Detecting maternal morbidity and mortality by traditional birth attendants in Burkina Faso

Abstract

In Burkina Faso health workers from maternity units in the provinces of Bobo-Dioulasso Koudougou and Zabre trained 2 traditional birth attendants (TBAs) from each of 142 villages in these provinces in aseptic obstetric techniques and in recognizing the signs and symptoms indicating the need to refer and evacuate women during pregnancy and delivery. In 1986-1987 researchers gathered operational file cards on 6129 women who sought care from a TBA at least once and analyzed the data to evaluate the TBA training program and to determine obstetrical coverage. Registration only covered 31.1% of forecasted pregnancies but it did increase significantly over the 2 years (25.7-34.4%; p < .01). TBAs provided prenatal monitoring to 91% of the women mostly in their homes (92.4%). The leading prenatal risks detected were in order of frequency fever bleeding anemia edema and severe vomiting. they successfully referred 70% to the closest health facility. Complications occurred in 3.7% of all deliveries. Obstructed labor accounted for 38.2% of complications followed by abnormal presentations (17.3%) and hemorrhage (13.2%). 145 women had to be evacuated due to delivery complications. 2% of women examined postpartum experienced problems. It was difficult to determine the problems however because of undetailed diagnoses. Among the detailed diagnoses hemorrhage was the leading problem (15.9%). 27 mothers died (a mortality ratio of 452/10000). The researchers assumed this to be low however because the file cards did not state the condition for 150 mothers. 16 mothers died postpartum. 10 deceased mothers had no complications. The perinatal mortality rate was 40.4/1000.