Knowledge of and Preventive Practices to HIV Exposure among Traditional Birth Attendants in Calabar Metropolis, Cross River State, Nigeria


Ekpe, Moses Essien , Antor O. Ndep , Pamela Obegu , Bernadine Ekpenyong , Elizabeth Moses ,

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Volume 10 - December 2021 (12)


Nigeria is listed among the Sub-Saharan African nations with 60-90% of births assisted by Traditional Births Attendants (TBAs). The annual total births in Cross River State, Nigeria stands at 171,902 out of which 12,205 are from Human Immunodeficiency Virus (HIV) positive women, and most of these women were attended to by TBAs. The main objective of this study was to assess TBAs’ knowledge of and preventive practices to HIV exposure in Calabar Metropolis. A Cross-sectional descriptive study design was used and 216 copies of an interviewer-administered questionnaire were administered, but 211(97.7%) were completed. 147(69.6%) of the respondents were between ages 40-59 years, 147(69.7%) TBAs have been trained on HIV prevention. Comparison between trained and untrained TBAs, there was a statistically significant relationship on TBAs self-reported knowledge on HIV with P=0.003; self-reported perceived susceptibility to HIV infection with P=0.000; knowledge on Prevention of mother-to-child transmission with P=0.028; compliance with basic preventive practices with P=0.001. Self-reported HIV status of TBAs revealed that 3(1.4%) were HIV positive. With a large number of untrained TBAs and even higher HIV positive pregnant women in the Calabar Metropolis posits that most TBAs stand a risk of being infected or infecting their clients. Therefore, periodic trainings of TBAs to update their knowledge on HIV prevention may improve their compliance to basic preventive practices needed in the reduction of HIV infection among TBAs and their clients.


Calabar Metropolis, Exposure, Human Immunodeficiency Virus (HIV), Knowledge of,Preventive Practices, Traditional Birth Attendants


      i.            Abiodun, O., Sotunsa, J., Ani, F., Olaleye, A., & Taiwo A. (2015). Elimination of Mother-to-Child Transmission of HIV in Nigeria: The Roles, preparedness and Determinants of successful involvement of Traditional Birth Attendants. J AIDS Cln Res, 6, 481. doi: 10.4172/21556113.1000481

     ii.            Adesina, S. I. (2015). Traditional Medical Care in Nigeria. from

    iii.            Afangide, A. I., Njar, G. N., Ewa, E. E., Eli, H. D., & Iwara, A. I. (2011). Assessment of Water Quality Status of Borehole in Calabar South Local Government Area, Cross River State. International Journal of Bioscience, 1(5), 71-76.

     iv.            Ahmed Omowunmi, Odunukwe Nkiru, Raheem Yekeen, Efienemokwu Chinyere, Junaid Muinat, Adesesan Segun, . . . Lateef, S. (2016). Knowledge, attitudes and perceptions of HIV/AIDS among traditional birth attendants and herbal practitioners in Lagos State, Nigeria. African Journal of AIDS Research, 3(2), 191–196 doi: DOI: 10.2989/16085900409490334

       v.            Archibong, E. I., & Agan, T. U. (2010). Review of policies and programmes for reducing maternal mortality and promoting maternal health in Cross River State, Nigeria. African Journal of Reproduction Health, 14(3), 37-42.

     vi.            AVERT. (2014, 2014). Origin of HIV/AIDS.   Retrieved 13th July, 2015, from

   vii.            Ayede, A. I. (2012). Persistent Mission Home Delivery in Ibadan: Attractive Role of Traditional Birth Attendants Annals of Ibadan Postgraduate medicine, 10(2), 22-27.

 viii.            Babette, P., Kilembe, M., & Nwateb, R. L. (1999). Report of KAP study results, Tanga region and same district, Tanzania.   Retrieved 18 May, 2016, from

     ix.            Balogun, M., & Odeyemi, K. (2010). Knowledge and Practice of Prevention of Mother to Child Transmission (PMTCT) Among Traditional Birth Attendants in Lagos State Nigeria. Pan African Medical Journal(5), 7.

       x.            Bassey, E. B., Elemuwa, C. O., & Anukam, K. C. (2007). Knowledge  of,  and  attitudes to,  Acquired  Immune  Deficiency Syndrome (AIDS) among Traditional  Birth Attendants (TBAs)  in rural communities  in Cross River State. International  Nursing Review, 354-358. doi: 10.1111/ j. 1466-7657. 2007. 00535x

     xi.            Bergstrom, S., & Goodburn, E. (2001). The Role of Traditional Birth Attendants in the Reduction of Maternal Mortality. . Studies in Health Service Organisation and Policy, 17, 85-89.

   xii.            Betton, M., Bailey, C., & Safrit, J. (2013, August 26th, 2015). HIV 101: Understanding HIV.  Retrieved from

 xiii.            Bhavana, S. (2010). Knowledge, attitude and practice of breastfeeding - a case study of Kumasi, Ghana. European Journal of Scientific Research, 40(3), 404-422.

 xiv.            BHIVA. (2014). British HIV Association guidelines for the management of HIV infection in pregnant women, 2012. HIV Medicine, 15(suppl. 4), 1-77. doi: 10.1111/hiv.12185

   xv.            BSMoH, FHI360, & UNAIDS. (2013). Cross River State Operational Plan for Elimination of MTCT of HIV 2013-2015.  Calabar, Cross River State.

 xvi.            Buldeo, P., & Gilbert, L. (2015). Exploring the Helath Belief Model and First-Year Students' Responses to HIV/AIDS and VCT at a South African University. African Journal of AIDS Research, 14(3), 209-218. doi: 10.2989/16085906.2015.1052527

xvii.            Buowari, B. Y. (2010). Training Workshop for TBAs at Aliero, Kebbi State, Nigeria; A Community Development Service at Aliero, Kebbi State, Nigeria. 7(2).

xviii.            C-Change. (2010). Peer Educators Training Manual, Module 3- Understanding HIV and AIDS. Communication for Change, Abuja, Nigerai.

 xix.            Cambell, O. M., & Graham, W. J. (2006). Strategies for Reducing Maternal Mortality: Getting on with what Works. Lancet, 368(9543), 1284-1299.

   xx.            CDC. (2015). HIV/AIDS in Cameroon. 1600 Clifton Rd Atlanta, GA 30333, USA: Division of Global HIV/AIDS (DGHA), Centers for Disease Control and Prevention.

 xxi.            Crowe, S., Utley, M., Costello, A., & Pagel, C. (2012). How Many Birth in Sub-Saharan Africa and South Asia will not be Attended by Skill Birth Attendant Between 2011 and 2015. 12, 4.

xxii.            CRSACA, & C-Change. (2013). Cross River State Socia and Behaviour Change Community Strategy.  Calabar, Cross River State, Nigeria: USAID/C-Change project Retrieved from

xxiii.            Dada, B. T. (2015). HIV Prevalence Rate in Nigeria Drops to 3.4percent. Retrieved from

xxiv.            Dallas, R. C., Thior, I., Kochhar, P., & Joyce, S. (2016). Adherence: the Key Element in HIV Prevention.  Retrieved from

xxv.            Darmstadt, G., Bhutta, Z., Cousens, S., Adam, T., Walker, N., & De Bernis, L. (2005). Lancet Neonatal Survival Steering Team. Evidence-Based, Cost Effective Interventions: How Many Newborn Babies Can Be Save. Lancet, 365(9463), 977-988. doi: 10.1016/S0140-6736(05)71088-6

xxvi.            Ebuehi, O. M., & Akintujoye, I. A. (2012). Perception and Utilisation of Traditional Birth Attendants by Pregnant Women Attending Primary Health Care Clinics in Rural Local Government Area in Ogun State, Nigeria. Intl.J. Women's Health, 4, 25-34.

xxvii.            Ejikeme, B. N., Umeora, O. U. J., & Obuna, J. A. (2007). HIV/AIDS: awareness and practice among Traditional Birth Attendants in rural Nigeria. Nigerian Medical Practitioner, 51(1/2), 6-10.

xxviii.            Enang, E., Ushie, M., Arikpo, I., Osonwa, K., Esu, E., Odey, F., . . . Meremikwu, M. (2013). Childbirth Practices in the Akpabuyo Rural Health and Demographic Surveillance System. Developing Country Study, 3(8).

xxix.            Ella, R. E., Ndep, A. O., & Akpan, M. I. (2016). Factors Affecting Exclusive Breastfeeding Practices in Rural Communities of Cross River State, Nigeria. International  Journal of Humanities Social Sciences and Education (IJHSSE), 3(4), 101-110. doi:

xxx.            Eni, D. D., & Ukpong, B. J. (2014). The Impact of Population Growth on Residential Land Use in Calabar, Cross River State. Research on Humanities and Social Sciences, 4(14).

xxxi.            Falle, T. Y., Mullany, L. C., Thatte, N., Khatry, S. K., LeClerg, S. C., Darmstadt, G. L., . . . Tielch, J. M. (2009). Potential Role of Traditional Birth Attendants in Neonatal Healthcare in Rural Southern Nepal. J.Health Population Nutrition, 27(1), 53-61.

xxxii.            Farlex, P. F. M. D. (2012). Medical Dictionary for Health Professions and Nursing. from http: //†health†professional

xxxiii.            FHI360. (2016). Country Design Document: Integrated Health Project in Nigeria.  Abuja.5-8.

xxxiv.            FMoH. (2005). National Guidelines on Prevention of mother to child transmission of HIV in Nigeria.National AIDS-STI Control Programme (NASCP).  Abuja, Nigeria.

xxxv.            FMoH. (2010). National Guidelines for Prevention of Mother-to-Child Transmission of HIV. (978-166-412-6). Nigeria.

xxxvi.            Franny, A. (2013). Gulu Women's Economic Development and Globalisation. from

xxxvii.            Gumbrecht, J. (2015). Cuba Ends Mother-to-Child Transmission of HIV and Syphilis [Press release]. Retrieved from

xxxviii.            Igberase, G. O., & Ebeigbe, P. N. (2007). Maternal mortality in rural referral hospital in the Niger Delta, Nigeria. J Obstet Gynaecol, 27(3), 275-278.

xxxix.            Imogie, A. O., Agwubike, E. O., & Aluko, K. (2002). Assessing the Role of Traditional Birth Attendants in Healthcare Delivery in Edo State Nigeria. African Journal of Reproduction Health, 6(2), 94-100.

     xl.            Israel, G.D. (2013). Determining sample size, University of Florida IFAS Extension, Gainesville, FL32611 Revised April, 2009. Revised June, 2013 PEOD6

   xli.            Lawn, J. E., Cousens, S., & Zupan, J. (2005). 4 Million Neonatal Death When ? Why ? Lancet, 365(9464), 891-900.

 xlii.            Madhivanan P., Kumar B.N., Adamson P., & K., K. (2010). Traditional birth attendants lack basic information on HIV and safe delivery practices in rural Mysore, India. BMC Public Health. doi: 10.1186/1471-2458-10-570

xliii.            Mandal, A. (2015). History of AIDS. News Medical. from

xliv.            Mbiydzenyuy, N. E. (2012). Traditional Birt Attendant:  Filling the Black Space in Rural Cameroon Midwife. International Training the Next Generation of Midwives., from http: //

 xlv.            Mrisho, M., Schellenberg, J. A., Mushi, A. K., Obrist, B., Mshinda, H., Tanner, M., & Scellenberg, D. (2007). Factors Affecting Home Delivery in Tanzania. Tropical Medicine and International Health, 12(7), 862-872.

xlvi.            NACA. (2014). Federal Republic of Nigeria Global AIDS Response Country Progress Report (GARPR) (pp. 1-46). Abuja, Nigeria: National Agency for the Control Of AIDS.

xlvii.            NARHS. (2013). HIV prevalence Across the State.  Abuja, Nigeria: National Agency for the Control of AIDS.

xlviii.            Nasidi, A., & Harry, T. O. (2006). The Epidemiology of HIV/AIDS in Nigeria (pp. 17-36).  Retrieved from

xlix.            Ndep, A. O. (2014). Informed Community Participation is Essential to Reducing Maternal Mortality in Nigeria. International Journal of Health and Psychology Research, 2(1), 26-33.

        l.            NIH. (2015). Understanding HIV/AIDS.  Nigeria: National Institute of Health Retrieved from

      li.            NIMH. (2015). What is Prevalence?  Bethesda, USA: national Institute of Mental Health Press Retrieved from

    lii.            Nkwo, P. O. (2012). Prevention of Mother-to-Child Transmission of Human Immunodeficiency Virus: The Nigerian Perspective. Annals of Medical and Health Science Research, 2(1), 56-65.

  liii.            NPC. (2014). Nigeria Demographic and Health Survey 2013. Abuja, Nigeria and Rockville, Maryland, USA: National Population Commission and ICF International.

   liv.            Obasi, E. Z. (2013). A Review of the Barriers and Socio-cultural Factors Influencing the Access to Maternal Health Care Service in Nigeria. (Master Degree Review), Helsinki Metropolia University of Applied Science.

     lv.            Okafor I.I., Arinze-onya, S. U., Onyekpa, J. I., & Ugwu, E. O. (2015). Audit of Childbirth Emergency Referrals by Trained Traditional Birth Attendants in Enugu, Southeast, Nigeria. Ann. Med. health sci. res., 5(4), 305-310. doi: 10:410/2141-9248.160180

   lvi.            Okon, E. B. (2015). Factors affecting exclusive breastfeeding practice in Ikom town, Cross River State, Nigeria. Bachelor of Public Health, University of Calabar

 lvii.            Okonofua, F., & Ogu, R. (2014). Traditional Versus Birth Attendants in Provision of Maternity Care: Call for Paradign Shift. African Journal of Reproduction Health, 18(1), 11-15.

lviii.            Omowunmi A., Nkiru O., Yekeen R., Chinyere E., Muinat J., Segun A., . . . S., L. (2004). Knowledge, attitudes and perceptions of HIV/AIDS among traditional birth attendants and herbal practitioners in Lagos State, Nigeria. Afr. J. AIDS Res., 3, 191-196. doi: 10.2989/16085900409490334

   lix.            Oshonwoh, F. C., Nwakwuo, G. C., & Ekiyor, C. P. (2014). Traditional Birth Attendants and Women's Health Practice:  A Case Study of Patani in Southern Nigeria. Journal of Public Health and Epidemiology, 6(8), 252-261. doi: 10.5897/JPHE2013.0634

     lx.            Osuji, A., Pharr, J., Nwokoro, U., Ike, A., Ali, C., Ejiro, O., . . . Ezeanolue, E. (2015). Impact of HIV Testing and Counseling, Knowledge on HIV Prevention Practices Among Traditional Birth Attendants in Nigeria. International Journal of Environmental Research and Public Health, 12(2), 1969-1982. doi: 10.3390/ijerph 120201969

   lxi.            Oyewo, T. O., & Taiwo, N. (2010). Exclusive Breastfeeding in Lagos: An awareness case study. Mass Communicator. 4(2), 20-29.

 lxii.            Peltzer, K., & Henda, N. (2006). TBAs HIV/AIDS and safe delivery in the Eastern Cape, South Africa-evaluation of a training program. SAJOG-South African journal of obstetric and gynaecology, 12(1), 140-145.

lxiii.            Perez, F., Aung, K., Ndoro, T., Engelsmann, B., & Dabis, F. (2008). Participation of Traditional Birth Attendants in Preventing Mother-toChild Transmission of HIV services in two rural districts in Zimbabwe: a feasibility study. BMC Public Health. doi: 10.1186/1471-258-8401

lxiv.            Seroney, G. C., Minnie, K., Otieno-Ayayo, Z. N., Mulaudzi, F. M., & Nyangena, E. (2012). KNOWLEDGE, ATTITUDES AND PRACTICES OF TRAINED TRADITIONAL BIRTH ATTENDANTS ON HIV/AIDS, KENYA. Baraton Interdisplinary Research Journal, 2(1), 8 - 16.

 lxv.            Sibley, L. M., Sipe, T. A., & Barry, D. (2012). Traditional Birth Attendant Training for Improving Health Behaviour and Pregnancy Outcomes (Review). CD005460(8), 1-82. doi: 10:.1002/14651858.CD005460.Pub3

lxvi.            Simpson, B. (2008). World Class Research on Slim Disease. Journal of Public Health, 30(12), 54-63.

lxvii.            Siziya, S., & Hazemba, A. (2010). Occupational risk factors for HIV infection among Traditional Birth Attendants in Copperbelt province, Zambia. African J Health Sci., 17, 5-9.

lxviii.            SNLN. (2011). Newborn Health in the Context of the Integrated Maternal, Newborn and Child Health Strategy (2nd ed., pp. 1-120). Saving Newborn lives in Nigeria.

lxix.            Sotunsa, J. O., & Solademi, O. B. (2014). Determination of Education Needs of Traditional Birth Attendants on the Prevention of Mother to Child Transmission of HIV in Ogun State, Nigeria. Quarterly.

 lxx.            Stretcher, V. J., & Rosenstock, I. M. (1997). The Health Belief Model. In Andrew Baum. Cambridge Handbook of Psychology, Health and Medicine. Cambridge UK: Cambridge University Press.

lxxi.            TAI. (2011). Where did HIV come from.  Washington DC: National Policy Office Retrieved from

lxxii.            Titaley, C. R., Hunter, C. L., Dibley, M. J., & Heywood, P. (2010). Why do some Women Still Prefer Traditional Birth Attendants and Home Delivery?: a Qualitative Study on Delivery Care Services in West Java Province, Indonesia. BMC Pregnancy Childbirth, 10, 43. doi: 10.1186/1471-2393-10-43

lxxiii.            Trans, M., & Stoppler, M. C. (2015). HIV/AIDS Facts. from

lxxiv.            UNAIDS. (1999). Prevention of Mother to Child Transmission:Strategic Option.  20 Avenue Appia-1211 Geneva 27 Switzerland: UNAIDS Retrieved from

lxxv.            UNAIDS. (2013). Global report: UNAIDS report on the global AIDS epidemic 2013. 20 Avenue Appia-1211 Geneva 27-Switzerland UNAIDS.

lxxvi.            UT. (2015). Health Belief Model.   Retrieved 15th September, 2015, from

lxxvii.            Vanguard. (2012, August 13th). Seventy Thousand Babies HIV Positive Annually, Nigerian Vanguard (Mobile Edition).

lxxviii.            WHO. (2005). The World Health Report (2005). Make Every Mother and Child Count.

lxxix.            WHO. (2007, 1st October). Prevention of Mother-to-Child Transmission (PMTCT) [Briefing Note]. Briefing Note. Geneva, Switzerland.

lxxx.            WHO. (2010). Classifying Health Workers.  

lxxxi.            WHO. (2010). PMTCT strategic vision 2010–2015 : preventing mother-to-child transmission of HIV to reach the UNGASS and Millennium Development Goals. Geneva, Switzerland World Health Organisation.

lxxxii.            WHO. (2012). Maternal Mortality. Fact Sheet.   Retrieved 348

lxxxiii.            WHO. (2015). Mother-toChild Transmission of HIV.  Retrieved July, 16th, 2015, from HIV/AID Department World Health Organisation

lxxxiv.            WHO. (2015). WHO Validates Elimination of Mother-to-Child Transmission of HIV and Syphilis in Cuba [Press release]. Retrieved from

lxxxv.            WorldBank. (2003). Reducing Maternal Mortality, Learning from Bolivia, China, Egypt, Honduras, Indonesia, Jamaica and Sri Lanka. Human Development Network, Health Nutrition and Population Series. Washington DC.

           lxxxvi.            Yamane, T.(1967). Statistics: An Introductory Analysis, 2nd Edition. New York: Harper and Row.

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