Using culture results from hands and razor blades to sensitise traditional birth attendants on infection prevention practices

Abstract

Abstract Background This study was prompted because of concerns about high infection rates among clients of traditional birth attendants (TBAs) in Chongwe district in Zambia. One factor that may contribute to infection rates is the lack of awareness about the potential sources of infections due to inadequate or lack of hand washing and use of dirty equipment in tying and cutting the umbilical cord during deliveries among TBAs. This article describes findings from one component of a multi-phased study on Infection Prevention Knowledge and Practices of Traditional Birth Attendants (TBAs) from 2006- 2012 The purpose of this paper is to describe the use of the swabbing and culturing activity as one component of a larger TBA educational intervention, and to share the results that suggest the effectiveness of this strategy in sensitizing TBAs to the importance of hand washing and using clean razor blades. Material and Methods. Poor hand washing and cutting the cord using traditional practices were identified during the needs assessment phase of the study. The study included two activities within the training programme for TBAs using a modified Ministry of Health (MoH) TBA Training Curriculum. One component of this curriculum involved sensitizing the TBAs on two poor infection prevention practices - poor hand washing, and cutting babies’ umbilical cords using any dirty rusted sharp instrument after tying with traditional ‘ulushishi’(fibre from inside of a tree bark). These practices cause maternal and infant morbidities. The researcher swabbed and cultured the TBAs’ hands and razor blades that were in their Clean Delivery Kits (CDKs), and subsequently shared the culture results with the TBAs. The seventy-eight (78) out of one hundred (100) intervention TBAs, whose right hands were swabbed for laboratory analysis, were chosen by simple random probability sampling. The training had both theoretical and practical components. They were trained in four groups of twenty-five TBAs in each group. The bacteriological screenings of ordinary razor blades found in CDKS were done on 26/09/07 and 02/10/07. The activities involved swabbing, culturing, isolating and identifying micro-organisms and the results were shared with the entire group. The main study was quasi-experimental supplemented by focus group discussions thus making it a mixed method to potentiate the quality of data collection Results The results showed no growth on the six razor blades after 48 hours incubation thus proving their sterility. The results from the hand swabbing showed one-hundred and seven (107) isolates that have the potential to infect mothers and babies during the birthing process. This result convinced the TBAs on the importance of hand washing. This was evidenced after the post-course as the proportion of TBAs who wash their hands before delivering their clients among the intervention group was significantly different (p<0.001) compared to control group (52) 48.6% and (100) 100%). There was significant difference (P<0.001) observed among the intervention TBAs who used blades from CDKs compared to the control TBAs [(78) 72.9%, (100) 100%]. Conclusion Increased evidence-based hand washing and using sterile blades in CDKs while conducting deliveries may have reduced infant and maternal infection rates among the intervention TBAs. Therefore, the results would inform the infection prevention policy on evidence-based practices. Although this sensitization contributed in evidence-based hand washing practice among TBAs and subsequent lowering of the TBA clients’ morbidity rates in Chongwe district, this study needs replication in other rural communities