Services Of Traditional Birth Attendants Research Articles

Medicinal Plants Used for Antenatal and Postnatal Care in Ondo Town, Nigeria

IntroductionPlants used in traditional medicine by different ethnic groups define the field of ethnomedicine, a subfield of ethnobotany. A preliminary survey revealed that Ondo women still engage in the services of traditional birth attendants till the present day. MethodsStructured questionnaires and personal interviews were used to obtain information from 124 respondents, consisting of males and females. ResultsThe major plant part used were leaves with a frequency of 35%. Some of the plants reported were solely administered, while others were administered in combination with other plants. The traditional solvents commonly used were water and coconut water. The main methods of herbal preparation were decoction and soups. The methods of administration ranged from half a cup or 2 taken 2–3 times daily. ConclusionsThis study has increased our knowledge of Ondo womens’ antenatal and postnatal care practices. Proper documentation of these traditional claims pending scientific validation is necessarily recommended.

Factors Associated with Use of Traditional Birth Attendants for Child Delivery: A Cross-Sectional Study.

Even though the use of skilled birth attendants at birth reduces the risk of maternal mortality and associated complications, some pregnant women prefer to use either traditional birth attendants (TBAs) or deliver at home. Although the use of assisted delivery was reduced between 2014 and 2016 in North Tongu, the rate of TBA use among pregnant women in the district was increasing. There is, therefore, the need to establish the reason for this increase in TBA use. We conducted a study to assess factors that influence the use of TBAs in the North Tongu district. A retrospective cross-sectional facility-based survey was conducted among 449 women who delivered within the past 12 months and were accessing postnatal care services in the North Tongu district. A simple random sampling method was used to select women who attend child welfare clinics. Bivariate and multivariate analyses were conducted to determine the factors that were significantly associated with use of TBAs. All statistical analyses were done at a 95% confidence level with statistical significance at p ≤ 0.05. The mean age of the respondents was 27.0 years ± 6.2 SD. The prevalence of use of TBA during childbirth among women was 26.5%. Factors that significantly influenced use of TBAs during childbirth were age, religion, educational status, and parity. Other significant factors included several antenatal care visits and the attitude of health workers toward pregnant women. Use of TBA services at birth in the study district remains relatively high. Women who use antenatal and postnatal care services should be educated on the importance of skilled delivery. There is also a need to equip TBAs and reposition them as link agents to facilitate referrals of pregnant women to health facilities where there is a need for additional birth attendants.

Knowledge, Practices and Attitudes of Traditional Birth Attendants towards Intermittent Preventive Treatment for Malaria Prevention among Pregnant Women within Ondo West Local Government Area of Ondo State, Nigeria

Intermittent preventive treatment (IPT) for malaria among pregnant women is a recommendation of the World Health Organization (WHO) to combat the various adverse outcomes of malaria in pregnant women. This adverse outcomes includes low birth weight, preterm delivery, severe anemia, maternal morbidity and mortality especially among primigravids. Traditional Birth Attendants (TBAs) has emerged as a significant influence in our society, particularly in the realm of maternal care and childbirth. Several economic, religious and socio-cultural factors have contributed to the preference of some pregnant women for the services of TBAs over medical facilities. Therefore, the study was carried out to assess the knowledge, practices and attitudes of traditional birth attendants within Ondo West Local Government area towards IPT for pregnant women reporting to them for care and delivery. The design employed in the study was descriptive cross-sectional survey. Data were collected by means of an adapted semi-structured interviewer administered-questionnaire. The analysis of the data was done using SPSS version 26.0. Demographic parameters were summarized with simple percentages and non-parametric chi-square test was used to determine the different associations of the variables. P values less than 0.05 were considered statistically significant. The findings indicated that most of the TBAs have good knowledge of the malaria vector and factors promoting the transmission of malaria. Majority (mean=82.9%) also demonstrated excellent understanding of the symptoms associated with malaria in pregnancy however, their knowledge on the risk associated with malaria in a pregnant woman remains comparably low (mean=61.1%) thereby affecting significantly their attitudes and practice to intermittent preventive treatment for malaria prevention. This is because 50% of the TBA have not heard about IPT (P=0.01) and therefore do not administer treatment to asymptomatic pregnant women as recommended by WHO (P=0.00) and report of this study shows that majority (57.40%) of them attend to more than 31 pregnant women in a year. There is need for a government-sponsored partnership between formal health workers and TBAs in this study to ensure they are trained, retrained and equipped. The integration of the TBAs into maternal health care will ensure the sustenance of government policy on the free treatment of all pregnant women intermittently for malaria as recommended by WHO.

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

Perception and utilization of traditional birth attendants among women attending primary healthcare centres in Ilishan-Remo, Ogun State, Nigeria

Despite the introduction of modern health facilities and safe motherhood initiative programs, some women still patronize TBAs, especially in developing countries which has caused a lot of havoc on the health of the mother and the child. This has triggered the interest of the researchers to assess the perception and level of utilization of traditional birth attendants among women in Ilishan Remo, Ogun State, Nigeria. This study adopted a descriptive survey design, 126 women were selected using a simple random sampling technique. Two (2) research questions and two (2) hypotheses were formed for the study. The hypotheses were analyzed using PPMC and Chi-square respectively. The findings revealed a negative perception and a low utilization among women towards Traditional Birth Attendants services. The study further showed a positive insignificant relationship between utilization and perception of women (r = 0.130.; p=0.147> 0.05), also showed a positive significant relationship between the level of education and the utilization of traditional birth attendant with a p-value <0.05 (21, X2=.132.195, r=0.594). In conclusion, antenatal health education should be effective in raising awareness of issues surrounding the well-being of women and unborn children and the need to constantly make use of approved healthcare centers and skilled birth attendants for delivery. Based on these findings, the researchers recommend that this study be replicated in other communities in Ogun State and even other parts of the country and that the federal government subsidize the price of maternity care to all pregnant women irrespective of their religion, age or economic status.

Mothers' experiences and perceptions about care provided during home deliveries in Alwa sub county, Kaberamaido district, Uganda- a qualitative study.

In Uganda 27% of deliveries take place outside a health facility. The existing gaps in quality of maternal and newborn health care must be addressed for Uganda to attain its health targets and consequently its economic targets. Some of the gaps include but are not limited to; ill-equipped healthcare facilities in rural settings, inadequate client/customer care skills by healthcare providers, and health worker absenteeism especially in the night hours. In Kaberamaido District, only 38.3% of the deliveries in Alwa sub county took place at a health facility. Despite the district local government and stakeholder efforts to promote health facility-based deliveries, sadly, a very low proportion of women use the health facilities for delivery. We sought to explore mothers' experiences and perceptions about care provided during home deliveries in Alwa sub county, Kaberamaido district. The study adopted a cross-sectional descriptive qualitative design. We purposively included 115 mothers who delivered outside the health facility and consented to participate and those who lost their babies within the last 24 months preceding the study. Other participants included in the study were village health team (VHT), traditional birth attendants (TBA) and older women. The main instruments used to collect data were focus group discussion (FGD) and in-depth interview (IDI) guides. All voice recordings from FGDs and interviews were transcribed and translated from the local language (Kumam) into English. Thematic content analysis was used to synthesize data by applying codes to segments of the transcripts upon which major domains were derived. Key findings were synthesized and quotes were carefully selected based on their relevance and representativeness to the analysis and study objective. Our findings indicated general satisfaction with the care provided during and after home delivery by TBAs as expressed by mothers. Motivation to seek services from TBAs was attributable to their vast experience spanning decades with history of safe delivery. Few mothers expressed discontent with TBA services citing abuse and rudeness. Our study underscored the common view that TBAs effectively managed home deliveries, providing satisfactory care to mothers. However, concerns emerged on TBAs' capacity to manage complications, emphasizing a need for their reintegration into formal healthcare systems, alongside further training, and standardization in maternal care practices.

The Knowledge and Utilization of Traditional Birth Attendants by Women in a Rural Community of Ilorin, Northern Nigeria

Background: One of the major factors contributing towards high maternal morbidity and mortality in many developing countries is the lack of access to skilled maternal healthcare services, as traditional birth attendants (TBAs) continue to serve as predominant providers of maternal healthcare in many rural communities.
 Aim: This study explores the knowledge and utilization of TBAs by women in a rural community, in order to identify healthcare gaps towards the provision of needed intervention.
 Study Design: This study is a descriptive cross-sectional study which was conducted in Alanamu community of Ilorin, northern Nigeria, in the year 2019.
 Methodology: A well-structured interviewer based questionnaire was 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, 18 (19.8%) had complications during their deliveries, of which 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 .04.
 Conclusion: Our study showed adequate knowledge and utilization of the services of TBAs by members of the community. The use of TBAs has continued to thrive in this rural community especially among the uneducated population and has been associated with maternal complications. The integration of TBAs with standard healthcare system as well as continuous sensitization of the public on their roles and limitations would go a long way in reducing maternal morbidity and mortality associated with the use of untrained TBAs.

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.

The Perspective of Ritual Communication in the Tradition of Childbirth in the Bugis Community in Talaka Village, Ma'rang District, Pangkajene Regency and Islands

The purpose of this study was to examine the perspective and meaning in the tradition of child birth in the Bugis community in Talaka Village, Pangkep Regency. The research method used is a qualitative research method with as many as 4 (four) informants, namely traditional birth attendants and the general public who use the services of traditional birth attendants with data collection techniques carried out in two ways, namely, primary data and secondary data. The method of data collection by conducting observations, interviews, documentation. The results show that ritual communication is always identified with habits or routines, understands rituals as a hereditary action that also contains transcendental values, rituals have a relationship with voluntary performances that are carried out from generation to generation based on habits. As a sociocultural unit, the community has long had a set of traditional ceremonies. Until now they still maintain the values contained in the traditional ceremony. Considering that these ceremonies have spiritual and social functions, psychologically it can create peace of mind, feel safe and calm that can be felt in the heart.

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.

Family Planning as A Determining Factor in Preference to Traditional Birth Attendants (TBAs) Among Somali Community in Dadaab Refugee Camps, Kenya

Statement of Problem: Family planning is a determining factor in the maternal health care choices for Somali pregnant mothers in Dadaab Refugee camps. Research has revealed that during delivery, the Somali mothers prefer the services of Traditional Birth Attendants (TBAs) to those of midwives in hospitals. The preference for TBAs is borne of the belief that when women deliver in hospitals, they could be subjected to family planning against their will. The contention is that Islam and socio-cultural practices of the Somali community do not advocate family planning. The purpose of this paper is to discuss Islam’s position on family planning in order to explain the response of the Somalis of Dadaab refugee camps on family planning. Methodology & Theoretical orientation: The paper is derived from a qualitative study that involved snowball sampling, in-depth interviews and focus group discussions (FGDs). These methods brought out family planning as a determining factor in the mother’s choice of TBAs as opposed to hospital midwives in Dadaab Refugee camps. Findings: Any discourse on Islam and family planning offers two perspectives: proponents of family planning and opponents of family planning. Both perspectives use the texts of the Qur’an and Hadith (traditions) and different interpretations to justify and support their respective positions and opinions. Through primary and secondary sources, the paper interrogates both perspectives of family planning in Islam. Conclusion & Significance: It is concluded that the Somalis’ belief on family planning is informed by the two perspectives of family planning, but the opponents’ perspective holds sway. This determines the preference for TBAs for fear that mothers who deliver in hospitals could be subjected to family planning contraceptives. Recommendation: there is need to educate the community further on Islamic teachings on family planning; and more sensitization conducted on the benefits of child spacing.

Reasons for the utilization of the services of traditional birth attendants during childbirth: A qualitative study in Northern Ghana.

Background:Skilled delivery reduces maternal and neonatal mortality. Ghana has put in place measures to reduce geographical and financial access to skilled delivery. Despite this, about 30% of deliveries still occur either at home or are conducted by traditional birth attendants. We, therefore, conducted this study to explore the reasons for the utilization of the services of traditional birth attendants despite the availability of health facilities.Method:Using a phenomenology study design, we selected 31 women who delivered at facilities of four traditional birth attendants in the Northern region of Ghana. Purposive sampling was used to recruit only women who were resident at a place with a health facility for an in-depth interview. The interviews were recorded and transcribed into Microsoft word document. The transcripts were imported into NVivo 12 for thematic analyses.Results:The study found that quality of care was the main driver for traditional birth attendant delivery services. Poor attitude of midwives, maltreatment, and fear of caesarean section were barriers to skilled delivery. Community norms dictate that womanhood is linked to vaginal delivery and women who deliver through caesarean section do not receive the same level of respect. Traditional birth attendants were believed to be more experienced and understand the psychosocial needs of women during childbirth, unlike younger midwives. Furthermore, the inability of women to procure all items required for delivery at biomedical facilities emerged as push factors for traditional birth attendant delivery services. Preference for squatting position during childbirth and social support provided to mothers by traditional birth attendants are also an essential consideration for the use of their services.Conclusion:The study concludes that health managers should go beyond reducing financial and geographical access to improving quality of care and the birth experience of women. These are necessary to complement the efforts at increasing the availability of health facilities and free delivery services.

Integration of Traditional Birth Attendants into Mental Healthcare: A Multistakeholder Qualitative Study Exploration.

Background A significant number of people with common mental disorders are undiagnosed or undetected at primary healthcare facilities. The experience of traditional birth attendants (TBAs) in reassuring perinatal mothers could be utilized in maternal mental healthcare. The aim of this study was to gain insight into the feasibility of integrating TBAs into maternal mental healthcare using multiple stakeholder views. Methods We conducted an exploratory qualitative study in September 2017 using focus group discussions (FGDs) and in depth interviews in Makueni County, Kenya. A total of 246 participants (TBAs, community health volunteers (CHVs), healthcare workers (HCWs), antenatal and postnatal mothers seeking care from TBAs and those seeking both hospital and TBA services, mothers in law and/or husbands of perinatal mothers, and opinion leaders based in the county) were purposively selected to participate in the discussions. Transcribed data was analyzed using NVivo version 10. Results Four major themes emerged from the qualitative data and were identified as follows; (a) involving TBAs in perinatal mental healthcare by assigning them roles, (b) utilizing TBAs' patient rapport and counseling experience, (c) recognition and appreciation of TBAs by the healthcare system, and (d) training and collaboration of TBAs with healthcare workers. Discussion The findings of this study reveal that although TBAs informally provide psychosocial interventions to pregnant mothers, their roles in mental health are not clearly defined. The importance of TBAs sharing their experience and being recognized as important stakeholders in mental healthcare for perinatal mothers was highlighted. Inclusion of TBAs in dialogue and training them to offer evidence-based mental healthcare were identified as important steps towards improving the mental wellbeing of mothers and the future generation.

Maternal contributors to intergenerational nutrition, health, and well-being: revisiting the Tanjungsari Cohort Study for effective policy and action in Indonesia.

Perinatal and maternal mortalities in Java became of concern in the 1980s. Since some 90% of births took place at home, the Tanjungsari (TS) district of West Java was identfied as a locality where community-based risk management strategy might reduce this health burden. In 1987, traditional birth attendants (TBA) were trained to identify risk factors for unfavourable birth outcomes. From January 1st 1988 to December 1989, some 4,000 pregnant women in TS were followed and assigned either a trained or untrained TBA. In the first year, early neonatal, and maternal mortality rates (MMR) (32.9 per 1000 and 170 per 100,000 deliveries respectively) were reduced, but not sustained in the second year. Nationally, MMR was 446 in 2009 and 126 in 2015. Although possible to improve health worker performance, and community engagement, the most likely explanation for benefit attrition is that people and material resources 'downstream' of the TBA services were inadequate. Three decades later, Indonesian neonatal and maternal mortality rates of 14 per 1000 and 126 per 100,000 live births in 2015 (globally 16.2 in 2009 and 216 in 2015) according to UNICEF, still demanded improvement, despite more hospital-based births. The original 1988 cohort of women, their children and grandchildren, can now be interrogated for medium to long term health outcomes of nutritional, such as birth weight and growth, and other risk factors. The evolving TS cohort health and nutrition intermediates and endpoints are instructive. Maternal and early life factors predict adult energy metabolism and cognitive function.

MALAY CULTURAL PRACTICE AND CHILDBIRTH WITH TRADITIONAL BIRTH ATTENDANTS: A QUALITATIVE STUDY IN WOMEN OF PRODUCTIVE AGE IN WEST BORNEO INDONESIA

Background: The decline in Maternal Mortality Rate (MMR) in developing countries still does not meet the target of Sustainable Development Goals (SDGs). The rise of childbirth with the help of traditional birth attendants and cultural practices still becomes the choice of women of productive age to give birth today. Objective: This study aimed to explore the Malay culture practice and childbirth with traditional birth attendants in women of productive age in West Borneo, Indonesia.Methods: This was a phenomenological study conducted on in 2018 in one district in West Borneo. Focus Group Discussion (FDG) was done with eight Malay tribal women who had given birth with the help of Traditional Birth Attendants (TBAs). Thematic analysis was used. Results: Cultural practices during pregnancy, childbirth and the care of newborns, the services of TBAs, and the economy factor were strong reasons for mothers to choose to give birth assisted by TBAs although they were aware of the risks. This study identified five main themes, namely: 1) Reason for choosing TBAs, 2) TBAs’ service, 3) Cultural trust in pregnancy, 4) Cultural trust in labor, and 5) Cultural trust in caring for newborns.Conclusion: Our findings revealed that culture and childbirth cannot be separated. Health practitioners should have different approach by involving culture and TBAs in childbirth among women of productive age in West Borneo Indonesia.

Factors influencing the utilization of TBA services by women in the Tolon district of the northern region of Ghana

Maternal mortality issues have become a major cause for concern especially in developing counties as they struggle to attain the Sustainable Development Goals 3.1 and 3.2. Tradi tional Birth Attendants (TBAs) have played a significant role in providing maternal health services, especially in rural Africa. Health service providers have done a lot to provide ma- ternal health services to pregnant women in Ghana yet most women, especially in rural areas, still, patronize the services of (TBAs). The aim of this paper is to determine the fac- tors that influence women in the Tolon district of Ghana to patronize the services of TBAs. The paper employed a mixed research approach and adopted the cross-sectional survey design to collect and analyse data. The study involved 360 women who have sought the services of TBAs within the last five years. Data were collected with the use of question- naires containing both open-ended and closed-ended questions. The factors that influenced the patronage of TBAs included the fact that TBA services are cheaper, more culturally ac- cepted, nearer to the homes of pregnant women than the hospital, TBAs being more caring than orthodox health workers and being the only maternity care that women know. It is recommended that since the factors that influence the patronage of TBA services cannot easily be abolished the health authorities should integrate TBA services in mainstream maternal health care delivery.

Initiation of traditional birth attendants and their traditional and spiritual practices during pregnancy and childbirth in Ghana

BackgroundPrior to the advent of modern obstetric services, traditional birth attendants (TBAs) have rendered services to pregnant women and women in labour for a long time. Although it is anticipated that women in contemporary societies will give birth in hospitals and clinics, some women still patronize the services of TBAs. The study therefore sought to gain an in-depth understanding of the initiation of TBAs and their traditional and spiritual practices employed during pregnancy and childbirth in Ghana.MethodsThe design was an exploratory qualitative one using in-depth individual interviews. Data saturation was reached with 16 participants who were all of Christian faith. Interviews were conducted with a semi-structured interview guide, audiotaped and transcribed verbatim. Content analysis was employed to generate findings.ResultsThe findings showed that TBAs were initiated through apprenticeship from family members who were TBAs and other non-family TBAs as well as through dreams and revelations. They practice using both spiritual and physical methods and their work was founded on spiritual directions, use of spiritual artefacts, herbs and physical examination. TBAs delay cutting of the cord and disposal of the placenta was associated with beliefs which indicated that when not properly disposed, it will have negative consequences on the child during adulthood.ConclusionAlthough, TBAs like maternal health professionals operate to improve maternal health care, some of their spiritual practices and beliefs may pose threats to their clients. Nonetheless, with appropriate initiation and training, they can become useful.

Traditional Birth Attendants (TBAs) Positioning on Strengthening Partnership with Midwives

Background of this research was the still high number of infant mortality and high use of Traditional Birth Attendants (TBAs). The This study aims aimed to determine TBAs positioning on the effort of strengthening partnership with midwives. A number of pregnant women, TBAs, and midwives become became informants, through in-depth interviews and focus group discussions. The results showed positioning TBAs still needed with different roles but side by side with midwife role, used by primi and multi pregnant women before and during pregnancy, during and after birth. The requirement forrequirement for TBAs was derived from parents as a cultural heritage, whereas the requirement for midwife obtained was from formal and non- formal information. The TBAs services toward maintain family health care including include cultural events. The midwife is givingserved professional servicescare. The partnership includes clients registration, motivation, abnormalities early detection. There has had been an unwritten financing unwritten agreement. The TBAs midwife partnership needs to be strengthened through legislation and , communication to diverse audiences in order to form the right positioning.

Strengthening close to community provision of maternal health services in fragile settings: an exploration of the changing roles of TBAs in Sierra Leone and Somaliland

BackgroundEfforts to take forward universal health coverage require innovative approaches in fragile settings, which experience particularly acute human resource shortages and poor health indicators. For maternal and newborn health, it is important to innovate with new partnerships and roles for Traditional Birth Attendants (TBAs) to promote maternal health. We explore perspectives on programmes in Somaliland and Sierra Leone which link TBAs to health centres as part of a pathway to maternal health care. Our study aims to understand the perceptions of communities, stakeholder and TBAs themselves who have been trained in new roles to generate insights on strategies to engage with TBAs and to promote skilled birth attendance in fragile affected settings.MethodsA qualitative study was carried out in two chiefdoms in Bombali district in Sierra Leone and the Maroodi Jeex region of Somaliland. Purposively sampled participants consisted of key players from the Ministries of Health, programme implementers, trained TBAs and women who benefitted from the services of trained TBAs. Data was collected through key informants and in-depth interviews and focus group discussions. Data was transcribed, translated and analyzed using the framework approach. For the purposes of this paper, a comparative analysis was undertaken reviewing similarities and differences across the two different contexts.ResultsAnalysis of multiple viewpoints reveal that with appropriate training and support it is possible to change TBAs practices so they support pregnant women in new ways (support and referral rather than delivery). Participants perceived that trained TBAs can utilize their embedded and trusted community relationships to interact effectively with their communities, help overcome barriers to acceptability, utilization and contribute to effective demand for maternal and newborn services and ultimately enhance utilization of skilled birth attendants. Trained TBAs appreciated cordial relationship at the health centres and feeling as part of the health system. Key challenges that emerged included the distance women needed to travel to reach health centers, appropriate remuneration of trained TBAs and strategies to sustain their work.ConclusionOur findings highlight the possible gains of the new roles and approaches for trained TBAs through further integrating them into the formal health system. Their potential is arguably critically important in promoting universal health coverage in fragile and conflict affected states (FCAS) where human resources are additionally constrained and maternal and newborn health care needs particularly acute.

Perception about traditional birth attendants by men and women of reproductive age in rural Migori County, Kenya

BackgroundSkilled birth attendance, a proven way of reducing maternal and perinatal mortality has remained low in low resource settings. Traditional Birth Attendants (TBAs) have continued to be culturally and socially accepted in many societies despite their limitation in handling childbirth complications. The study objective was to assess the perception of traditional birth attendants (TBAs) by the men and women of reproductive age in rural Migori. MethodologyThis was a qualitative study carried out in four villages in Migori County, Nyanza region which involved married women of child bearing age and married men. Separate focus group discussions (FGDs) were done for men and women, where one FGD was conducted per group in each village. Content analysis was done after coding and categorizing data into thematic areas. ResultsThe findings indicated varied perceptions of men and women about the TBAs. Themen appreciated the services of TBAs mainly because of financial reasons while women enjoyed their friendly attitude and welfare services. The community was well aware of the risks of delivering with a TBA, however, they still opted for their services for reasons such as availability, accessibility and their friendly attitude. ConclusionThe men and women of reproductive had varied perceptions, both positive and negative about the traditional birth attendants. The TBAs still have a role to play in the community.