Abstract
In low-and-middle-income countries (LMICs), traditional birth attendant (TBA) training programs are increasing, yet reports are limited on how those programs affect the prenatal clinical abilities of trained TBAs. This study aims to assess the impact of clinical training on TBAs before and after a maternal health-training program. A prospective observational study was conducted in rural Guatemala from March to December 2017. Thirteen participants conducted 116 prenatal home visits. Data acquisition occurred before any prenatal clinical training had occurred, at the completion of the 14-week training program, and at six months post program completion. The paired t-test and McNemar’s test was used and statistical analyses were performed with R Version 3.3.1. There was a statistically significant improvement in prenatal clinical skills before and after the completion of the training program. The mean percentage of prenatal skills done correctly before any training occurred was 25.8%, 62.3% at the completion of the training program (p-value = 0.0001), and 71.0% after six months of continued training (p-value = 0.034). This study highlights the feasibility of prenatal skill improvement through a standardized and continuous clinical training program for TBAs. The improvement of TBA prenatal clinical skills could benefit indigenous women in rural Guatemala and other LMICs.
Highlights
Significant worldwide progress has been made towards lowering rates of maternal mortality in the last two decades [1]
The Guatemalan government has aimed to decrease this discrepancy by promoting institutional births [4], up to 70% of indigenous women living in rural Guatemala continue to deliver at home without receiving adequate prenatal care [5]
A community-based, prospective observational study was conducted in six rural communities throughout the department of Sololá, Guatemala from March through December 2017 to assess direct Prenatal Clinical Skills (PCS) acquisition and retention from the School of POWHER training program during prenatal home visits
Summary
Significant worldwide progress has been made towards lowering rates of maternal mortality in the last two decades [1]. Maternal mortality ratios (MMR) in the developing world, especially in rural regions and within indigenous populations, continue to be unacceptably high [2] This holds true in Guatemala where the national average of 88 maternal deaths per 100,000 births [1] does not reflect the major disparities that exist between the MMR for indigenous women which is twice that of their counterparts (163 per 100,000 compared to 78 per 100,000) [3]. The Guatemalan government has aimed to decrease this discrepancy by promoting institutional births [4], up to 70% of indigenous women living in rural Guatemala continue to deliver at home without receiving adequate prenatal care [5]. Despite the significant role TBAs hold, there are limitations, as few sustainable
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