Health workers' knowledge on mother to child transmission of HIV and infant feeding options available for HIV positive mothers in Dar es Salaam

Abstract

A cross sectional study was conducted in three Districts (Ilala, Kinondoni, and Temeke) of Dar es Salaam Region in June 2005. The aim of the study was to determine health workers knowledge on Mother to Child Transmission of HIV and infant feeding options available for HIV positive mothers. The study objectives were to determine knowledge of health workers on MTCT and infant feeding options available for HIV positive mothers. Determining explanatory factors of these levels of knowledge, source of the health workers information and problems faced by the health workers when giving advice to HIV Infected mothers. Also to determine whether health workers are trained on HIV and infant feeding. A total of 255 health workers from various government and private health facilities were interviewed. Stratified random selection was applied in the selection of private and government health facilities and also on selection of level of health facility. Simple random sampling method was used in selecting health facility within strata. In the selected health facility all the health workers eligible for the study were interviewed. Information was obtained by using structured questionnaire with both closed and open- ended questions.

In-depth interview was conducted with managers of HIV / AIDS related health projects and officials in the Ministry of health. A semi-structured questionnaire with open-ended questions was used. Questions asked were on policy issues, training of the health workers and dissemination of information to the target population. Data entry, cleaning and analysis was done using Epi info 6 packa~e. The main findings of the study showed that 71.8% of respondents had moderate level of knowledge on MTCT of HIV whereby a higher proportion of respondents from government (73.3%) had moderate level compared to the private (69.7%). The most known mode of MTCT of HIV was transmission through breastfeeding. Poor level of knowledge on infant feeding option was found in 52.9% of respondents whereby a higher proportion of respondents with poor knowledge were from private health facilities. The most common breast milk option mentioned was exclusive breastfeeding for six months and commercial infant formula as replacement feeding option. Explanatory factors of the levels of knowledge were cadre of the respondent, education, ownership and level of health facility, training status of the respondent on HIV and infant feeding. Sources of information for majority of the health workers (64.7%) was through mass media such as radio and TV. 44.3% mentioned on the job training as source of where they learn about MTCT and infant feeding options available. A lower

Vlll proportion of respondents (19.3%) from private facilities got informed through seminars compared to government 23.9%. There was inadequacy of IEC materials on infant feeding in all private and government health facilities. IEC materials such as brochures, posters and leaflets on MTCT were found in a slightly higher proportion in government health facilities 33.6% compared to private 12.8%. Problems faced by the health workers when grving advice to HIV positive mothers include financial constraints of the mothers, stigma attached to HIV, inability to implement choices by HIV positive women, lack ofVCT services, lack of knowledge on infant feeding options available for HIV positive mothers and heavy workload which lead to respondents not having enough time to talk to the mothers. Training of health workers on HIV and infant feeding was found to be inadequate as only 14.1% out of 255 respondents were trained, those trained majority were from government health facilities compared to private. A slightly higher proportion of trained respondents were from health centers compared to other levels of health facility. Also a higher proportion of trained respondents were from MCH clinics compared to labor ward and pediatric wards.

lX HfV and infant feeding is not included in training curricula of health care providers. Some health workers have received training on mv and Infant feeding, however, retraining of health care providers on these was lacking due to inadequacy of funds. It was established that there is lack of VCT and PMTCT services and also lack of National policy on mv and infant feeding and clear strategies to decrease stigmatization of those affected by my. Recommendations given were that there is need to conduct trainings and seminars on HfV and infant feeding to health workers in both public and private health facilities. HIV and infant feeding be integrated in pre service medical and nursing curricula. Promote use of mass media (radio, newspapers, brochures and leaflets) in disseminating information on infant feeding options in both public and private health facilities. Relevant authorities e.g. MOH, NGOs and Institutions should organize public education campaigns and provide education materials that address MTCT, infant feeding, stigma and discrimination for community use. The government to develop National Policy on mv and infant feeding so as to provide guidance to the different stakeholders in the field of infant and young child nutrition. Expand the existing services of PMTCT and VCT sites to areas where they are not available.