The trained traditional birth attendant: a study of her role in two cultures.

Abstract

The training of the traditional birth attendants (TBAs) in the national program in Liberia and in the innovative health program of the Rural Unit for Health and Social Affairs (RUHSA) program in South India is evaluated. The study was part of the national evaluation of the training of TBAs in Liberia and was carried out in 4 counties avoiding the areas where the national evaluation teams were operating. 12 towns were identified in which trained and untrained TBAs were practicing. 26 trained and 24 untrained TBAs were randomly selected to participate in the study. A structured questionnaire was administered to the selected TBAs to test the following hypotheses: trained TBAs are more knowledgeable than untrained TBAs; trained TBAs perform better and provide more informed and skilled care than untrained TBAs; and maternal and perinatal mortality is lower in deliveries performed by trained TBAs than untrained TBAs. 100 women delivered recently by the 2 study groups were interviewed. 38 TBAs in South India were interviewed. 223 mothere were also interviewed. There has been an improvement in coverage with prenatal care and immunization with tetanus toxoid associated with a fall in the incidence of low birth weight and neonatal tetanus. The need for repeated refresher courses for effective back-up in case of emergencies and for close supervision to prevent risk-taking is stressed. Even though the performance of the untrained TBAs improved with regard to the assessment of pregnancy and the idetification of risk factors the trained TBAs tended to handle complicated births retained placenta and prolonged labor by themselves. Whatever the reasons it stresses the need for the supervisory back-up to work closely with the trained TBAs.