Perceptions of traditional birth attendants and midwives related to neonatal airway management in rural Uganda: a focused ethnographic qualitative study

Abstract

Background The neonatal mortality rate in rural Uganda is 38/1000 births as compared to 6/1,000 in the United States. Hypoxic events, also referred to as birth asphyxia, represent 24% of neonatal deaths in Sub-Saharan Africa. Nearly 60% of birth asphyxia worldwide occurs in home-based deliveries with informally trained birth attendants. The World Health Organization has defined two categories of birth attendants in low- and middle-income countries (LMICs): i) midwife skilled birth attendants, who are formally educated; and, ii) traditional birth attendants (TBAs) who usually acquire skills through apprenticeship and have home-based practices in rural areas. Thus, there is an urgent need to provide neonatal resuscitation education and build capacity in rural areas, where access to healthcare is poor and the burden of long-term impairment due to hypoxic brain effects is substantial. Methods We collected data using a focused ethnographic approach to incorporate: i) field-notes; ii) informal interviews while observing five Ugandan midwives providing perinatal care; iii) semi-structured interviews with medical center managers and clinic coordinators; and, iv) a focus group with seven traditional birth attendants in Uganda. This qualitative study used a feminist theoretical stance to show the lived reality of women taking care of other women’s health with limited resources during childbirth and neonatal airway management. Results Our findings showed that the more formally trained midwives exhibited competence in providing neonatal airway management. In contrast, the traditional birth attendants experienced barriers to performing optimal neonatal airway management due to lack of resources, limited knowledge, and cultural practices. The traditional birth attendants identified their learning preferences as demonstration, poem, or song, and by using local spoken language to learn and implement neonatal airway management. Conclusions Findings will contribute to development and dissemination of a culturally tailored educational intervention to enhance TBAs’ understanding of effective neonatal airway management. The joint effort of midwives and traditional birth attendants as a foundation for creating a training intervention with their preferred learning method constitutes a scaled-up team approach to meet the World Health Organization’s Sustainable Development Goal #3 to decrease neonatal mortality. Building on the internationally recognized Helping Babies Breathe model, this integrative initial analysis can be replicated to develop sustainable intervention for other rural areas of low- and middle-income countries.