, traditional birth attendants underwent an interviewer-administered questionnaire in the local language of Kannada on practices and knowledge around birthing and HIV/ prevention-of-mother-to-child transmission. Of the 417 traditional birth attendants surveyed, the median age was 52 years and 96% were Hindus. A majority (324, 77.7%) had no formal schooling, 88 (21.1%) had up to 7 years and 5 (1%) had more than 7 yrs of education. Only 51 of the 417 traditional birth attendants (12%) reported hearing about HIV. Of those who had heard about HIV, only 36 (72%) correctly reported that the virus could be spread from mother to child; 37 (74%) identified unprotected sex as a mode of transmission; and 26 (51%) correctly said healthy looking people could spread HIV. Just 22 of those who had heard about HIV (44%) knew that infected mothers could lower the risk of transmitting the virus to their infants. An overwhelming majority of traditional birth attendants (401, 96.2%) did not provide antenatal care to their clients. Over half (254, 61%) said they would refer the woman to a hospital if she bled before delivery, and only 53 (13%) felt referral was necessary if excessive bleeding occurred after birth. Traditional birth attendants will continue to play an important role in maternal child health in India for the foreseeable future. This study demonstrates that a majority of traditional birth attendants lack basic information about HIV and safe delivery practices. Given the ongoing shortage of skilled birth attendance in rural areas, more studies are needed to examine whether traditional birth attendants should be trained and integrated into prevention-of-mother-to-child transmission and maternal child health programs in India.

Editors’ note: That 88% of the 417 traditional birth attendants interviewed in this study had never heard of HIV is astounding given the age of the HIV epidemic in India (more than two decades) and general public awareness documented in sentinel surveillance surveys in rural areas (75% in 2006). But it is not just HIV knowledge that is lacking. Considering that obstetrical haemorrhage and sepsis are the leading causes of maternal deaths in India, knowledge about safe birthing practices was also low. Given that India has a Millennium Development Goal to reduce the estimated maternal mortality ratio from 450 to 109 maternal deaths per 100,000 live births, given that only 20% of the estimated 50,000 HIV-positive pregnant women receive prophylaxis to prevention HIV transmission to their infant, and given the shortage of skilled birth attendants in rural areas, programme planners face a dilemma. Can illiterate, unskilled traditional birth attendants play significant roles in improving maternal and child outcomes and preventing HIV transmission? They could do so if their services could be integrated into maternal child health programmes in India with adequate training, supplies, supervision, and support – but this will take some doing.