ABSTRACT
OBJECTIVE: To determine attitudes toward and utilization of testing for HIV, syphilis, and hepatitis B among obstetric care providers in Kabul, Afghanistan. DESIGN: Cross-sectional survey. SETTING: Three public maternity hospitals in Kabul, Afghanistan. PARTICIPANTS: One hundred and fourteen (114) doctors and midwives. MAIN OUTCOME MEASURE: Prevalence and correlates of ever having tested patients for HIV, syphilis, and hepatitis B and agreement with statements concerning attitudes toward testing and care. RESULTS: Less than half of the patient care providers surveyed had previously tested a patient for HIV, syphilis, or hepatitis B. Presumed rarity of these infections in Afghanistan was the most frequently stated reason for not testing, although many midwives stated that they did not have the authority to order tests. Most providers supported testing to promote neonatal health, but some midwives expressed concern regarding patient and family perceptions. CONCLUSIONS: Due to logistical and cultural barriers, obstetric care providers underutilize testing for antenatal patients in Afghanistan. Improved training, empowerment of female providers, and availability of rapid testing are needed.
Subject(s)
Attitude of Health Personnel , Obstetrics/organization & administration , Practice Patterns, Physicians'/organization & administration , Pregnancy Complications, Infectious/diagnosis , Prenatal Care/organization & administration , Sexually Transmitted Diseases/diagnosis , Adult , Afghanistan , Chi-Square Distribution , Cross-Sectional Studies , Female , Guideline Adherence , Health Knowledge, Attitudes, Practice , Health Services Needs and Demand , Hospitals, Maternity , Hospitals, Public , Humans , Logistic Models , Male , Multivariate Analysis , Nursing Methodology Research , Obstetrics/education , Personnel, Hospital/education , Personnel, Hospital/psychology , Practice Guidelines as Topic , Pregnancy , Stereotyping , Surveys and QuestionnairesABSTRACT
BACKGROUND: Little current information is available for prevalence of vertically-transmitted infections among the Afghan population. The purpose of this study is to determine prevalence and correlates of human immunodeficiency virus (HIV), syphilis, and hepatitis B and C infection among obstetric patients and model hepatitis B vaccination approaches in Kabul, Afghanistan. METHODS: This cross-sectional study was conducted at three government maternity hospitals in Kabul, Afghanistan from June through September, 2006. Consecutively-enrolled participants completed an interviewer-administered survey and whole blood rapid testing with serum confirmation for antibodies to HIV, T. pallidum, and HCV, and HBsAg. Descriptive data and prevalence of infection were calculated, with logistic regression used to identify correlates of HBV infection. Modeling was performed to determine impact of current and birth dose vaccination strategies on HBV morbidity and mortality. RESULTS: Among 4452 women, prevalence of HBsAg was 1.53% (95% CI: 1.18 - 1.94) and anti-HCV was 0.31% (95% CI: 0.17 - 0.53). No cases of HIV or syphilis were detected. In univariate analysis, HBsAg was associated with husband's level of education (OR = 1.13, 95% CI: 1.01 - 1.26). Modeling indicated that introduction of birth dose vaccination would not significantly reduce hepatitis-related morbidity or mortality for the measured HBsAg prevalence. CONCLUSION: Intrapartum whole blood rapid testing for HIV, syphilis, HBV, and HCV was acceptable to patients in Afghanistan. Though HBsAg prevalence is relatively low, periodic assessments should be performed to determine birth dose vaccination recommendations for this setting.
