title: A survey of occupational blood contact and HIV infection among traditional birth attendants in Rwanda.
abstract: OBJECTIVE
  To investigate the risk of occupationally acquired HIV infection among traditional birth attendants (TBA) in Rwanda, Africa.
  
  
  METHODS
  A serosurvey was conducted among 219 TBA practicing in a rural but densely populated area in southern Rwanda. Each TBA was interviewed about sociodemographic information, work-related habits and practices, and presence of nonoccupational risk factors for HIV infection. The frequency of skin exposure to HIV-infected blood was estimated for each TBA from HIV seroprevalence data collected previously from pregnant women stratified by the geographic zones in which the TBA practiced.
  
  
  RESULTS
  Four TBA (1.8%) tested HIV-1-antibody-positive; all four had reported nonoccupational risk factors for HIV infection. We estimated that the 215 HIV-negative TBA had 2234 potentially infectious blood-skin contacts out of a total of approximately 35,000 deliveries assisted in the past 5 years. However, we found no evidence of HIV infection caused by occupational blood contact (none out of 2234; upper limit of the 95% confidence interval because of one potentially infectious blood-skin contact = 0.2%).
  
  
  CONCLUSIONS
  Although these findings may not be universal to all TBA in Africa, the risk of occupationally acquired HIV infection among TBA appears small. The high frequency of blood-skin contact among TBA in Rwanda highlights the need to include infection control precautions in the training of TBA.
authors.affiliation: Centre Universitaire de Santé Publique (CUSP), School of Medicine, National University of Rwanda, Butare.
authors.forename: P
authors.initials: P
authors.lastname: Habimana
authors.forename: M
authors.initials: M
authors.lastname: Bulterys
authors.forename: P
authors.initials: P
authors.lastname: Usabuwera
authors.forename: A
authors.initials: A
authors.lastname: Chao
authors.forename: A J
authors.initials: AJ
authors.lastname: Saah
mesh_terms: D000328:Adult; D001294:Attitude to Health; D001769:Blood / Q000382:microbiology; D005260:Female; D015483:HIV Antibodies / Q000097:blood; D015658:HIV Infections / Q000097:blood / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D015497:HIV-1; D006801:Humans; D006920:Hygiene; D008297:Male; D008875:Middle Aged; D008880:Midwifery; D009784:Occupational Diseases / Q000453:epidemiology*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000097:blood; D012307:Risk Factors; D012424:Rural Population; D012432:Rwanda / Q000453:epidemiology; D016036:Seroepidemiologic Studies
chemical_list: D015483:HIV Antibodies