Traditional Birth Attendants Research Articles

Pengaruh Edukasi Kesehatan Tentang Inovasi Biduran (Bidan Dan Dukun Kemitraan) Terhadap Minat Ibu Bersalin Ke Fasilitas Kesehatan Di Puskesmas Cimanggu Kabupaten Pandeglang Banten Tahun 2022

Introduction: Maternal mortality is closely related to birth attendants, in some areas, the presence of traditional birth attendants as confidants in assisting childbirth. The Cimanggu Health Center in Pandeglang Regency 2017 has been doing Biduran innovation. One of the efforts to increase the interest of pregnant women to give birth in health facilities is by providing health education through the right media, including leaflets. The purpose of the study was to determine the effect of health education on midwife innovation (midwives and traditional birth attendants) on maternal interest in giving birth at health facilities at the Cimanggu Health Center, Pandeglang Regency Banten in 2022. Methods: The research method is a quasi-experimental design with a one-group pre-test-post-test design, the number of samples is 40 respondents, and the sampling technique is total sampling. The research instrument used a questionnaire. The data is primary data analyzed using the paired sample test, which was previously tested for normality Results: The results of the research on maternal interest in giving birth to health facilities before being given health education through leaflet media about hives innovation were mostly in the medium category as much as 55,0% after that with the high category as much as 60,0%. Breast milk production in breastfeeding mothers before giving mung bean juice was found to increase by 70,0%, and after that, it increased to 100%. The results of the bivariate analysis showed that there was an effect of health education on Biduran innovation on maternal interest in giving birth to health facilities with a p-value of 0,000. Discussion: The conclusion of health education about the innovation of hives has an effect on the interest of mothers in giving birth to health facilities. Maternity mothers are expected after receiving health education about the innovation of hives to give birth in health facilities so that when abnormalities are found during delivery, immediate action can be taken because the available facilities are more complete compared to giving birth at home.

Tuberculosis management and referral practices among traditional medicine practitioners in Lagos, Nigeria

Introduction: Despite the potential role of Traditional Birth Attendants (TBAs) and Traditional Healers (THs), little is known about their knowledge of tuberculosis (TB) management and referral practices in Nigeria. Objective: To determine knowledge and self-reported practices of traditional birth attendants and traditional healers in managing TB in Lagos, Nigeria. Methods: A cross-sectional study of 120 THs and TBAs in three high TB burden Local Government Areas (LGAs) in Lagos, Nigeria. Data were collected between April 2018 to September 2018 through interviewer-administered questionnaires. We used Statistical Package for Social Sciences software for data analyses. Independent predictors of being TBA or TH were determined using logistic regression at the statistical significance of P0.05 and 95% confidence interval. Results: TB knowledge increased from 52.7% pre-test to 61.7% post-test and did not differ between TBAs and THs. Of the 120 Traditional Medical Practitioners studied, 70% (84) never treated TB; 57.3 % (69) ever referred chronic cough patients to a health facility; 90% (108) were willing to collaborate with National Tuberculosis, Leprosy and Buruli Ulcer Control Programme (NTBLCP), 85% (102) attached monetary and token incentive as a condition for the collaboration. THs had decreased odds of ever referring TB patient to the hospital (AOR: 0.3, 95% CI:0.14-0.64, P=0.002); currently referring TB patients (AOR: 0.06, 95% CI:0.02-0.17, P0.0001) and consulting 40 patients in a year (AOR: 0.22,95% CI:0.09-0.53, P0.0001). Conclusion: Majority of the THs and TBAs were willing to collaborate with NTBLCP in the identification and referral of Presumptive TB patients. We suggest that NTBLCP empowers the TBAs and THs to help with an early referral of TB patients.

A descriptive analysis of the relationship between place of birth and type of birth attendant with breastfeeding feeding practices among children in Kenya

Background: According to the World Health Organization (WHO), all infants should be breastfed immediately after birth, exclusively for 6 months, and for a minimum of two years thereafter. This study determined the relationship between place of birth and type birth attendant with breastfeeding practices in Kenya. Methods: Data from 21,773 households participating in the 2015/2016 Kenya integrated household budget survey (KIHBS) were analysed. Respondents provided information on duration and exclusivity of breastfeeding practices as well as place of birth, and the type of birth attendant. Results: 99.4% of the children 0-59 months had been breastfed with about 62.8 % exclusively breastfed for 6 months. 54% of the children were born in a hospital or health care center. 49% of all the births were attended by a nurse/midwife and 27% by traditional birth attendants (TBA). Those born at home were less likely to EB (Z2=24.6; p<0.001) than those born in the hospital. Those whose birth was attended by a TBA were less likely to EB for 6 months (Z2=28.6, p<0.001). Conclusions: These findings suggest that interventions could focus on identifying factors that hinder women from giving birth in hospitals or health care facilities which are able to provide resources on infant feeding practices.

Effects of COVID-19 on Kenya’s Healthcare System: Healthcare Providers’ Experiences with Maternal Health Services Utilization in Coastal Kenya

The COVID-19 pandemic overstretched health systems in developed and developing nations. Like other African nations, Kenya has a frail health system, making responding to the pandemic a problem. Recent studies during COVID-19 have shown that Kenya’s health systems were either strained to their maximum capability or worse in handling patients. Therefore, citizens were advised not to go to the hospital unless necessary. This advice applies to all, including pregnant mothers. This article utilized the anthropological description of the healthcare system, viewed as a cultural system attached to particular provisions of social institutions and forms of social connections. It is a social and cultural system in origin, structure, function, and significance. In every society, healthcare systems are forms of social reality in which they embody specific social roles and relationships between these roles. There is a dearth of information on how healthcare providers experienced the effects of COVID-19 on Kenya’s healthcare system, which this study addresses for those in Coastal Kenya. This rapid qualitative study utilized data from sixteen purposefully selected healthcare providers in charge of various departments in Kilifi County of Coastal Kenya. We utilized thematic analysis and textual description to present our findings. It emerged that there was a diversion in resources allocated for maternal health programs, health facilities were temporarily shut down due to inadequate resources and equipment for health workers, there was a lack of preparation by health workers, there was a reduced flow of pregnant mothers and missing scheduled appointments for ante- and postnatal clinics, maternal mortality increased, and mothers resorted to traditional midwives for deliveries. These findings show that maternal health services were negatively affected. Thus, the government needs to institute alternative measures for continued access to maternal health services during pandemics. We recommend expanding and supporting the existing community midwifery model (CMM). For instance, incorporating community health workers (CHWs) and other local health institutions in the community, such as traditional birth attendants (TBAs), and creating midwifery centers managed by trained midwives in communities.

Practicing Local Listening with Village Midwives in Sudan: A Case Study for Theological Ethics

According to Paul Farmer, “the experiences of those who are sick and poor remind us that inequalities of access and outcome constitute the chief drama of modern medicine.” One particular global health flashpoint in under-resourced communities is newborn mortality. This chapter is a case study of Helping Babies Breathe Sudan, a training for a national program to train village midwives or traditional birth attendants in basic newborn care. The program’s successes and challenges offer important lessons about the process of developing partnerships for accompaniment. Focused on local listening and participation, this article examines lessons from this case for thinking about ethical partnerships for health and development. For theological ethics, Farmer’s own work and this case provide concrete examples that the option for the poor can be put into practice through prioritizing participation and local listening.

Why Do Pregnant Mothers Prefer to Give Birth at Home After they Attended Antenatal Care Visits in Southern Ethiopia? A Phenomenological Study Design

Background: Common causes of maternal deaths are direct obstetric complications that can be managed by healthcare providers in health facilities. Women giving birth at home have a higher contribution to maternal mortality and morbidity as well as a poor fetal outcome. Sub-Saharan Africa accounts for an estimated 66% of all maternal deaths. This study aimed to explore why pregnant mothers prefer to deliver at home after antenatal care follow-up in South Ethiopia. Methods: Phenomenological study design was used to explore the factors that push women to home delivery despite antenatal care being provided. A purposive technique was used to recruit the twenty pregnant mothers for the focused group discussion and ten healthcare providers for an in-depth interview. The data saturation approach determined the sample size. A focused group discussion was commenced with women who had ANC follow-ups during pregnancy gave birth at home and came for immunization services in health facilities. The in-depth interview was done with physicians, midwives, health officers, and traditional birth attendants. Data were translated into English by a bilingual translator and analyzed thematically using Open Code software. The result was presented in a table and text. Results: The study includes a total of 20 women for FGDs, seven health professionals, and three traditional birth attendants from selected health facilities. The age of most FGD participants was 25-35 years. The ideas of the participants were grouped into five themes and subthemes. Fear of health professionals’ disrespect and abuse, a family decision on the place of delivery, lack of transport and money, traditional birth attendants’ acceptability by the community, and sociocultural influences were commonly raised as barriers to institutional delivery. Conclusion: Most of the barriers are related to behavioural issues, and effort should be made to change the behaviour of the community in general. Improving the quality of the antenatal care service and adequate counseling may be an appropriate intervention to increase health facilities' delivery.

Knowledge, Beliefs, and Practices around Newborn Resuscitation in Hilly Tribal Homebirth Settings: A Qualitative Observational Study

Objective The study explores home-based newborn resuscitation methods among the Porja hilly tribe in Andhra Pradesh, India. Methods This study was community-based qualitative observational study conducted between October 2021 and March 2022 at 3 intervals. Among the 28 homebirths, 13 were saved with home-based newborn resuscitation methods. The role of traditional birth attendants to save newborn life were found to be highly appreciable. To document its importance, 28 in-depth interviews (IDIs) and two focus group discussions (FGDs) were employed in the study. The participants were 28 mothers of neonates including 13 mothers whose newborns’ first breaths were initiated with different cultural methods and were purposively selected for the IDIs. The data was cross-checked with five untrained traditional birth attendants and 12 elderly female members involved in home deliveries to manage the newborns’ lives. Data collection was carried out using a semi-structured questionnaire on traditional practices, which measured demographic characteristics and women’s perceptions and practices of home-based newborn resuscitation methods. Results The materials used in neonatal awakening were loud sounds with heavy metals, splattering water, thumb pressures on the forehead, chest, and soles region. Four themes were generated: (a) newborn resuscitation is not required on crying neonates, (b) newborn resuscitation is required on noncrying neonates, (c) knowledge of loss of first breath in newborns, (d) post-resuscitation care methods. Conclusion Culture-specified newborn health practices and traditional beliefs still play a crucial role in shaping newborn care practices among hilly tribal communities. The qualitative studies on tribal newborn resuscitation are most important to preserve beneficial traditional methods and preventing harmful practices can help improve the health status of tribal newborn babies, where there are inadequate neonatal services in poor socio-economical resource settings.

TRIPARTITE PARTNERSHIP PATTERNS IN INCREASING THE BIRTH RATE BY HEALTH WORKERS IN CIGINGGANG VILLAGE

Health is a basic right of all people. The main priority at this time is health services for pregnant women. The selection of birth attendants for pregnant women is something that must be considered. Prior to the tripartite partnership, many people chose to give birth with the help of a dukun than to give birth with a health worker. The process of forming a tripartite partnership, namely collaboration between cadres, traditional birth attendants and midwives, began with the signing of the MoU which was directly supervised by the camat, babinsa and lurah. The existence of cadres and traditional birth attendants who continuously accompany pregnant women makes them trust them to use the services of health workers and give birth at health facilities. There was an increase in the number of birth mothers assisted by midwives who partnered with traditional birth attendants at Poskesdes with an average increase of 2. 8% for the past 2 years. The obstacles in implementing this tripartite partnership are the very low level of education of cadres and traditional birth attendants, the remote location of health services and the financial capacity of postpartum mothers.

Where, why and who delivers our babies? Examining the perspectives of women on utilization of antenatal and delivery services in a developing country

BackgroundThe differences in maternal mortality between developed and developing countries is due to differences in use of antenatal and delivery services. The study was designed to determine the views of women on utilization of antenatal and delivery services in urban and rural communities of Ebonyi state, Nigeria.MethodsCommunity based descriptive exploratory study design was employed. Qualitative data was collected through use of pre-tested focus group discussion (FGD) guide. Eight FGDs were conducted among women who were pregnant and others who have delivered babies one year prior to the study. Four FGDs each were conducted in urban and rural communities. QDA Miner Lite v2.0.6 was used in the analysis of the data.ResultsMost of the participants in urban and rural areas prefer the man and woman deciding on where to receive antenatal and deliver care. All the participants in urban and rural communities wish for the support of their husbands when pregnant. Perceived quality of care is the major reason the women choose a facility for antenatal and delivery services. Others reasons included cost of services and proximity to a facility. Participants in rural communities were of the opinion that traditional birth attendants deliver unique services including helping women to achieve conception. For participants in urban, traditional birth attendants are very friendly and perhaps on divine assignment. These reasons explain why women still patronize their services. The major criticism of services of traditional birth attendants is their inability to manage complications associated with pregnancy and delivery. The major reasons why women delivery at home included poverty and cultural beliefs.ConclusionsAll efforts should be made to reduce the huge maternal death burden in Nigeria. This may necessitate the involvement of men and by extension communities in antenatal and delivery matters. There is need to train health workers in orthodox health facilities on delivery of quality healthcare. Public enlightenment on importance of health facility delivery will be of essence. Encouraging women to deliver in health facilities should be prioritized. This may entail the provision of free or subsidized delivery services. The deficiencies of primary health centers especially in rural communities should be addressed.

Improving access to HIV testing for pregnant women in community birth centres in Nigeria: an evaluation of the Prevention of Mother-to-Child Transmission program.

The elimination of mother-to-child HIV transmission requires access to HIV testing services (HTS) for pregnant women. In Akwa Ibom, Nigeria, 76% of pregnant women receive antenatal care from traditional birth attendants and may not have access to HIV testing. This study examines the contribution of traditional birth attendants and other healthcare workers in community birth centres in improving access to HTS among pregnant women and their HIV-exposed infants. A retrospective cross-sectional study of previously collected programme data at two points in time to evaluate the prevention of mother-to-child transmission (PMTCT) programme. We assessed programme records before and after introducing an intervention that engaged traditional birth attendants and other healthcare workers in community birth centres to expand access to HTS among pregnant women and their HIV-exposed infants in Akwa Ibom State, Nigeria. Data were abstracted from the programme database for the preintervention period (April 2019 to September 2020) and the intervention period (October 2020 to March 2022). Data abstracted include the number of pregnant women tested for HIV, those diagnosed with HIV, the number of HIV-exposed infants who had samples collected for early infant diagnosis and those diagnosed with HIV. The data were analysed descriptively and inferentially. Before the intervention, 39,305 pregnant women and 2248 HIV-exposed infants were tested for HIV. After the intervention, the number of pregnant women tested increased to 127,005 and the number of HIV-exposed infants tested increased to 2490. Among pregnant women, the postintervention testing increased by 3.2-fold, with community birth centres reporting 63% of all tests. The intervention also resulted in an 11% increase in HIV-exposed infants benefitting from early infant diagnosis with community birth centres reporting 5% of all tests. Of those diagnosed with HIV, 24% of pregnant women and 12% of infants were diagnosed at community birth centres. Community-based HIV testing for pregnant women can reduce mother-to-child transmission and improve early diagnosis and treatment of exposed infants. Collaboration with birth attendants is crucial to ensure testing opportunities are not missed. Prospective research is needed to understand the clinical outcomes of intervention programmes in the community.

“Fit to Be a Midwife”: Protestantism, Moral Character, and the State Supervision of Black Lay Midwives, 1931–1946

ABSTRACTScholars of religion and medicine have discussed the rise of scientific birthing while also capturing the significance of religion among Black midwives in the American South. Yet they have seldom discussed the place of Protestantism and African American Protestantism in state-sponsored midwifery programs for Black women in the twentieth century. This essay focuses on the 1945–1946 Leon County “Plan for Improving the Midwife Service Program” in North Florida to argue how state health workers promoted Black religion to determine the moral fitness of Black women to practice midwifery in their communities. Black religion was incorporated into the regulatory scheme of the health state. Using primary documents from state archives, this paper adds to the history of African American religion and medicine by demonstrating that African American Protestantism was integral to the state health apparatus and consequently used to legitimate the authority of modern obstetrics for Black communities in the Depression and World War II periods.

Medical Pluralism and Cultural Practices Associated with Umbilical Cord-Care in Rural Communities in Zimbabwe

This study explores how Traditional Birth Attendants (TBAs) in rural Zimbabwe care for babies’ umbilical cords, examining cultural practices associated with umbilical cord care. This study relies on a qualitative interpretive approach, guided by symbolic interactionist theory, involving 16 Key Informant Interviews (KIIs). The respondents were de jure (trained) and de facto (untrained) TBAs in Mawadza village in Mutasa District in Manicaland, Zimbabwe. The data from the KIIs were analysed using the framework analysis method. Umbilical cord care is embedded in cultural practices and symbolic meanings. There are various local substances, such as cooking oil, petroleum jelly, local herbs, mothers’ breast milk and vaginal discharge as well as pet (cat and chicken) dung, used for cord care. Many of the substances are harmful and associated with a high risk of child morbidity and mortality in the study area. Only a few TBAs revealed that they used bio-medically recommended substances. The finding suggests that the risks associated with harmful umbilical cord care methods are high in the study communities. This points to the need to strengthen concerted initiatives to improve universal access to modern postnatal healthcare to reduce neonatal mortality..

The Determinants of Places of Delivery by Women in the Savelugu/Nanton Municipality, Ghana

Despite improvement in health care services in Ghana, many women still choose to deliver at home. This practice has serious implications for maternal and child health. The phenomenon is not different in Savelugu/Nanton Municipal is even seriously educated women sometimes ignore the health facilities and deliver at home. This paper examines the factors associated with the choice of places of delivery by women in the Savelugu/Nanton Municipality. An analytical cross-sectional study design was used involving women, health workers, Traditional Birth Attendants, opinions, traditional and religious leaders and some key informants. Data was collected through questionnaires, in-depth interviews, focus group discussions and observations. The result indicates that distance to health centres, personal likes and dislikes of women and availability of TBAs in the community were among the factors influencing the choice of places of delivery. It was also revealed that bad attitudes of health workers and ineffective communication between health workers and patients are some of the factors that influence women's choice of places to deliver. The paper concludes that, despite improvement in health service delivery in Ghana, many women still deliver at home. The paper recommends effective health education by stakeholders to reverse the situation.

Enablers and Barriers to Chlorhexidine Use in Umbilical Cord Care: Voices of Care Givers and Healthcare Providers in Selected Counties in Kenya

Neonatal sepsis contributes to increased rates of mortality among newborns during their first month of life. Chlorhexidine (CHX) has proven effective in the prevention of neonatal sepsis due to umbilical stump infection after birth. Despite shifting from dry cord care techniques to CHX use, there is still a high prevalence of improper cord care in low-resource settings in Kenya. This study sought to explore barriers and enablers to CHX use in Kwale, Vihiga and Machakos counties in Kenya. We adopted mixed methods cross-sectional survey with 582 women of reproductive age with a young child less than one year as respondents to the quantitative survey. Qualitative data entailed thirty (30) key informant interviews with healthcare workers and national policymakers. Six (6) focus group discussions with mothers, caregivers, community health volunteers (CHVs) and traditional birth attendants were conducted. An observation checklist was used to assess the availability of CHX services and supplies in fourteen (14) health facilities was conducted. Results indicated variation in umbilical cord care practices for newborns across counties. Of 582 caregivers, only 1.3% reported having ever used CHX. Majority mentioned using methylated spirits (41.6%), other antiseptics (23.3%) and salty water (11.3%). Other substances used for cord care included plain water, herbal extracts, cow dung, soil, and breast milk. Despite 100% awareness of CHX among health workers, only a third of caregivers (38.7%) had heard of CHX. About 76.9% of participants preferred the gel formulation and 8.9% did not know where to get the product. Drivers of CHX use included faster cord healing, infection control in hospitals, ease of use, cost implications, ease of access, influence from key decision makers and preferred CHX formulation. Barriers included minimal awareness among caregivers, cultural practices and taboos on cord care, inadequate capacity building of CHVs on CHX, unclear CHX user guidelines for caregivers, prolonged stockouts and inadequate knowledge of CHX in communities. Healthcare workers highlighted poor dissemination of CHX guidelines by the Ministry of Health, unavailability in the Kenya Medical Supplies Authority (KEMSA) and Mission for Essential Drugs and Supplies logistic management information system making it difficult to procure. There is a need for advocacy to promote the uptake of CHX in facilities and increase knowledge of communities on CHX as well as manage the supply chain to increase CHX availability

Implication des maris dans les soins anténatals: enquête sur les facilitateurs et les barrières: Cas des habitants de Bosomtwe au Ghana

RésuméContexteCet article a abordé les facilitateurs et les obstacles relatifs à l’implication des maris dans les soins prénatals dans le district de Bosomtwe au Ghana, du point de vue des maris, des femmes enceintes avec et sans expérience d'accouchement, des mères allaitantes, des sage-femmes et des accoucheuses traditionnelles.MéthodologieL’étude s’est basée sur une conception de recherche qualitative pour recueillir et analyser les données sur les facilitateurs et les obstacles relatifs à l’implication des maris dans les soins prénatals. Le champ d’analyse était constitué de 36 participants, dont 14 maris, 8 femmes enceintes ayant déjà accouché et mères allaitantes, 6 femmes enceintes n’ayant jamais accouché, 6 sage-femmes et 2 accoucheuses traditionnelles—sélectionnés délibérément. Les données de l’étude ont été recueillies par le biais d'entretiens approfondis et analysées par l’approche du contexte.RésultatsNombreux facteurs empêchent la participation active des maris aux soins prénatals. Ces facteurs sont d’ordre économique (contraintes de temps), culturels (l’association de la maternité et ses obligations aux femmes) et le système de santé (manque de Services prénatals destinés aux maris et le comportement des personnels de santé). Malgré cela, certains maris ont participé aux soins prénatals en raison de l'importance qu'ils accordent à la santé et à la sécurité de leurs femmes et du fœtus, de l'évolution des rôles de chacun des sexes et des traitements préférentiels reçus par leurs femmes dans les maternités (en raison de la participation de leurs maris aux soins prénatals).ConclusionLa mise en œuvre des stratégies alternatives, telles que le conseil aux couples, la prolongation des heures d’ouverture des centres de santé pour accueillir les hommes fonctionnaires, est recommandée afin d'offrir aux maris un moyen plus souple et plus attrayant de soutenir leurs femmes pendant la grossesse. Ces efforts doivent être renforcés par tous dans la société en modifiant l’opinion erronée selon laquelle la conception de la grossesse et l’éducation de l’enfant sont les devoirs de la femme seule.

Measures adopted by indigent mothers in Kilifi County to tackle maternal health challenges during the COVID-19 pandemic: A qualitative study.

Many sub-Saharan African countries have experienced various challenges that threaten the quality of health services offered to the population. The COVID-19 pandemic disrupted access to healthcare services in many countries as they grappled with implementing measures to curb its spread. The consequences of COVID-19 have been catastrophic for maternal and newborn health. There is a dearth of information on expectant mothers' negotiation mechanisms to access maternal health services during COVID-19 in Kenya. This rapid qualitative study draws data from purposefully selected 15 mothers who were either pregnant or had newborn babies during the COVID-19 pandemic in Kilifi county in Kenya. Data were analyzed thematically and presented in a textual description. Women used the following alternatives to access maternal health: giving birth at the homes of traditional birth attendants (TBAs), substituting breastfeeding with locally available food supplements, relying on limited resources and neighbours for delivery and local savings and rotating credit associations. This study shows that urgent measures are needed to provide high quality maternal and child health services during and after the COVID-19 pandemic. These include but are not limited to developing special interventions for the pregnant women for any emergency and establishing trust between communities and individuals through the TBAs.

Issues to consider when applying indigenous medical knowledge to provide healthcare by county governments in Kenya

Rationale of Study – This study explores issues that should be considered in implementing IMK in providing quality healthcare by county governments in Kenya. The study’s specific objectives were to determine different categories of IMK systems, to analyse categories of IMK practitioners and to propose issues that need to be considered in the application of IMK in the provision of quality health care by county governments in Kenya.Methodology – The study used a qualitative research approach. Data was collected from literature sources identified purposively through different search engines based on their relevance to the research topic.Findings – The study found that there are different systems of IMK, including pharmacology, physiotherapy, spiritual therapy and surgical therapy. In terms of practitioners, the study found that IMK practitioners can be categorised as herbalists, generalists, bone setters, dentists, traditional birth attendants and spiritual healers. Further, the issues that the county government should consider the application of IMK in the provision of health care include governance issues, intellectual property rights, application of IMK to health care provision, and proper management of IMK covering creation, codification, transfer, utilisation, validation and preservation.Implications – The study recommended that county governments in Kenya should: involve IMK practitioners in their healthcare delivery, address IMK management issues, and put in place appropriate legal and policy instruments to guide their efforts in integrating IMK systems in healthcare delivery. Implementing these recommendations will ensure that county governments can pull back their healthcare challenges by appropriately investing in their IMK resources.Originality – The study was original and explores a unique issue within the context of traditional knowledge in Kenya.

Some plants used for reproductive health by women in Agbarha-Otor community, Delta State, Nigeria

Background: Overtime, the state of maternal health in Nigeria is poor and can be attributed to inadequate access to reproductive health services, poverty and in some areas, cultural resistance. Medicinal plants used in Agbarha-Otor, Ughelli, Nigeria for managing women’s reproductive health concerns such as conception, pregnancy, birth, contraception, menstruation, post-partum and general reproductive health were investigated in this study. Methods: Surveys were conducted both in Urhobo and English languages using semi structured questionnaire. Guided field-walk method was employed where respondents, specifically, Traditional Birth Attendants (TBAs), were interviewed. A total of 30 plants belonging to 23 families having properties against different conditions, ailments and peculiarities related to female reproductive health and gynecological conditions were surveyed, documented and their medicinal activity validated non-experimentally. Results: Most of the documented plants belong to Asteraceae family. Also, most of the reported plants were majorly herbs and shrubs which were surveyed plants from the wild. Leaves were the most frequently used plants’ part. The medications were majorly prepared as decoctions and administered orally. The choice of oral administration over possible alternatives is because some solvents such as water, palm oil, or local wine or gin called “ogogoro” serve as good vehicles to transport the remedies’ active principles. Conclusion: From the survey, it can be deduced that the use of medicinal plants for reproductive healthcare and gynaecological conditions in the study area is still in practice. However, scientific validation of the biological properties of the surveyed plants is highly recommended.

Ethonursing Study of Pain Management in Neonates in Indonesia

PurposeEven though Indonesia is comprised of at least 1,300 ethnic groups, no specific traditional method for reducing pain, especially in neonates, has been elaborated. AimThis study aimed to investigate the traditional methods used by the Sundanese people in Indonesia to manage pain in neonates. MethodsThis ethnonursing study was conducted in the Pangandaran District, West Java Province, Indonesia. Thirty informants including health cadres, midwives, and community leaders in the health sector, such as trained traditional birth attendants and female elders, participated in this study. Data were collected through interviews and focus group discussions, as well as from field notes. Data were analyzed using the four phases of qualitative analysis based on Leininger's theory. ResultsSix themes were identified in this study: (1) Preference for the use of traditional methods to treat pain in neonates and infants, (2) Desire to obtain information on the safe use of traditional medicine, (3) Desire to use practical pain management methods, (4) Easy to get modern medicine, (5) Use of medicinal plants, (6) Physical methods. ConclusionsThis study demonstrates the need for better harmonization between the use of traditional and modern medicines, in both research and practice, to determine the most appropriate mix that combines the strengths of each method based on accurate scientific evidence.

Barriers and enablers to emergency obstetric and newborn care services use in Wolaita Zone, Southern Ethiopia: a qualitative case study

BackgroundGlobally, 11.4 million untreated obstetric complications did not receive Emergency Obstetric and Newborn Care (EmONC) services yearly, with the highest burden in low and middle-income countries. Half of the Ethiopian women with obstetric complications did not receive EmONC services. However, essential aspects of the problem have not been assessed in depth. This study, therefore, explored the various aspects of barriers and enablers to women’s EmONC services utilization in southern Ethiopia.MethodologyA qualitative case study research design was used in nine districts of the Wolaita Zone. A total of 37 study participants were selected using a purposive stratified sampling technique and interviewed till data saturation. Twenty-two key informant interviews were conducted among front-line EmONC service providers, managers, community leaders, and traditional birth attendants (TBAs). Individual in-depth interviews were conducted among 15 women with obstetric complications. The trustworthiness of the research was assured by establishing credibility, transferability, conformability, and dependability. NVivo 12 was used to assist with the thematic data analysis.ResultFive themes emerged from the analysis: service users’ perception and experience (knowledge, perceived quality, reputation, respectful care, and gender); community-related factors (misconceptions, traditional practices, family and peer influence, and traditional birth attendants’ role); access and availability of services (infrastructure and transportation); healthcare financing (drugs and supplies, out-of-pocket expenses, and fee exemption); and health facility-related factors (competency, referral system, waiting time, and leadership).ConclusionMany women and their newborns in the study area suffered severe and life-threatening complications because of the non-utilization or delayed utilization of EmONC services. A key policy priority should be given to enhancing women’s awareness, eliminating misconceptions, improving women’s autonomy, and ensuring traditional practices’ role in EmONC service utilization. Community awareness interventions are required to enhance service uptake. Furthermore, the health systems must emphasize improving the quality of care, inequitable distribution of EmONC facilities, and essential drugs. The financial constraints need to be addressed to motivate women from low socioeconomic status. Furthermore, intersectoral collaboration is required to maintain a legal framework to control and prohibit home deliveries and empower women.