Practices Of Traditional Birth Attendants Research Articles

Knowledge and attitudes of midwives towards collaboration with traditional birth attendants for maternal and neonatal healthcare services in rural communities in South Africa

ObjectivesWe assessed the knowledge and attitude of registered midwives towards collaborating with traditional birth attendants for maternal and neonatal healthcare services in rural communities. DesignA descriptive cross-sectional survey was followed in this study. ParticipantsRegistered midwives in selected clinics in the City of Tshwane Municipality. Participants were recruited by stratified random sampling. Data was collected at the Thirty-four primary healthcare facilities in Gauteng province, South Africa. Measurement and resultsA self-assessment questionnaire was administered to 304 registered midwives. Two-hundred and sixty respondents returned the questionnaire representing a response rate of 86.6 % which was statistically significant. The majority of Midwives in South Africa displayed a low level of knowledge (mean = 41.8, SD=1.7) on the role and practices of traditional birth attendants). Only 30.8 % (n = 80) of midwives knew of the roles of traditional birth attendants for maternal and neonatal healthcare (MNH) services. With respect to knowledge, there was significant associated with the Professional category (p < 0.015). In terms of attitude, registered midwives displayed negative attitudes towards collaborating with traditional birth attendants (mean = 46.8, SD=2.1). Approximately half (54.2 %, n = 140) of midwives were amenable towards collaborating in the provision of antenatal care, and 70.4 % (n = 183) of midwives agreed to collaborate with traditional birth attendants for extended roles such as accompanying women to health facilities. Association of demographic data and level of attitude showed there was significant relationship (p < 0.05) between registered midwives’ level of education and their attitude towards collaboration. Key conclusionsMidwives demonstrated positive attitude towards collaborating with traditional birth attendants at the antenatal care level only. Midwives were not amenable to collaboration at the level of intrapartum and postpartum care. Implications for practiceBased on our results, collaboration should be at antenatal care level to allow for early detection, treatment, and prevention of antenatal complications thus reducing maternal mortality and morbidity.

Knowledge and utilization of Traditional Birth Attendants by Women of Reproductive Age in Alanamu Community Ilorin, Northern Nigeria

INTRODUCTION The lack of access to skilled healthcare services during childbirth remains a major factor for high maternal mortality in developing countries, as traditional birth attendants (TBAs) continue to serve as the predominant providers of maternal health care in rural communities. This study explores the knowledge and utilization of TBAs by women of reproductive age in a rural community of Ilorin, kwara state Nigeria. METHODSThis study is a descriptive cross-sectional study which was conducted using a well-structured interviewer based questionnaire, administered to 212 women of reproductive age-group to collect data on their knowledge and utilization of the services of TBAs. Analysis was done using Statistical Product and Service Solutions (SPSS) software version 20. RESULTS One hundred and fifty three respondents (72.2%) had background knowledge of TBAs, 91 (40.8%) had visited a TBA at least once to carry out their deliveries, of which 73 (80.2%) of them had successful deliveries, while 18 (19.8%) had complications during their deliveries, and 7 (7.7%) were referred to health care facilities for expect management. The study showed statistical significance between the level of education of respondents and their patronage of TBAs with a p-value of 0.041, and showed no statistical significance with their level of income. CONCLUSION This study showed adequate knowledge and utilization of the services of TBAs by members of the community. The practice of TBAs has continued to thrive in rural communities; integrating their services with the standard healthcare system as well as continuous sensitization of rural communities on their roles and limitations would go a long way in reducing maternal morbidity and mortality associated with the use of poorly trained TBAs

Traditional Birth Attendant in the Maternal and Child Health Space in Nigeria: Ancient Practices and Modern Recommendations

Background: Arguments on the usefulness of Traditional Birth Attendants (TBAs) in maternal and child health care and the reduction of maternal and child morbidity and mortality indices or not, persist. This paper sought to explore the ancient practices of TBAs and to strike a balance to portray modern recommendations that would contribute to improved maternal and child health status. Methods: The method used was review of relevant literatures from open-access journals and google scholar data base, as well as research reports on variables of the subject in developing countries. Results: Findings revealed that the overlapping root of TBAs’ practice burden include poor social amenities, inadequate health facilities and services in rural areas where over 70% of the population reside. While evidencebased report showed that even when 93% of rural women registered for Ante-Natal Care, 49% were delivered at home by TBAs and 73% has sought help from them for retained placenta with bleeding. Also, 41% of women of child bearing age indicated that maternal and child infection is a risk associated with the patronage of TBAs, whereas 32.8% indicated that bleeding during and after delivery were equally risks associated with TBA-provided maternal health services. Such circumstances of service were associated with harmful practices with attendant health and medical complications to recipient mother and child. However, helpful ancient practices of TBAs include; home visiting to promote well-being of mother and child (9.84%), sitz bath (17.20%), encouraging breastfeeding up to 2years (18.90%) etc. The modern recommendations, x-rayed the remedial actions on the harmful practices and associated negative consequences to improving maternal and child health indices in Nigeria. Conclusion: For reasonable and sustainable reduction in the burden associated with the practices of TBAs in maternal and child health care in Nigeria, contextual focused training and continuous mentoring is a necessity.

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

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. To determine knowledge and self-reported practices of traditional birth attendants and traditional healers in managing TB in Lagos, Nigeria. 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 P<0.05 and 95% confidence interval. 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, P<0.0001) and consulting <40 patients in a year (AOR: 0.22,95% CI:0.09-0.53, P<0.0001). 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.

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.

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

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&lt;0.001) compared to control group (52) 48.6% and (100) 100%). There was significant difference (P&lt;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

Examine the Perception of Contemporary Midwives and Pre Service Midwives About the Practice of Traditional Birth Attendants in Kwasmintim District

The paper focused on examining the perception of contemporary midwives and pre-service midwives about the practice of Traditional Birth Attendants (TBAs) in Kwesimintsim District. It is believed that the success of the programme of Traditional Birth Attendants practice is dependent strongly on the cooperation and collaboration with midwives. Therefore, determining the perception of this key stakeholders (contemporary midwives and pre-service midwives) is fundamental to the quality maternal health care system: this is the motivation for this paper. The paper followed qualitative analytical approach with exploratory design. It emerged that despite the existing programme for TBAs practice, majority of the midwives and pre-service midwives perceived their practice as dangerous. It was also found The TBAs were perceived as though diligent but stereotyped, conservative and unwilling to sacrifice traditions and cultural for modern practices. It is recommended that the skilled birth attendants (Midwives and pre service midwives) should be engaged in the TBA programme for effective partnership. It is further recommended that community service with TBAs should be mandatory as part of the pre service programme for midwives. Keywords: Traditional Birth Attendants, Skilled Birth Attendants, Midwives, and Pre-service Midwives DOI: 10.7176/JHMN/94-04 Publication date: October 31 st 2021

HEALTH CARE PROVIDERS’ VIEWS CONCERNING KNOWLEDGE AND PRACTICES OF TRADITIONAL BIRTH ATTENDANTS IN TAJIKISTAN: A QUALITATIVE STUDY

Introduction: This study seeks to explore health care providers’ perspectives of the traditional birth attendants’ knowledge and practices. Methods: This qualitative study was conducted in 2018 with 16 health care professionals working at various levels of maternal health care system in two purposefully selected research settings, Khorog town and Dushanbe, which have different social, economic and ethnic backgrounds. Semi-structured face-to-face interviews were conducted to gather the data. Duration of interviews ranged from 30-60 min. NVivo software for qualitative research was used to analyse the results. Results: This study has shown that health care workers have extremely negative views of the knowledge and practices of traditional birth attendants. They highlight the lack of adequate knowledge of traditional birth attendants on biomedical aspects of birth, poor skills in infections control and lack of use of clean delivery practices. They also claim that the traditional birth attendants’ practices also lead to different complications while they are woefully unprepared to recognize obstetric complications during birth. Conclusion: The study recommends providing a skilled birth attendant in every area. It also recommends avoiding a homogeneous approach to address maternal health issues in diverse countries of the Global South and reviewing maternal health care policies and programs to provide the most marginalized groups of women with skilled birth services to improve their maternal health and further decrease maternal mortality in Tajikistan.

Orthodox and unorthodox practices by traditional birth attendants in Nsukka area of Enugu State, Southeast Nigeria

Unskilled Traditional Birth Attendants (TBA) is prevalent in rural Nigeria due to communal culture and traditions, their compassionate attitude, and non-availability of appropriate health facilities within the communities. Yet, there is no clear framework defining their roles, locations and practices. This study aimed to identify the pattern and practices of TBA in Nsukka area of Enugu State, and evaluate their roles in rural maternity services in Enugu state of Nigeria. This was a mixed method cross sectional study involving a questionnaire-based survey and Focus group discussions (FGD). Seventy-eight TBAs, were recruited for this study. Structured interviewer-administered questionnaire was used to collect quantitative data and a semi-structured discussion guide was used for the FGD – one FGD for each development center. SPSS version 25 was used for statistical analysis. Records of FGD sessions were transcribed, condensed into themes, and analyzed. A total of 78 TBAs were interviewed, 26 from each of the three development areas. Majority (66.0%) completed primary education while 9.0% did not have any formal education. Almost two-third (65.4%) uses exclusively traditional methods in their practice, whereas 34.5% combined orthodox method. Three focused group discussions showed almost all the TBAs in the study could neither identify different complications and when to refer nor signs separating different stages of labour. Poorly educated TBA in the Nsukka area of Enugu State combines orthodox medicine with herbs and traditional healing methods. Their appreciation and management of danger pregnancy signs and referral system are lacking. Key words: Traditional birth attendants, healthcare, Nsukka, informal health, Labor.

Infection prevention and control practice among traditional birth attendants in Lagos State, Nigeria

Background The World Health Organization has defined a traditional birth attendant as a ‘person who assists the mother during childbirth and initially acquired her skills by delivering babies herself or through apprenticeship to other traditional birth attendants’. It is estimated that over 40 million neonatal deaths occur annually worldwide; some of these deaths are the result of infection, which may be attributed to the practices of traditional birth attendants. In Nigeria, maternal mortality because of puerperal sepsis occurs in 12% of cases. This study aimed to assess infection prevention and control practice among traditional birth attendants in Lagos State, Nigeria. Methods This is a descriptive study of infection prevention and control among traditional birth attendants in the three local government areas of Ikorordu, Mushin and Surulere. Simple random sampling (balloting) was used to select 144 registered traditional birth attendants. A self-structured questionnaire made up of four sections (sociodemographic characteristics, knowledge, attitude and practice) was used for data collection. The participant knowledge scores were categorised into ‘good’ (60–100%) and ‘poor’ (0–59%). Descriptive and inferential statistics were used to analyse the data and tested for significance at P=0.005. Results The mean age of the respondents was 48 ± 10.6 years. Over one-third (37.5%) of the respondents had poor knowledge of infection control. There was a statistically significant association between respondent age and practice of infection prevention and control (P=0.003). There was no significant difference between the duration of practice and infection prevention and control (P=0.688). Additionally, there was no significant association between the length of training and infection prevention and control (P=0.890). Conclusions There is a need to increase the knowledge of traditional birth attendants by organising training for them on infection prevention and control. Over 70% of the respondents identified that practice could be improved by additional training. This will reduce maternal and infant morbidity and mortality caused by infection in Lagos, Nigeria.

Maternal and neonatal service delivery by traditional birth attendants in rural Benin: A case for integration?

ABSTRACT The Republic of Benin faces high maternal, newborn and child (MNCH) morbidity and mortality. Traditional birth attendants (TBAs) continue to operate on the margins of the health system yet provide critical services to women and children. This study aims to further the understanding of TBA’s scope of practice for developing appropriate strategies to strengthen MNCH services at the community-level. TBAs were identified and surveyed on education, training, system support and scope of practice including management of obstetric and newborn emergencies. TBAs were found to perform diverse preventive and health promotion activities, including antenatal and newborn care counselling, promotion of family planning and immunizations. Among 109 TBAs, 11,102 births were documented in the prior year with a maternal mortality ratio (MMR) of 790/100,000 and neonatal mortality rate (NMR) 12.2/1000. The scope of TBA practices is broad and rural communities rely on this cadre for services. However, TBAs report higher rates of adverse maternal events compared to national statistics. Better understanding is needed on community preferences, training and methods of participation of TBAs within the health system. This could improve identification and referral for emergencies, reinforce safer practices and increase preventive and promotive health activities at the community level.

Effectiveness of the training model to increase the knowledge, attitude, and practice of traditional birth attendants about early initiation of breastfeeding in Bogor District, Indonesia

The proportion of women assisted by TBAs during delivery is still high. It is necessary to transform their role from delivery attendance to an agent of change to deliver health messages. One of the important health messages will be on Early Initiation of Breastfeeding (EIBF). The aims of this study is to determine the impact of TBA-Friendly Training model on TBAs’ knowledge, attitude and practice (KAP) to enhance their role as agent of change in the EIBF practice. The quantitative approach used applied quasi-experimental design and a qualitative used Rapid Assessment Procedure (RAP). Results revealed that the training can enhance the KAP of EIBF among TBAs. TBAs who got the training have higher level of knowledge, attitude and practice than those who did not receive training (p value: 0.000). The qualitative findings that TBAs are happy and feel fortunate for being trained. More than half of the TBAs’ clients have good EIBF KAP, meaning that the TBAs are able to apply the skills trained and to promote EIBF practice. Findings of this study suggest that there should be a policy to adopt and use such a TBA-Friendly Training model for EIBF implementation.

Obstetric fistula and sociocultural practices in Hausa community of Northern Nigeria.

Obstetric Fistula is a childbirth injury that disproportionately affects women in sub-Saharan Africa. Although poverty plays an important role in perpetuating obstetric fistula, sociocultural practices has a significant influence on susceptibility to the condition. This paper aims to explore narratives in the literature on obstetric fistula in the context of Hausa ethno-lingual community of Northern Nigeria and the potential role of nurses and midwives in addressing obstetric fistula. Three major cultural practices predispose Hausa women to obstetric fistula: early marriages and early child bearing; unskilled birth attendance and female circumcision and sociocultural constraints to healthcare access for women during childbirth. There is a failure to implement the International rights of the girl child in Nigeria which makes early child marriage persist. The Hausa tradition constrains the decision making power of women for seeking health care during childbirth. In addition, there is a shortage of nurses and midwives to provide healthcare service to women during childbirth. To improve health access for women, there is a need to increase political commitment and budget for health human resource distribution to underserved areas in the Hausa community. There is also a need to advance power and voice of women to resist oppressive traditions and to provide them with empowerment opportunities to improve their social status. The practice of traditional birth attendants can be regulated and the primary health care services strengthened.

Perception of maternal deaths and referral practices of traditional birth attendants in Enugu, Nigeria: A cross sectional study

Perception of maternal deaths and referral practices of traditional birth attendants in Enugu, Nigeria: A cross sectional study

Progresses and Challenges of Utilizing Traditional Birth Attendants in Maternal and Child Health in Nigeria

Background and Objectives:Despite advances in modern healthcare, Traditional Birth Attendants (TBA) have continued to be heavily utilized in rural communities in Nigeria. Major disparities in maternal health care in Nigeria remain present despite the goal of the United Nations Millennium Development Goal to reduce maternal mortality by 2015. The objective of this study is to review the contribution of TBAs in the birthing process in Nigeria, and to examine barriers and opportunities for utilizing TBAs in improving maternal and child health outcomes in Nigeria.Methods:A literature review of two major electronic databases was conducted using the PRISMA framework to identify English language studies conducted between 2006 and 2016. Inclusion criteria included articles that examined the role of traditional birth attendants as a factor influencing maternal health in Nigeria.Results:The value of TBAs has not been fully examined as few studies have aimed to examine its potential role in reducing maternal mortality with proper training. Eight manuscripts that were examined highlighted the role of TBAs in maternal health including outcomes of utilizing trained versus non-trained TBAs.Conclusion and Global Health Implications:Specific areas of training for TBAs that were identified and recommended in review including: recognizing delivery complications, community support for TBA practices through policy, evaluation of TBA training programs and increasing collaboration between healthcare facilities and TBAs. Policies focused on improving access to health services and importantly, formal health education training to TBAs, are required to improve maternal health outcomes and underserved communities.

Knowledge, attitudes and practices of traditional birth attendants in pastoralist communities of Laikipia and Samburu counties, Kenya: a cross-sectional survey.

IntroductionCurrent efforts to reduce maternal and newborn mortality focus on promoting institutional deliveries with skilled birth attendants (SBAs), and discouraging deliveries at home attended by traditional birth attendants (TBAs). In rural Kenya, semi-nomadic pastoralist communities are underserved by the formal health system, experience high maternal and neonatal mortality, and rely primarily on TBAs for delivery care, despite Government proscription of TBA-assisted births. This study examined the knowledge, attitude and practices of TBAs serving these communities to assess the potential for collaboration between TBAs and SBAs.MethodsA cross-sectional, interviewer-administered survey was conducted among 171 TBAs from Maasai and Samburu pastoralist communities in Laikipia and Samburu counties, Kenya, as part of a larger mixed-methods study in partnership with a local service provider.ResultsBAs were relatively elderly (mean age 59.6 years), and attended an average of 5-6 deliveries per year. A minority (22.2%) had received formal training. They provided antenatal, intra-partum and post-partum care. Most TBA care was non-interventionist, but not necessarily consistent with best practice. Most had encountered birth complications, but knowledge regarding management of complications was sub-optimal. Most had previously referred at least one woman to a health facility (80.1%), were key participants in decision making to refer women (96.5%), and had been present at an institutional delivery (54.4%).ConclusionTBAs continue to be key providers of maternal and neonatal healthcare in regions where the formal health system has poor coverage or acceptability. Strengthening existing TBA/SBA collaborations could improve both community links to the formal health system, and the quality of care provided to pastoralist women, while remaining consistent with current Government policy.

Self-reported practices among traditional birth attendants surveyed in western Kenya: a descriptive study.

BackgroundThe high rate of home deliveries conducted by unskilled birth attendants in resource-limited settings is an important global health issue because it is believed to be a significant contributing factor to maternal and newborn mortality. Given the large number of deliveries that are managed by unskilled or traditional birth attendants outside of health facilities, and the fact that there is on-going discussion regarding the role of traditional birth attendants in the maternal newborn health (MNH) service continuum, we sought to ascertain the practices of traditional birth attendants in our catchment area. The findings of this descriptive study might help inform conversations regarding the roles that traditional birth attendants can play in maternal-newborn health care.MethodsA structured questionnaire was used in a survey that included one hundred unskilled birth attendants in western Kenya. Descriptive statistics were employed.ResultsInappropriate or outdated practices were reported in relation to some obstetric complications and newborn care. Encouraging results were reported with regard to positive relationships that traditional birth attendants have with their local health facilities. Furthermore, high rates of referral to health facilities was reported for many common obstetric emergencies and similar rates for reporting of pregnancy outcomes to village elders and chiefs.ConclusionsPotentially harmful or outdated practices with regard to maternal and newborn care among traditional birth attendants in western Kenya were revealed by this study. There were high rates of traditional birth attendant referrals of pregnant mothers with obstetric complications to health facilities. Policy makers may consider re-educating and re-defining the roles and responsibilities of traditional birth attendants in maternal and neonatal health care based on the findings of this survey.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-1007-8) contains supplementary material, which is available to authorized users.

Community and provider perceptions of traditional and skilled birth attendants providing maternal health care for pastoralist communities in Kenya: a qualitative study.

BackgroundKenya has a high burden of maternal and newborn mortality. Consequently, the Government of Kenya introduced health system reforms to promote the availability of skilled birth attendants (SBAs) and proscribed deliveries by traditional birth attendants (TBAs). Despite these changes, only 10 % of women from pastoralist communities are delivered by an SBA in a health facility, and the majority are delivered by TBAs at home. The aim of this study is to better understand the practices and perceptions of TBAs and SBAs serving the remotely located, semi-nomadic, pastoralist communities of Laikipia and Samburu counties in Kenya, to inform the development of an SBA/TBA collaborative care model.MethodsThis descriptive qualitative study was undertaken in 2013–14. We conducted four focus group discussions (FGDs) with TBAs, three with community health workers, ten with community women, and three with community men. In-depth interviews were conducted with seven SBAs and eight key informants. Topic areas covered were: practices and perceptions of SBAs and TBAs; rewards and challenges; managing obstetric complications; and options for SBA/TBA collaboration. All data were translated, transcribed and thematically analysed.ResultsTBAs are valued and accessible members of their communities who adhere to traditional practices and provide practical and emotional support to women during pregnancy, delivery and post-partum. Some TBA practices are potentially harmful to women e.g., restricting food intake during pregnancy, and participants recognised that TBAs are unable to manage obstetric complications. SBAs are acknowledged as having valuable technical skills and resources that contribute to safe and clean deliveries, especially in the event of complications, but there is also a perception that SBAs mistreat women. Both TBAs and SBAs identified a range of challenges related to their work, and instances of mutual respect and informal collaborations between SBAs and TBAs were described.ConclusionsThese findings clearly indicate that an SBA/TBA collaborative model of care consistent with Kenyan Government policy is a viable proposition. The transition from traditional birth to skilled birth attendance among the pastoralist communities of Laikipia and Samburu is going to be a gradual one, and an interim collaborative model is likely to increase the proportion of SBA assisted deliveries, improve obstetric outcomes, and facilitate the transition.

English

According to the World Health Organization (WHO), current estimate of maternal mortality ratios is at more than 1000 per 100,000 live births in most African countries. Despite the existence of modern health facilities in Nigeria, over 58% of deliveries take place at home whereas only 37% take place in hospitals. As outcomes of pregnancy and their sequelae are purely left to the providence of women in many rural communities, the place of delivery is a great determinant of maternal and child morbidity and mortality. With the shortage of skilled birth attendants and uneven geographical distribution of the few available ones; traditional birth attendants tend to fill in the gap. This study employed a cross sectional design and using a simple random sampling technique, 420 women within the reproductive age (18 - 45 years) meeting the inclusion criteria for the study were selected. Results from the study indicated a high (88.8%) knowledge of Traditional Birth Attendants (TBAs) but a poor (51.1%) perception about their practices. A significant relationship was shown between age (P<0.05), education status (P<0.05) and the frequency of patronage of TBAs Services. Although, perception about TBAs practices was poor, the role of TBAs in the improvement of women’s health (maternal and child health) in rural Nigeria cannot be ignored. TBAs remain major health resources in rural communities in developing countries as well as some parts of urban areas. Efforts need to be harnessed for training of TBAs through the Ministry of Health and Primary Health Care facilities close to their area of practices. Key words: Knowledge, perception, traditional birth attendants, maternal mortality, Southern Nigeria.

Involving traditional birth attendants in emergency obstetric care in Tanzania: policy implications of a study of their knowledge and practices in Kigoma Rural District

IntroductionAccess to quality maternal health services mainly depends on existing policies, regulations, skills, knowledge, perceptions, and economic power and motivation of service givers and target users. Critics question policy recommending involvement of traditional birth attendants (TBAs) in emergency obstetric care (EmoC) services in developing countries.ObjectivesThis paper reports about knowledge and practices of TBAs on EmoC in Kigoma Rural District, Tanzania and discusses policy implications on involving TBAs in maternal health services.Methods157 TBAs were identified from several villages in 2005, interviewed and observed on their knowledge and practice in relation to EmoC. Quantitative and qualitative techniques were used for data collection and analysis depending on the nature of the information required.FindingsAmong all 157 TBAs approached, 57.3% were aged 50+ years while 50% had no formal education. Assisting mothers to deliver without taking their full pregnancy history was confessed by 11% of all respondents. Having been attending pregnant women with complications was experienced by 71.2% of all respondents. Only 58% expressed adequate knowledge on symptoms and signs of pregnancy complications. Lack of knowledge on possible risk of HIV infections while assisting childbirth without taking protective gears was claimed by 5.7% of the respondents. Sharing the same pair of gloves between successful deliveries was reported to be a common practice by 21.1% of the respondents. Use of unsafe delivery materials including local herbs and pieces of cloth for protecting themselves against HIV infections was reported as being commonly practiced among 27.6% of the respondents. Vaginal examination before and during delivery was done by only a few respondents.ConclusionTBAs in Tanzania are still consulted by people living in underserved areas. Unfortunately, TBAs’ inadequate knowledge on EmOC issues seems to have contributed to the rising concerns about their competence to deliver the recommended maternal services. Thus, the authorities seeming to recognize and promote TBAs should provide support to TBAs in relation to necessary training and giving them essential working facilities, routine supportive supervision and rewarding those seeming to comply with the standard guidelines for delivering EmoC services.