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Base de données d'évaluation

Evaluation report

KEN 1999/800: Baseline KAP Survey of Health Workers and Communities Regarding Mother to Child Transmission of HIV in Homa Bay and Nyeri

Executive summary


Recent research findings have demonstrated that transmission of HTV from mother to child can occur during pregnancy, delivery and through breastfeeding. The encouraging finding, however, is that anti-retroviral therapy now offers opportunity to significantly reduce mother to child transmission of HIV. The current recommendation for replacement feeding for infants of HIV positive mothers is a great challenge for developing countries; due to lack of safe and affordable alternatives. There is therefore, need to plan interventions based on solid and current data on health workers counseling and communication skills, their knowledge, attitudes and practices, regarding mother to child transmission of HIV; and furthermore, to have information on the community's perspectives, views, concerns and perceptions on replacement feeding. It is against this background that this study was designed to provide information for planning communication and service delivery interventions aimed and reducing Mother to child transmission of HIV.

Purpose / Objective

The study was commissioned by UNICEF with the following objectives:
- Determine the knowledge, attitudes and practices of health care providers regarding HIV and breastmilk transmission
- Determine the training needs of health care providers in preparing them to manage and counsel mothers regarding HIV and breastmilk transmission
- Document the communities' perspectives regarding alternatives to breastfeeding among HIV-positive women


Two districts, Nyeri and Homa Bay, were covered. A total of 373 health workers covering all health care cadres involved in maternal and child health responded to the self administered questionnaire. All levels of health care were included; government, mission, private and NGO sponsored personnel. Focus group discussions were held to extract qualitative information from the community.

Key Findings and Conclusions

Results of this study show clearly that all cadres of health workers have high levels of knowledge specifically related to mother to child transmission of HIV (>90% of participants) and in general on transmission of HIV and other sexually transmitted diseases in the population. However, only about half of the health workers are familiar with the methods of reducing mother to child transmission. Knowledge of family planning for HIV infected women is also low with majority (>90%) indicating that the condom is the only method that can be used for family planning for HIV infected women.

Majority of the health workers had high levels of knowledge on child feeding both in relation to exclusive breastfeeding, timing of complementary feeding and feeding frequency. Regarding complementary feeding, both the community members and health workers identified cow's milk and porridge as the initial foods introduced to infants as they continued to breastfeed. They indicated appropriately that complementary feeding should be started in the period of 4-6 months. Regarding replacement feeding both the health workers and the community members identified cow's milk as the first choice of replacement food. Formula milk did not feature either as a complementary or replacement food in the study population.

It was clear from the community study that stigmatisation associated with HIV/AIDS is still very common and those women who may stop breastfeeding stand the chance of either being labelled as prostitutes or identified as HIV positive by the community. Although majority (70%) of health workers indicated that voluntary testing should be made universally available in the health facilities there was also a feeling that the knowledge of the HIV status of patients may interfere with quality of health care provided to the patient.

The results however do indicate that the health workers are still carrying out health education on various issues. However 33% of the health workers indicated that they are not confident enough to counsel mothers on mother to child transmission. Only a small proportion of health workers, 14%, have received training on counseling for HIV hence a felt need to improve skills in counseling for mother to child transmission of HIV was expressed.


Enhance the counseling skills of health workers combined with provision of current information regarding HIV transmission and innovative approaches to combat HIV spread.

Support Voluntary Counseling and Testing (VCT) at community level so that both mothers and health workers can make informed choices especially on whether to or not to breastfeed.

Identify/develop and ensure access to safe and affordable breast milk substitutes for women infected with HIV.

Study the growth of children fed on traditional replacement feeds and come up with the nutrient profiles.

Provide and ensure access to affordable retroviral therapy. Enhance programmes at community level for promoting primary prevention of HIV in the general community and in pregnant women specifically.

Develop strategies for providing psychosocial support to HIV positive mothers who choose not to breastfeed to protect them from stigmatisation.

Explore innovative approaches for primary prevention of HIV especially among the youths.

Seek and encourage the participation of communities at every level in the development of interventions on MTCT of HIV.

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