Improving Access to PMTCT Through the Involvement of Traditional Birth Attendants in Program Activities in the Far North Region of Cameroon: A Retrospective Cohort Study.

Background: Majority of deliveries occurring in the Cameroon part of the Lake Chad basin is assisted by traditional birth attendants (TBA). The aim of the present study was to assess if training and involving TBA in community-based Prevention of Mother to Child Transmission (PMTCT) interventions can contribute in improving targeted population access to these interventions.

Methods: This was a retrospective cohort study that assessed among mothers of children aged 0-24 months the effect of training and involving TBA in PMTCT activities. The exposed mother-child pairs were those inhabiting communities were TBA were trained and involved during the 24 previous months in PMTCT activities (exposed communities) while the non-exposed groups where those living in communities with no study intervention. Data were collected in households selected by stratified cluster random sampling from children's mothers or guardians using a face-to-face administered questionnaire (undocumented) and from antenatal booklets (documented) used in health facilities to record antenatal care.

Results: A total of 637 mothers-children couples were included, 416 (65.3%) in the exposed group and 221 (34.7%) in the control group. Exposed mother-child pairs had significantly higher documented access to mother antenatal HIV testing compared to the couples living in non-exposed communities with adjusted relative risk (ARR) of 4.20 (2.52-6.99). The mean number of antenatal consultations was significantly higher in the exposed group (Student T-test =6.00, p= 0.000). However, this exposure to community with trained TBA increased but not significantly the proportion of pregnant women who benefit from antenatal consultations (ARR=0.94 (0.70-1.25), p=0.678) and those who withdraw their HIV test results (X2 = 0.271, p=0.786).

Conclusion: The training and involvement of TBA in delivering PMTCT interventions at the community level can improve population access to these interventions. The consistency of these findings should be tested in other communities in needs and with other health care interventions.