Background
Despite the implementation of WHO guidelines on the Prevention of Mother to Child Transmission of HIV (PMCTC), the persistent burden of HIV among children remains a significant public health challenge that warrants urgent attention. In Cameroon, significant strides are being made toward alleviating this burden; however, the national objectives aimed at completely eradicating pediatric HIV have yet to be fully achieved.
Numerous studies have identified various barriers that hinder access to PMTCT services among targeted populations, including financial constraints, geographical limitations, and a general lack of essential information regarding HIV prevention strategies. Comprehensive demographic and health surveys conducted over the past three decades in Cameroon reveal a concerning overlap between low access to antenatal care and inadequate uptake of PMTCT services, especially pronounced in the Far North Region. Here, the limited coverage of interventions designed for pregnant women remains significantly below the established targets.
According to the 2018 demographic health survey and the 2017 Cameroon Population-based HIV Impact Assessment, the prevalence rates of HIV in the Far North region were recorded at 1.1% and 1.5%, respectively. However, a 2020 PMTCT national report indicated that only 63% of children exposed to HIV between 6 and 8 weeks of age underwent screening via Polymerase Chain Reaction (PCR). Alarmingly, there was also a documented mother-to-child HIV transmission rate of 17.33% in the same region.
In efforts to enhance access to PMTCT services, several innovative strategies have been launched. Notably, the integration of multiple health interventions has proven effective in significantly increasing the coverage of service utilization among patients attending health facilities. Furthermore, the adaptation of the “Reaching Every District” (RED) approach has been instrumental in expanding the coverage, access, and utilization of PMCTC services. This approach focuses on detecting and delivering necessary care to underserved populations who are not adequately reached by conventional facility-based care mechanisms. In rural areas of Cameroon, where access to healthcare is often constrained by geographical, cultural, and financial barriers, the role of traditional birth attendants (TBA) has been highlighted as a key factor in enhancing the delivery of prenatal, natal, and post-natal care.
Recognizing the importance of collaboration, the integration of TBA with health personnel in executing PMTCT interventions is expected to improve access to essential services for target populations, thereby bridging the gap in healthcare delivery.
M.A. SANTE (Meilleur Accès aux Soins de Santé), a Cameroon-based non-governmental organization, implemented an 18-month project from May 2018 to April 2020 aimed at improving access to PMTCT interventions in the Kousseri and Mada health districts, located in the Far North region. This initiative involved training and engaging TBA to identify and refer pregnant women from local communities to health facilities for antenatal care while organizing community sessions to administer vital PMTCT interventions for those unable to access facility-based services. The community-based sensitization sessions informed women about effective HIV prevention measures and the importance of attending antenatal services, which are crucial for safeguarding maternal and child health.
Materials and Methods
Activities of TBA in Exposed Communities
In exposed communities, TBA were trained to refer pregnant women to health facilities for vital antenatal care consultations and services. They were also tasked with identifying high-risk pregnancies and ensuring these cases received appropriate referrals to medical facilities to ensure timely and effective care.
Study Settings and Period
The survey was conducted in November 2020. The study was implemented in the health districts of Mada and Kousseri located in the Cameroonian region near Lake Chad. This area is characterized by challenging conditions, including ongoing conflict from Boko Haram terrorism and limited access to healthcare due to geographical and seasonal factors.
Between May 2018 and April 2020, 37 villages received support through this project aimed at enhancing community access to PMTCT interventions by training 60 TBA to effectively organize and deliver community-based PMTCT care. Data collection occurred six months after the intervention’s implementation.
Outcome Assessment
The primary outcome measured was the frequency of mothers’ HIV testing during their index pregnancy, as documented in antenatal care booklets.
Data Collection Tools and Variables
The data collection form was developed electronically by the study team, local health personnel involved in PMTCT care, and local volunteers.
Data Collection
Data were systematically collected by trained surveyors using Open Data Kit (ODK) forms on smartphones, through face-to-face interactions with the heads of households.
Sample Size
The minimum sample size estimated was 195 participants for each group, calculated using statistical parameters aimed at ensuring the reliability of the study’s findings.
Data Analysis
Characteristics of mothers and children were compared among the exposed and non-exposed groups using statistical analysis to determine the effectiveness of training and engaging TBAs in the PMTCT program.
Ethical Considerations
Results
Characteristics of Study Population
A total of 637 mother-child couples participated in the study, with a notable distribution between the exposed and control groups.
Association Between Exposed Mother-Child Pairs and PMTCT Outcomes
The results indicated a considerably higher access to mother antenatal HIV testing within exposed communities compared to non-exposed ones, marking a significant achievement in reaching at-risk populations.
Comparing Other Key Elements of PMTCT Cascade Between Study Groups
The evaluation showed that although the proportion of mothers receiving their HIV test results was similar across both groups, other critical aspects of the PMTCT cascade demonstrated varying results that merit further investigation.
Discussion
This study explores the impact of TBAs in promoting education about HIV prevention and screening, significantly increasing the rates of maternal HIV testing and screening among pregnant women.
Conclusions
The findings suggest that involving traditional birth attendants in educational outreach and organized testing can lead to increased rates of HIV screening amongst pregnant women in vulnerable communities. However, additional research is needed to enhance access to prenatal consultations.
Data Sharing Statement
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Ethics Approval and Consent to Participate
The protocol was approved by the Cameroon National ethics committee. All participants provided their written consent prior to participation.
Acknowledgments
We would like to acknowledge the health authorities of the Mada and Kousseri health districts for their invaluable support and involvement during the implementation of study activities.
Funding
The present study was funded by The Positive Action for Children Fund (ViiV Healthcare). The funding body was not involved in the study’s design, data collection, analysis, or writing of the manuscript.
Disclosure
The authors declare that they have no competing interests.
References
HIV and Traditional Birth Attendants: A Cameroonian Saga
Alright, folks, gather around. Today, we’re diving into something that sounds like a serious medical drama set in Cameroon but is actually all about addressing the big bad wolf known as HIV. I mean, if HIV were a character in a soap opera, it’d definitely be that villain that just won’t go away, isn’t it?
The Ugly Truth About HIV Transmission
So, despite the gospel of the WHO’s guidelines on the Prevention of Mother to Child Transmission of HIV (PMTCT) blaring from every health corner, the sandcastle that is HIV prevention among children is at risk of getting swept away by the tide. In Cameroon, they’ve got their surfboards out, but they’re still struggling to keep afloat. The national objectives? Still hanging around like a bad smell.
The studies suggest the usual suspects are at play here: money—who has it?—the location—who can get to care?—and basic information—who knows what? It’s like a bad game of Monopoly but without any fun. In fact, in the Far North Region, antenatal care and PMTCT access are doing a sad little tango, where neither partner is stepping up to the mat. And the stats? Not pretty. Only about 63% of children exposed to HIV are being screened by the fancy PCR method. That’s like having a fancy car but never driving it. What’s the point?
Traditional Birth Attendants to the Rescue? Maybe…
Now, let’s talk about some of the strategies that are sprouting up as solutions. You’ve got your trusty Traditional Birth Attendants (TBAs) being trained to save the day—think of them as the superheroes of this tale, minus the capes but with plenty of heart. The idea here is to integrate these local heroes into PMTCT interventions like they’re the secret sauce to this recipe of care. And Dr. Marvel and his friends seem to think this could actually work!
The local NGO M.A. SANTE (which hilariously stands for “Better Access to Health Care” but sounds like a brunch place) rolled up their sleeves and trained these TBAs between May 2018 and April 2020. They got them in on the action—guiding pregnant women like they’re leading a group tour through the wilds of HIV prevention. And who wouldn’t want that? “First stop: health facility for antenatal care!”
Shenanigans with Data: Did it Work? Spoiler Alert!
Now let’s talk data! They managed to pull together a cohort of 637 mother-child pairs. No, it’s not the cast of a reality show, but they did manage to dig up some gold. Those exposed to the guidance of trained TBAs showed a significantly higher rate of HIV testing than their counterparts living the ‘non-exposed’ life. It’s like they discovered a hidden buffet while everyone else was still nibbling on chips.
But hang on a minute! Before you throw a parade, the picture isn’t all roses. Access to formal antenatal care didn’t see much of a bump. It’s still stuck in the mud. So while we might have increased the HIV testing among pregnant women (hooray!), we’re still battling that stubborn access issue. It’s like sending a toddler to a candy shop and wondering why they still cry for cookies.
The Wrap-Up: What’s Next?
In conclusion, training and involving TBAs might just be the glimmer of hope in this HIV-ridden wilderness. But there’s still work to do—like motivating mothers to stroll into health facilities for antenatal care. Honestly, I think we need a TBA with a megaphone saying, “Get tested! It’s good for you!” Because let’s face it, sometimes it takes that little extra nudge.
So, if you’re in Cameroon or anywhere else facing a similar drama, find the community champions. Bring them in! And for everyone watching from the sidelines, the best health interventions combine local wisdom with formal healthcare support. We need both to push this evil villain of mother-to-child HIV transmission into the shadows.
And there you have it—an insightful journey into the world of PMTCT in Cameroon, wrapped in humor, sharp observations, and the sharp reality of health disparities. Stay tuned, folks! There’s always more to this story.
Ged to gather a diverse group of 637 mother-child pairs for some serious investigation into the big question: Can TBAs really make a difference in PMTCT outcomes? Spoiler alert—apparently, the answer is a resounding “yes”! Those who received help from our TBA superheroes had higher rates of antenatal HIV testing compared to those who didn’t. It’s like comparing apples to slightly sadder apples, but it’s still progress!
The results indicated that while both groups received similar follow-ups for HIV test results, the TBAs seemed to have cracked the code on bringing more women into the fold. By serving as trusted community figures, they were able to bridge gaps that regular healthcare providers sometimes can’t reach—sort of like a friendly neighborhood Spiderman, but with a focus on maternal care.
The Road Ahead: What Next?
But hold your horses! While the study paints a promising picture, it doesn’t mean there’s no work left to do. The research indicates that we need more than just testing; we need to ensure these women can get access to complete prenatal consultations, and that’s a whole other can of worms. The fight against the HIV villain is ongoing, and while we’ve got some strategies that are working, they need to be expanded and improved upon.
In the “HIV and Traditional Birth Attendants” saga that continues to unfold, one thing’s clear: leveraging community resources in innovative ways can create waves of change. For those involved in the fight against HIV, it’s all about collaboration—between health professionals, community leaders, and the invaluable TBAs who hold the keys to reaching populations that might otherwise slip through the cracks.
Final Thoughts
So there you have it, folks! The fight against HIV in Cameroon is a complex and challenging journey, but with initiatives like training TBAs and integrating community-level interventions, there’s hope. As we continue down this winding road, let’s keep the faith and remember that sometimes, heroes don’t wear capes—they just show up with compassion and knowledge, ready to change lives, one pregnant woman at a time.
