**Improving Access to PMTCT through the Involvement of Traditional Birth Attendants in Program Activities in the Lake Chad Basin Area of Cameroon: A Retrospective Cohort Study**

**Jerome Ateudjieu1,2,3, Ketina Hirma Tchio-Nighie1, Anthony Njimbia Chebe1, and Charlette Nangue1** 1Meilleur Accès Aux Soins De Santé (M.A. SANTE), Yaounde, Cameroon

2Department of Public Health, Faculty of Medecine and Pharmaceutical Sciences, University of Dschang 3Cameroon Ministry of Public Health

Maternal and child mortality is higher in the Cameroon part of the Lake Chad basin compared to the rest of the country because of limited access to recommended care during pregnancy and delivery. The majority of deliveries in these settings are assisted by traditional birth attendants (TBA). This project was conducted to assess whether training and involving TBA in community-based PMTCT interventions can contribute to improving targeted population access to these interventions. In targeted communities, TBA were trained in identifying and referring pregnant women from the community to health facilities for antenatal care and in organizing community sessions to deliver PMTCT interventions to the targeted population. After the implementation of the intervention, an endline survey was conducted targeting mothers of children aged 0- 24 months in communities exposed to the intervention and in neighboring communities randomly selected to collect data on access to antenatal care, HIV testing, and resulting care. The effect of the intervention was assessed by comparing the coverage of antenatal care, recommended HIV testing, and test results withdrawal by using appropriate tests. In total, 293 mothers–children couples were included from communities that benefited from the intervention (exposed) and 288 from those that did not benefit (non-exposed). Exposed mother–child couples had significantly higher reported and documented access to mother antenatal HIV testing compared to the couples living in non-exposed communities with adjusted relative risk (ARR) of 1.6 (1.2-2.0) and 3.5 (2.4-5.1), respectively. The mean number of antenatal consultations was not significantly higher in the exposed group [regression coefficient ®=0.18 (-0.18-0.55), p-value (p)=0.327)], whereas the mean number of HIV tests received by the mothers in the exposed communities during the antenatal life of children was significantly higher [R=1.12 (0.93-1.32), p=0.00)]. The proportion of mothers who withdrew their HIV test results in the exposed group was significantly higher compared to the proportion in the nonexposed group (Chi-square test= 4.77, p=0.029). 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 need and with other healthcare interventions.

### Methods

In targeted communities, TBA were trained in identifying and referring pregnant women from community to health facilities for antenatal care and in organizing community sessions to deliver PMTCT interventions. After the implementation of the intervention, an end line survey was conducted targeting mothers of children aged 0-24 months in communities exposed to the intervention and in neighboring communities randomly selected to collect data on access to antenatal care, on HIV testing and resulting care. The effect of the intervention was assessed by comparing the coverage of antenatal care, recommended HIV testing and test results withdrawal by using appropriate tests.

#### Results

In total, 293 mother–children pairs were included from communities that benefited from the intervention (exposed) and 288 from those that did not benefit (non-exposed). Exposed mother–child pairs had significantly higher reported and documented access to mothers' antenatal HIV testing compared to the pairs living in non-exposed

communities, with adjusted relative risk (ARR) values of 1.6 (1.2-2.0) and 3.5 (2.4-5.1), respectively.

The mean number of antenatal consultations was not significantly higher in the exposed group [regression coefficient (R)=0.18 (-0.18-0.55), p value (p)=0.327)], whereas the mean number of HIV tests received by the mothers in the exposed communities during the antenatal life of children was significantly higher [R=1.12 (0.93-1.32), p=0.00)]. The proportion of mothers who withdrew their HIV test results in the exposed group was significantly higher compared to the proportion in the non-exposed group (Chi square test= 4.77, p=0.029).

#### Conclusion

The training and involvement of TBA in delivering PMTCT interventions at a community level can improve population access to these interventions. The consistency of these findings should be tested in other communities in need and alongside other healthcare interventions.

Improving Access to PMTCT through the Involvement of Traditional Birth Attendants in Program Activities in the Lake Chad Basin Area of Cameroon: A Retrospective Cohort Study

#### Authors

Jerome Ateudjieu1,2,3, Ketina Hirma Tchio-Nighie1, Anthony Njimbia1, and Charlette Nangue1

1 Meilleur Accès aux Soins de Sante (M.A. SANTE), Yaounde, Cameroon,

2 Department of Public Health, Faculty of Medecine and Pharmaceutical sciences, University of Dschang 3 Cameroon Ministry of Public Health

### Introduction

Maternal and child mortality is higher in the Cameroon part of the Lake Chad basin compared to the rest of the country. This is mainly due to limited access to recommended care during pregnancy and delivery. The majority of deliveries in these settings are assisted by traditional birth attendants (TBA). This project was conducted to assess whether training and involving TBA in community-based PMTCT interventions can contribute to improving the targeted population's access to these interventions.

## **Impact of Housing Water and Sanitation (WATSAN) Facilities on Health: Evidence from Pakistan**

#### **Zara Bari1 and Imran Bari2**

<sup>1</sup> Semiotics Consultants (Pvt.) Ltd., Islamabad, Pakistan

2George Washington University, Washington DC, United States

One of the major factors in health degradation is the housing environment, including housing building materials, water sources, sanitation facilities, waste disposal, and indoor air pollution. Health varies with different socioeconomic, demographic, and environmental characteristics. The study analyzed the association of various socioeconomic and housing environmental factors on health. Using the data from the nationally representative survey, the Pakistan Panel Household survey, a detailed analysis was done on the effects of housing water and sanitation (WATSAN) facilities on the health of individuals through bivariate and multivariate analysis (logistic regression). The association was measured through three indicators: total population reported ill; population reported ill with selected water-borne diseases (infectious intestinal problems and jaundice); children reported sick with diarrhea. The result showed that different socioeconomic factors had a very strong association with the health of the individuals. Another objective was to measure the effects of WATSAN facilities on health. The logistic regression showed that the probability of falling ill slightly increased in individuals living in households having no piped water source and no drainage system. The population reported ill with water-borne diseases and diarrhea showed a significant association for bivariate and multivariate analysis. The likelihood of falling ill with these diseases increases significantly in houses lacking the proper toilet facility and covered drainage system. As for the unsafe source of drinking water, it showed no relation in increasing the likelihood of falling ill with diarrhea and other selected waterborne diseases. Pakistan's socioeconomic and demographic factors strongly affect health; water-borne diseases, including diarrhea in children, were found to have a significant association with housing sanitation facilities, whereas a weak association of these diseases was found with the source of drinking water.

Zara Bari1 and Imran Bari2

1 Semiotics Consultants (Pvt.) Ltd., Islamabad, Pakistan

2 George Washington University, Washington DC, United States

#### Introduction

One of the major factors contributing to health degradation is housing environment, which includes housing materials, household water sources, household sanitation, household waste disposal and indoor air pollution. This study analysed the association of various socioeconomic and housing environmental factors on health.

#### Methodology

Data sourced for analyses in this study were taken from the Pakistan Panel Household Survey, 2010. A detailed analysis was carried out on the effects of housing Water and Sanitation (WATSAN) facilities on the health of individuals using logistic regression.

The association was measured through three indicators: total population reported ill; population reported ill with selected water-borne diseases (infectious intestinal problems and jaundice); and children reported sick with diarrhea.

#### Results

Logistic Regression Analysis of Population reported lll with Water borne Diseases




Logistic Regression Analysis of Population reported III



#### Conclusions

