Traditional Birth Attendants Research Articles

Experiences of women with physical disabilities accessing prenatal care in low- and middle-income countries.

Women with physical disabilities experience barriers to accessing patient-centered and accommodative care during the prenatal and childbirth periods. While there is a growing body of work in high-income countries to address these needs, there is little research detailing specific challenges in low- and middle-income countries (LMICs) where a woman's' burden- and need-is greatest. We conducted an integrative review to synthesize the experiences of women with physical disabilities accessing prenatal care and childbirth services in LMICs. Five databases were searched for systematic reviews, retrospective cohort studies, cross-sectional studies, narrative literature reviews, as well as other evidence types. We used Ediom's EvidenceEngine™, a machine-assisted search engine that uses artificial intelligence to conduct this search using pertinent keywords to identify original research published between January 2009 - September 2018. These results were augmented by hand searching of reference lists. Forty articles were identified using this method and 11 retained after duplicates were removed and inclusion and exclusion criteria applied. Four types of experiences are described in these 11 studies: (1) limited physical and material resources; (2) health care worker knowledge, attitudes, and skills; (3) pregnant people's knowledge; and (4) public stigma and ignorance. People with physical disabilities face specific challenges during pregnancy and childbirth. Importantly, these findings offer targets for enhanced clinical training for nurses, midwives, traditional birth attendants and public health workers, as well as opportunities for the improved delivery of prenatal care and childbirth services to these vulnerable women.

Maternal mental health of adolescent mothers: a cross-sectional mixed-method study protocol to determine cultural and social factors and mental health needs in Lilongwe, Malawi

IntroductionAdolescence marks a transition of life from childhood to adulthood. Becoming a mother during adolescence presents unique challenges that have a significant mental and physical burden and may increase the...

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Dracaena steudneri Engl. (Dracaenaceae) is a medicinal plant that is used in labour by traditional birth attendants to induce labour, relieve pain and treat various diseases; albeit no documentation. This study determined the analgesic, anti-inflammatory and oxytocic effects of the D. steudneri stem bark aqueous extract. D. steudneri stem bark was collected, authenticated, oven-dried at 45ºC for 48 h, pulverized and extracted using the decoction method. The analgesic effect of the aqueous extract was determined using the acetic acid writhing test, anti-inflammatory activity was determined using paw oedema method while oxytocic activity was determined using abortion and other standard test procedures and were tested at 12.1 24.1 and 48.2 mg/kg. The results of the analgesic study showed that the extract reduced the number of abdominal writhing between 53.51 and 92.40% at 6.02 and 48.2 mg/kg dose, respectively while the standard drug showed a reduction of 36.58% at 10 mg/kg. The anti-inflammatory results showed percentage inhibition of 18.6% (2 h), 22% (2 h) and 18.9% (6 h) at 12.1, 24.1 and 48.2 mg/kg, respectively. The in vivo oxytocic activity showed average time taken for the rats to deliver was between 20.63 h at lowest dose (12.1 mg/kg) and 8.25 h at highest dose (48.0 mg/kg) while Oxytocin the reference drug exhibited, 22 h as the average time taken for delivery. Key words: Analgesic, oxytocic, anti-inflammatory and obstetrics.

DETERMINANTS OF LABOR FACTORS IN TRADITIONAL BIRTH ATTENDANTS AT THE EILOGO SABU RAIJUA PUBLIC HEALTH CENTER

A safe and safe delivery is the hope for maternity mothers. Until now, there are still many deliveries carried not in health facilities. This has an impact on increasing MMR and IMR and becoming a health problem in Indonesia. The research design used a cross sectional study approach. The population in this study were all pregnant women who gave birth to traditional birth attendants in 2021 with a total sample of 70 respondents. The measuring instrument uses a questionnaire
 The results showed that there was a relationship between knowledge (p=0.000), mother's attitude (p=0.000), socio-culture (p=0.001), delivery history (0.002) and social support (0.000) with childbirth at traditional birth attendants in the work area of ​​the puskesmas. Eilogo Sabu Raijua Regency. It is hoped that health workers will further improve services by giving more special attention to every pregnant woman by continuing to provide counseling about safe deliveries assisted by health workers and in health service facilities.

Socio-cultural beliefs and practices during pregnancy, child birth, and postnatal period: A qualitative study in Southern Ghana

Despite investments in interventions to reduce maternal and neonatal morbidity and mortality, progress has been slow, especially in developing countries. Socio-cultural beliefs in communities often lead to the adoption of certain practices during pregnancy, childbirth, and postnatal period. Therefore, this study was conducted to identify these beliefs and practices and how they affect maternal and child health care services. Purposive sampling was used to select focus group discussion participants (13) among community members, pregnant women whose gestation was at least 6 months, and women with babies less than 6 months of age. In addition, 22 in-depth interviews were conducted among health workers at district, subdistrict, and community levels. All interviews were audio-recorded and transcribed verbatim. With the aid of NVivo 11, the data was analysed thematically. The study’s findings showed that socio-cultural beliefs and practices are widespread covering antenatal through childbirth to the postnatal period. Both harmful and harmless practices were identified. Protecting pregnancy from evil forces resulted in the practice of confinement and consequently late initiation of antenatal care. The use of herbal preparations to augment labour was reported and this practice favoured home delivery and use of Traditional Birth Attendant. The study concludes that socio-cultural beliefs are common and transcend the entire peripartum period. Some of these social practices tend to affect utilisation of some essential maternal and child health practices. However, accepting harmless social practices during labour will improve trust and cater for community’s worldview about childbirth and foster skilled delivery.

A lack of reproductive agency in facility-based births makes home births a first choice regardless of potential risks and medical needs—a qualitative study among multiparous women in Somaliland

ABSTRACT Background Around 20% of births in Somaliland take place at health facilities staffed by trained healthcare professionals; 80% take place at home assisted by Traditional Birth Attendants (TBAs) with no formal training. There has been no research into women’s choice of place of birth. Objective In this study, we explore multipara women’s needs and preferences when choosing the place of birth. Method An explorative qualitative study using individual in-depth interviews analysed inductively using content analysis. The interviews were conducted in Somaliland with 25 multiparous women who had experience of giving birth both at home and at a health facility within the past three years. Results The results provide a description of how, for women in Somaliland, a lack of reproductive agency in facility-based births makes home births a first choice regardless of potential risks and medical need. The women in this study desired intentionality in their role as mothers and sought some measure of control over the environment where they planned to give birth, depending on the circumstances of that particular birth. The results describe what quality care means for multipara women in Somaliland and how women choose birthplace based on previous experiences of care. The expectation of respectful care was a vital part for women when choosing a place of birth. Conclusion To meet women’s needs and preferences in Somaliland, further investments are needed to strengthen the midwifery profession and to define and test a context specific midwife-led continuity of care model to be scaled up. A dialogue to create new roles and responsibilities for the TBAs who attend most home births is further needed to link them to the formal healthcare system and assure timely healthcare seeking during pregnancy and birth.

The identified patterns of utilization/non utilization of institutional facility for delivery by women of rural community

A simple descriptive study using the survey to determine the utilization pattern of institutional facility for childbirth by women in certain rural communities in West Bengal. The objectives were to identify the reasons for institutional & home delivery & seeking association between the institutional facility utilization pattern for delivery with selected demographic factors. A sample of 572 mothers were selected& the tool was a personal and obstetric interview schedule and 20 needs-based questions. The proportion of institutional and home delivery found to be 3:7. The reasons for institutional delivery were the availability of health care staff (67% nurses), health care workers motivated the choice(100%), the distances of health centre were less than 4 km (60%), the expenses were reasonable (73%), no obstetric/medical or disease history (80%) and no psychosocial beliefs were associated. The reasons identified for home childbirth were the easy availability of traditional birth attendants (52%), didn’t receive any information or motivation from health workers (71%), the distances of health facility were over 4 km (80%), the spending was smaller (90%)at home, the decision-making authority waste in-laws (74%), psychosocial believes were associated (60%) with delivery.

Beyond Performative Compliance: Local Forms of Resistance to Anti-FGM Campaigns in Ethiopia

Abstract The Afar region, one of the hot spots of female genital mutilation (FGM) in Ethiopia and the Horn of Africa, has attracted several international and local anti-FGM campaigns including the longitudinal global UNFPA-UNICEF joint initiative. The region is often praised as a showcase for the acclaimed social norm change brought by intervention projects. Religious leaders and traditional birth attendants (TBAs) were among the key local actors targeted as agents of change and norm mediators. The declaration passed by the religious leaders outlawing FGM, and the numerous community public declarations made all applauded the success in social norm change. Such accounts are often in tune with a narrative of linear progress of norms whereby global norms of gender equality successfully diffuse to local settings. The discourse pronouncing the diffusion of global norms often overshadows the norm contestations and resistance happening at the grassroots level. Based on an ethnographic study conducted in the Afar region, this contribution examines the different aspects of norm contestation and resistance happening at the grassroots level throwing light onto the resurgence of FGM in the region where the practice continued beyond the observational gaze of the government and other stakeholders. Furthermore, the article discusses the discursive strategies that the local community adopted ranging from performative compliance, negotiation for a milder form of the practice to devising alternative ways and platforms for performing FGM. The article critically reflects on the direct and subtle forms of resistance, the framing of the debate and the interplay of several factors that undermined the efficiency of the interventions.

Midwife and Shaman Partnership Relationship with MCH Service Coverage in the Work Area of the West Limboto Health Center

The cooperation between midwives and traditional birth attendants is referred to as a partnership between midwives and traditional birth attendants. In order to promote the health of mothers and newborns, it must be mutually advantageous for all parties and built on the principles of openness, equality, and mutual confidence. The purpose of this research is to evaluate the collaboration interaction between midwives and traditional delivery attendants in the context of the enhancement of maternal and infant health services at West Limboto Health Center in Uganda, Africa. In this study, a cross-sectional research strategy using the Chi Square test was employed. The sampling approach used in this research was incidental sampling, which is to say, the technique of determining samples was used. The findings indicated that the Chi Square test was 0.005 or the p value was less than 0.005, which led to the conclusion that there was a link between midwives and traditional delivery attendants in order to promote the health of mothers and newborns.

Maternal Time Use Drives Suboptimal Complementary Feeding Practices in the El Niño-Affected Eastern Ethiopia Community.

Ethiopia is affected by recurrent drought and food-insecurity crises, including El Niño. El Niño started in mid-2014, worsened in 2015, and continued in 2016, leading to a widespread food-insecurity emergency resulting in a surge in the rate of acute malnutrition in infants due to suboptimal feeding practices. This study explored how El Niño influenced complementary feeding practices in the eastern Ethiopia community from March to September 2016. It was an exploratory qualitative study with a basic interpretative qualitative approach. A general inductive approach was used for the analysis. The study involved 11 focus group discussions (FGD) with a total of 76 people, including three with mothers, three with Health Development Army (HDA) leaders, two with fathers, two with traditional birth attendants, and one with religious leaders. El Niño resulted in failed crops and loss of livestock, resulting in reduced dietary diversity and meal frequency. El Niño resulted in suboptimal complementary feeding practices by reducing food access and altering livelihood and coping strategies, reducing the time mothers allocated to child feeding, keeping them away from home, and stressing community health services. The maternal suboptimal time allocation is central to the poor complementary feeding practices. Thus, the women should be supported with climate-resilient livelihood options in their villages, allowing them to feed their children and attend education sessions with HDA leaders.

Women’s perception of quality and utilization of antenatal care and delivery services in Oshimili South Local Government Area of Delta State, Nigeria

Background: The perception of quality of antenatal care and delivery services is one of the several factors that influence utilization of these services. This study assessed the perception of quality and utilization of antenatal care (ANC) and delivery services among women of childbearing age in Oshimili South Local Government Area (LGA) of Delta State, Nigeria.Methods: A cross-sectional study among 301 women aged 15-49 years selected by multistage random sampling technique using mixed methods of data collection. Quantitative data were analyzed using SPSS version 21 while thematic analysis was done for the qualitative data.Results: The mean age of the women was 32.0 ± 2.5 years. Most were married 287 (95.3%), had secondary education 211 (70.1%)) and self-employed 227 (75.4%). One hundred and forty-eight (49.2%) had good perception of technical competence of staff, 132 (43.9%) their safety consciousness and 134 (44.5%) effectiveness/efficiency of drugs. However, 136 (43.5%) had poor perception of waiting time, 118 (39.2%) health workers respectfulness and 116 (38.5%) compassion for patients. Two hundred and seventy-three (90.7%) and 251(83.4%) utilized ANC and delivery services, respectively, while 22 (7.3%) delivered at home.Conclusion: The women’s perception of quality of ANC and delivery services varied across domains. There was a high level of utilization of antenatal care and delivery services. However, there were few traditional birth attendant (TBA) and home deliveries. Addressing the issues of long waiting time and attitude of health workers will encourage full scale utilization of health facilities and discourage TBA and home deliveries
 Keywords: Antenatal care; Delivery services; Perception; Quality of care; Utilization; Nigeria

Sustaining maternal and child health programs when donor funding ends: A case study of stakeholder involvement in Indonesia.

There has been a dearth of evidence in exploring the role of stakeholders in making the transition process from donor to local responsibility successful in relation to maternal and child health programs to date. This study aimed to generate practical experiences concerning stakeholder involvement in sustaining maternal and child health programs when donor support ends, so as to lead systematic strategies for supporting the success of the post-transition process and capture critical challenges of the programme's sustainability. This study employed Focus Group Discussion (FGD) with district healthcare stakeholders such as hospital managers, district health officers, community health centres, community associations and local authorities. In-depth interviews one to one with the local authority, health staff, informal leaders, and traditional birth attendants were conducted. From the final research project sample of participants, we extracted the interviews to analyse their narratives. Content analysis revealed 5 main themes from the FGDs and interviews: (1) Stakeholders' collaborative culture and organisational capacity; (2) Stakeholders' commitment; (3) Challenges in partnership and coordination; (4) Barriers to sustainable local financial support (5) Policy for maintaining institutionalisation. Two areas of concern were the priorities for follow-up to sustain the maternal and neonatal care programme and factors responsible for the continuation when donor funding ends, specifically longevity of stakeholder engagement and commitment and internal resource capacity for long-term implementation. Recommendations include increased networking of active cooperation from all levels of administration, especially with a top-down approach involving the national, provincial, down to the district and community-based networks.

The unspoken grief of multiple stillbirths in rural Pakistan: an interpretative phenomenological study

BackgroundPakistan has the highest rate of stillbirth (30.6 stillbirths per 1000 total births) as compared to other South Asian countries. The psychological impact of stillbirths on bereaved women is well documented; however, there is a dearth of literature on lived experiences of women with multiple stillbirths in Pakistan.ObjectiveThe purpose of this research is to understand the lived experiences of women who had multiple stillbirths in Thatta, Pakistan.MethodsAn interpretative phenomenological study was conducted in district Thatta with eight women who experienced more than one stillbirth. A semi-structured in-depth interview guide was used for data collection. The data were analyzed by using thematic analysis approach.ResultsThe results of this study show that experiencing multiple stillbirths has a devastating impact on women’s mental and social wellbeing. The women who experienced multiple stillbirths are stigmatized as “child-killer” or cursed or being punished by God. They are avoided in social gatherings within the families and community, because of these social pressures these women seek spiritual and religious treatment, and struggle to conceive again to deliver a live baby. It was observed that the psycho-social and medical needs of these bereaved women remain unaddressed not only by the healthcare system but also by the society at large.ConclusionsThe physical, social and mental well-being of women who experience multiple stillbirth are at stake. These women are being considered social outcast. Health care providers including physicians, lady health workers, and traditional birth attendants should be trained on provision of psychosocial support along with the routine care that they provide in communities and health facilities. The health care providers should also inform the bereaved women about the biomedical causes of stillbirths that would be helpful to mitigate the stigma associated with stillbirths. Moreover, the health care providers should also counsel family members especially in-laws of these sorrowful women about the biomedical causes of stillbirths that would also be helpful to mitigate the stigma associated with stillbirths.

Treatment-seeking and uptake of malaria prevention strategies among pregnant women and caregivers of children under-five years during COVID-19 pandemic in rural communities in South West Uganda: a qualitative study

BackgroundDespite efforts to avert the negative effects of malaria, there remain barriers to the uptake of prevention measures, and these have hindered its eradication. This study explored the factors that influence uptake of malaria prevention strategies among pregnant women and children under-five years and the impact of COVID-19 in a malaria endemic rural district in Uganda.MethodsThis was a qualitative case study that used focus group discussions, in-depth interviews, and key informant interviews involving pregnant women, caregivers of children under-five years, traditional birth attendants, village health teams, local leaders, and healthcare providers to explore malaria prevention uptake among pregnant women and children under-five years. The interviews were audio-recorded, transcribed and data were analyzed using thematic content approach.ResultsSeventy-two participants were enrolled in the Focus Group Discussions, 12 in the in-depth interviews, and 2 as key informants. Pregnant women and caregivers of children under-five years were able to recognize causes of malaria, transmission, and symptoms. All participants viewed malaria prevention as a high priority, and the use of insecticide-treated mosquito bed nets (ITNs) was upheld. Participants' own experiences indicated adverse effects of malaria to both pregnant women and children under-five. Home medication and the use of local herbs were a common practice. Some participants didn’t use any of the malaria prevention methods due to deliberate refusal, perceived negative effects of the ITNs, and family disparity. The Corona Virus Disease-2019 (COVID-19) control measures did not abate the risk of malaria infection but these were deleterious to healthcare access and the focus of malaria prevention.ConclusionsAlthough pregnant women and caregivers of children under-five years recognized symptoms of malaria infection, healthcare-seeking was not apt as some respondents used alternative approaches and delayed seeking formal healthcare. It is imperative to focus on the promotion of malaria prevention strategies and address drawbacks associated with misconceptions about these interventions, and promotion of health-seeking behaviors. As COVID-19 exacerbated the effect of malaria prevention uptake and healthcare seeking, it’s critical to recommit and integrate COVID-19 prevention measures in normative living and restrict future barriers to healthcare access.

Mothers’ Experiences of Delivery Services by Traditional Birth Attendants at Egbe Community, Yagba West Lga Kogi State, Nigeria

A lot of women gave birth in their homes historically, and are often attended by a family member or assisted by a woman residing in the communities who are known as Traditional Birth Attendants (TBAs).The mothers’ experiences before labor, after delivery and care of the new born was a mixed one. This study was aimed to explore mothers’ that have delivered with TBAs in the past at Egbe Community, Yagba West Local Government Area, Kogi State, Nigeria. The study employed a qualitative research design with in-depth interview supported with two Focus Group Discussions as method of data collection, to explore the experiences of mothers’ during with TBAs. Sixteen participants were used for FGD, eight in each group and thirteen participants for one-on-one in-depth interview using a snowball sampling technique. Both the FGD and IDI sessions were audio taped and transcribed verbatim. The research was analysed using a manual method of qualitative data. The findings revealed that majority of the participants used the services of traditional birth attendants because of the affordable cost. Majority were delivered at their homes and they had good experience. Relatives were allowed to stay with them during labor. They were not given food during labor and their babies were taken good care of. However, few of them would like to deliver at a regular hospital in next delivery due to some complications they experienced. In conclusion, many of the women patronized TBAs because of the cost and services provided were just basic. Therefore, it’s recommended that the cost of delivery at the hospitals should be subsidised and the TBAs should be trained and supervised on a regular basis by the Primary health care centres at the Local Government Areas nearest to them.

Perception of pregnant women towards early antenatal visit in Fiji: a qualitative study

BackgroundAntenatal Care (ANC) is an opportunity to provide care to prevent potential maternal and new born mortality and morbidity and reduce new born mortality and morbidity. There has been an increase in the number of women receiving early ANC over the last two decades, however, in many developing regions such as Fiji, women are still delaying initiation of ANC. Therefore, the aim of this study is primarily to explore reasons for delayed initiation of ANC appointments and to explore knowledge and perception of pregnant mothers towards early antenatal appointments in Fiji.MethodsThe study uses a qualitative approach. Data was collected among pregnant women more than 18 years of age after 12 weeks of gestation attending their first ANC clinic at the Ba Mission Hospital (BMH) from February 28 to April 2, 2020. Heterogenous purposeful sampling method was used to select 25 pregnant women for the study. A semi-structured open-ended questionnaire was used for face to face in-depth interviews. Data was analyzed manually using thematic content analysis after verbatim transcription of the interviews.ResultsThe mean age of the participants was 25.8 ± 5.9 years (age range of 19–40 years). The average gestational age of those making a booking for a consultation was 5.4 ± 1.4 months with a range of 4 to 8 months. The majority of women were multigravida (64%) and multiparous (40%). The main themes that emerged from the study were: i) perception of early ANC booking; ii) perceived barriers of early ANC booking and; iii) enabling factors of early ANC booking. Even though pregnant women have a good knowledge of when to initiate ANC, the practice of early booking was influenced by many other factors.ConclusionsThe results of this study highlight the need to change the current booking system. Efforts are needed to attract the hard-to-reach women through outreach visits and increased communication between health care workers and the community with the use of community resources such as community health workers and traditional birth attendants. The media should be used to create awareness on timing and importance of early ANC visits at a community level.

IbM baby Massage Training for Cadres in Kiyaran, Bantul

Baby massage is a unique affection communication between mother and their baby. During the process, ultimately mother and baby have a wonderful an joy moment to etablished not merely physicalyy but also emotionaly contact as well as bonding attachment building moment. In fact, many mothers prefer to send their baby to the birth attendance or called traditional birth attendants in Bahasa to get a routine baby massage. However, those who are called traditional birth attendants were obtain sufficient appropriate knowledge on baby massage technique are remain scarce. Thus, this community service is to provide such a training for those who in need, either mother and or traditional birth attendant. This community service were provided in Dusun Kiyaran Bantul, Yogyakarta. Our participants were mothers who hava an under five years as well as traditional birth attendants. The methods of implementation include lecturer and sharing session, following conduct the training through small group participation. The participants were excited to practice the skills companied by the facilitators

Factors related to the selection of baby massage services

<pre><strong><em>Background: </em></strong><em>Many factors influence parents in making the decision to do baby massage. These factors should be screened by health workers in providing counseling to mothers. </em><em>So,</em><em> it is hoped that the mother can choose the right facility. </em></pre><pre><strong><em>Objectives: </em></strong><em>The purpose of this study was to analyze what factors influence mothers in the selection of baby massage services. </em></pre><pre><strong><em>Methods:</em></strong><strong><em> </em></strong><em>The research method is quantitative, with a cross sectional study. The research was conducted at PBM Nanik Sidoarjo. The population in this study were mothers who had children aged 3 - 12 months. Samples were taken using purposive sampling. Inclusion criteria in sampling are mothers who are aged 3-12 months without health problems/complications of accompanying diseases. The independent variables in this study are the factors that influence the mother, namely the socio-demographic of the community (age, occupation, education, income, and </em><em>traditional baby massage culture</em><em>), while the dependent variable is the selection of baby massage methods. Direct data collection using questionnaires distributed to mothers. Furthermore, the data were analyzed by chi square test. </em></pre><pre><strong><em>Results:</em></strong><strong><em> </em></strong><em>The results showed that the number of respondents who chose to do baby massage to traditional birth attendants and to health facilities was the same, namely 40%. The results of the statistical analysis showed that educational and cultural factors were related to the selection of baby massage services with p-values of 0.006 and 0.003 <0.05. While the factors of age, occupation and income did not show significant results with a p value > 0.05. </em></pre><pre><strong><em>Conclusions</em></strong><em>: So it can be concluded that the factors that influence the selection of baby massage services are educational and cultural factors.</em></pre>

Respectful maternal care and by who? perspectives of Somali community at IFO refugee Camp, Dadaab, Kenya

Respectful maternity care is where women are accorded the freedom to make informed choices, protects them from any form of harm and harassment, provides continuous support during labour and child birth and also upholds their privacy, confidentiality and dignity. Previous studies have demonstrated that any care deemed to disrespect the woman may henceforth determine her care seeking behaviour. In the lacuna created by some forms of disrespect of women of child bearing age in the healthcare system, some women may seek alternative care from traditional birth attendants, who are neither skilled nor able to promptly recognize, manage or refer complications arising during pregnancy, labour, child birth and puerperium. Globally, the high maternal mortality rate is associated with preventable complications which occur during pregnancy, labour, child birth and the puerperium, with those who encounter near misses or who narrowly survive death, end up suffering lifelong disability which affects their quality of life. Services offered by traditional birth attendants (TBAs) continue to be sort by a few women of reproductive age in both rural and urban settings including Dadaab, despite the availability of both public and private health facilities. TBAs are preferred among the Somali community as they are deemed to offer a type of care that is regarded as being respectable to the woman and her family as well as being aligned to their culture and religion. Hence, this study aimed to investigate the perspectives of the Somali community residing in Dadaab refugee camps on respectful maternal care. A qualitative study was conducted at Ifo refugee camp in Dadaab, where three TBAs, two save mothers, two married men and two expectant women were interviewed. Two focused group discussions were conducted among the men and pregnant women. The TBAs and the save mothers were interviewed. The TBAs were also video recorded as they performed some of their activities. Data was coded, categorized into thematic areas and the content was analyzed. The findings demonstrated that TBAs and save mothers accorded the women both social and psychological support during pregnancy, child birth, and postnatal period, and treated them with respect. They accompanied the mother throughout the labour and childbirth and gave her so much encouragement. The findings further revealed that cultural beliefs and practices such as prayer, disposal of the placenta and the gender of the care provider, play a big role in maternal care of the women. The placenta is valued as a significant part of the woman’s body and thus has to be buried according to their culture, as opposed to it being disposed of after giving birth in a health facility. Respectful maternal care should be accorded to all women irrespective of their background and should also be culturally sensitive

Factors contributing to neonatal mortality reduction in three regions in Ghana: a mixed-methods study using the Lives Saved (LiST) modelling tool

Background Ghana had significant reductions in neonatal mortality during the Millennium Development Goal (MDG) era. Few studies have attempted to identify the interventions, programs and policies that contributed to this progress. To understand the underlying factors which contributed to the reduction in neonatal mortality and to inform strategies to reach the Sustainable Development Goal (SDG) target to end preventable neonatal deaths, we conducted a mixed-methods study in the Northern, Upper West, and Volta Regions of Ghana. Methods The quantitative component consisted of an analysis of trends in coverage of key neonatal health interventions using subnational data from the Ghana Demographic and Health Surveys (DHS) and the Multiple Indicator Cluster Surveys (MICS). The Lives Saved Tool (LiST) was used to assess the contribution of various neonatal health interventions which resulted in reductions in neonatal mortality. Qualitative in-depth interviews (N=38) were conducted with government health officials, health workers, staff from non-government organizations, and community leaders, including traditional birth attendants and local chiefs from the Northern Region of Ghana. Findings Multiple interventions and contextual factors contributed to declines in the neonatal mortality rate (NMR) in all three regions. The Volta and Upper West Regions improved labor and delivery management practices which accounted for approximately one-third of the decline in NMR. The Northern Region had a substantial decline in NMR; the greatest proportion of the decline was attributed to control and management of infections in newborns (sepsis and pneumonia). Qualitative interviews suggest that improvements in neonatal survival were achieved through the prioritization of neonatal health at community-based health planning (CHPS) compounds and the development of a national-level strategic plan, coupled with neonatal health-related training for health workers. The establishment of neonatal intensive care units and strong partnership with local leaders and women’s groups to increase facility births and promote clean birth practices were also considered important. Conclusions The strategies that supported the reductions span from national-level policy intervention to facility-based quality improvement, to community level engagement. These strategies can be continued, strengthened, and scaled to improve neonatal survival in the SDG era.