Couple counselling and testing for HIV at antenatal clinics: views from men, women and counsellors.

The purpose of this study was to gain insight from views of Tanzanian men and women on couple voluntary counselling and testing (CVCT) for HIV at antenatal clinics (ANC) in Tanzania. Data collection was through focus group discussions with women aged 25-48 years (n=8), women 18-24 years (n=10), HIV counsellors (n=11), men aged 20-34 (n=8) and men aged 35-75 years (n=8) and in-depth interviews (IDI) with five men and eight women. Participants were asked their views concerning men volunteering for CVCT for HIV, motivation of couples to receive results together and effective ways of counselling sero-discordant couples. Many participants agreed on the importance of incorporating CVCT at ANC, while others expressed reservations due to the cultural belief that ANC is for women. The importance of love, care and respect between sero-discordant couples was stressed; nonetheless, many anticipated that disclosure of HIV-positive status to an HIV-negative spouse could result in abandonment, divorce or violence against the woman whether she was sero-negative or -positive. Couple counselling and testing at ANC incorporating the suggestions made by study participants could become an important intervention for the prevention of HIV transmission and maintenance of good relations between sero-discordant partners.

Use of educational workshop to promote mobility during childbirth.

OBJECTIVE: To evaluate the impact of an educational intervention to introduce the principles of evidence based obstetric care and encourage mobility during labour in government hospitals in Dar es Salaam. DESIGN: An observational study. SETTING: Four government hospitals; two in Dar es Salaam and two in coastal region of Tanzania. RESULTS: Following implementation of the workshops, practice changed significantly for mobility during labour at the district and regional hospitals; midwives at these hospitals appeared to be aware of the benefits and were willing to encourage women to be mobile during labour. Practice changed little at the referral hospital. Most women delivering at the referral hospital had been transferred from regional or district hospitals with complications. CONCLUSION: This small study demonstrates the potential of using educational workshops to change childbirth practice at the district and regional level in Tanzania. Institutionalisation of practice changes involves influencing policy-makers, engaging opinion leaders to disseminate evidence and advocacy for change among their peers, as well as developing mechanisms to overcome barriers to practice change at the hospital level. Results from this study will feed in to a project to develop evidence-based guidelines for childbirth care, involving policy makers, practitioners and hospital managers.

Recognition of risk factors in pregnancy among women attending antenatal clinic at Mbagala, Dar es Salaam.

A study on the recognition of risk factors in pregnancy by pregnant women attending antenatal clinic (ANC) at Mbagala, Dar es Salaam, Tanzania was done. 203 women with ages ranging from 15-43 years were seen on their first visit. 32.51% were primigravidas while 67.5% were multiparous with parity varying from 2-13 deliveries. 32.5% had received no formal education; 13.4% had 1-6 years education, while 54.2% had 7-12 years of formal education. Most of the women did not know when in the course of pregnancy they should start ANC: 52% of the women booked and reported that the best gestational age for booking was in the second trimester. There was no definite answer as to why the women came for the 1st visit to the ANC at a particular gestational age. 5% of the women felt that a woman could start to have children between age 10-14 years. 62.1% thought a woman could start to have children between 15-20 years. 10.3% did not know when a woman could start to have children. Some of the risk factors identified at the clinic included: shortness, age below 19 (11.8%), age 35 and more than 4 deliveries (13.3%) and HB below 75%, malaria and hookworm (9.9%). It appears that pregnant women attending Mbagala ANC booked within the second and third trimester. Their knowledge regarding risk factors in pregnancy was very low. A comprehensive antenatal intervention programme should be introduced at Mbagala ANC to educate women on risk factors in pregnancy. It should be conducted through client oriented problem and need approach.