Prenatal Skills Pilot Study of Graduates from a Traditional Birth Attendant Training Program in Rural Guatemala [5M

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INTRODUCTION: In developing countries the importance of training traditional birth attendants (TBAs) has been recognized. There is limited data on direct effect on clinical skills and referring capacities from training programs. This pilot study tests the efficacy of a WHO-adapted skills checklist in capturing prenatal skills and referrals in real time in rural Guatemala. METHODS: There have been three graduating classes from Saving Mothers TBA training program from 2014-2016 with a total of forty-eight participants. Seventeen graduates were recruited and consented. Four Saving Mothers medical volunteers observed 84 prenatal home-visits in 6 weeks and measured clinical skills in real time. RESULTS: 92% of prenatal visits by TBAs from the first graduating class, who have had three years of training, were complete. TBAs with four to six months of prenatal skills training performed complete prenatal visits 26% of the time. 30 women were referred to a government clinic and/or hospital; one revealed fetal demise. In 90% of prenatal home visits blood pressure and pulse were correctly taken. Review of at least one of four signs requiring immediate refer to a hospital occurred at 67% of visits. Hand washing only occurred on 35% of total visits. CONCLUSION: This pilot testing of a WHO adapted skills checklist appropriately captured clinical skill and referral capabilities in our cohort of TBAs. Continued in-field training improves prenatal clinical skills and referring capacities. This WHO-adapted checklist will be subsequently used in a large-scale study to measure direct skill improvement before and after our training program.