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Base de données d'évaluation

Evaluation report

ZAM 1999/801: The Mother-to-Child Transmission Intervention: A Report on the Formative Research Conducted in Chipata Health Centre and Its Catchment Area

Author: Mukuka, C.; Siyandi, R.

Executive summary


In Zambia, the estimated HIV prevalence by 1997 was 19.5%, with the number increasing among women of child- bearing age. With the prevailing high fertility rates, the major mode of transmission of HIV is from infected mothers to their children during pregnancy, delivery or breastfeeding. About 25-35% of infants born to HIV positive women become infected with the virus themselves. The Central Board of Health, through the Mother-to-Child Transmission (MTCT) working group is embarking on piloting the feasibility of an implementation program for the prevention of MTCT. In order to mobilise community partnership and participation for the intervention, an insight into the knowledge, attitudes, practices, behaviour and beliefs of the community is essential to the success of the programme. The formative research conducted at Chipata compound and the University Teaching Hospital sought to do just this.

Purpose / Objective

The general objective was to ensure that the community is part of the MTCT initiative by taking into consideration their knowledge, attitudes, practices, beliefs and behaviours (KAPB) during the planning and implementation of activities.


Information was collected from health care providers namely: health centre-in-charge, labour ward-in-charge, maternal and child health-in-charge and various health workers; at the University Teaching Hospital (UTH), the labour ward-in-charge and a focus group discussion comprising midwives and their in-charge. There are no active community health workers (CHWs) in Chipata compound and a focus group discussion with this group was therefore not possible.

The community groups included in the study were the Neighbourhood Health Committee, the Chipata Catholic Church home based care group, Bwafwano home-based care group, the Chipata Mother Support Group and groups of men and women taken from the community.

Exit interviews were conducted with 112 mothers attending the antenatal clinic. Additionally focus group discussions were held with two groups of ten women. For the men's focus group discussion, two groups of 10 men were gathered from the market and interviewed.

Key Findings and Conclusions

The Chipata community is aware of HIV/AIDS, its modes of spread, features and its prevention. A number of local terms have been coined to describe HIV/AIDS. The wasting nature of the disease (kalyolyonde and hang wire) and the burden that the illness places on mothers to care for patients (kalaye noko, kavute noko) is reflected in the names. The serial manner in which the disease claims lives (serial killer) and the blame placed on the promiscuous woman for the spread of the disease (Julia) are other names.

Most people have heard about voluntary counselling and testing for HIV. Antenatal mothers reported that they knew someone who had been tested (53.6%). The main reason for having a test was in order to know one' serostatus (94.8%). The women felt that the reasons for having a test were to enable individuals to plan their lives and to know how to look after themselves.

The spouse (81.3%) and parents were the popular people to consult in deciding to go for a test. The same individuals would be told the results of the test. The neighbours and other community members would not be informed of the result because of the amount of talk that such information brings about.

Mother-to-child transmission was thought to occur mostly during pregnancy (41.9%) and it was thought that all HIV-positive mothers pass on the virus to their baby. There was some ambivalence about whether HIV-positive mothers should breastfeed or not. On one hand, the benefits of breastfeeding were recognised and on the other, the risk of a mother infecting her baby through breast milk was an undesirable situation.

A mother who ceases to breast feed earlier than the usual 19-24 months may be regarded as being lazy, uncaring, westernised, ill (probably with tuberculosis or HIV) and other negative opinions. Wet nursing is practised by some in the community after consultation with relatives. The decision as to who should wet nurse is reached after this process and this may be assisted by the presence of a relative who is currently breastfeeding (preferably the maternal aunt or grandmother to the baby).

The pill and condom are the commonly used methods of family planning and 90% of the antenatal women thought that condoms were effective in the prevention of STDs and HIV.

In the case of infant feeding, breastfeeding is practised widely in the community although exclusive breastfeeding is known to be practised by few people. Mothers are supplementing early and the alternatives to breastfeeding used by the few who are not breastfeeding are commonly infant formula, fresh cow' milk and porridge.

The community networks' involvement in HIV/AIDS activities is mainly in the area of home-based care and health education. In the case of infant feeding, only the breastfeeding support groups who said that they support mothers in this aspect. The Neighbourhood Health Committee is willing to collaborate on the intervention as long as support is provided.

The major findings of the research were that MTCT is relatively a new issue in the knowledge of HIV/AIDS. People know about MTCT but as to how it happens and its transmission rates, there are information gaps. The stigmatisation of HIV-positive people is still strong. Voluntary counselling and testing is not a new concept; most people are aware of it but not everyone knew where the
service could be accessed.


The main recommendations emerging from the research were that MTCT information should be disseminated using appropriate channels. Infant-feeding counselling will be a critical component of the project so there is need for the training of relevant key players. Strategies to encourage male involvement will be critical to the success of the VCT service. Finally, the community networks will need to be strengthened and collaborated with.

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