Traditional Birth Attendants Research Articles

Barriers experienced by community midwives to provide basic emergency obstetric and newborn care in rural Pakistan

BackgroundConsidering the high maternal mortality rate, the government of Pakistan has deployed Community Midwives (CMWs) in rural areas of Pakistan. This relatively new cadre of community-based skilled birth attendants has previously reported to experience several challenges in providing maternal and child healthcare. However, what barriers they experience in providing basic emergency obstetric and newborn care needs to be further studied.MethodsThis was a cross-sectional study conducted in twelve districts in Sindh province, Pakistan, with poor maternal and child health indicators. A total of 258 CMWs participated in this study and completed the questionnaire on a pretested, validated tool in their community-based stations. The trained data collectors completed the questionnaires from the respondents. The problems identified were categorized into three major issues: financial, and transport and security related; and were analyzed accordingly. Ethical approval was obtained from the institutional review board (IRB) of Health Services Academy (HSA) Islamabad, Pakistan.ResultsThe majority (90%) of 258 CMWs had formal training in maternal and neonatal care from the recognized institutions. Financial difficulties faced by CMWs were identified as the most frequent barriers and others were transport, security, and other issues. In univariate analysis, 38.1% and 61.9% of the community midwives who faced financial difficulties had completed a graduation or intermediate level of education, respectively (p = 0.006). Round-the-clock availability for emergencies was inversely associated with having financial difficulties, i.e., 71.4%, in contrast to 28.4% who had financial difficulties were available round-the-clock for emergency calls in their community clinics (p = 0.008). Formal training (p = 0.001), work experience (p = 0.015), longer duration of work (p = 0.003), and liaison with health workers and posting district (p = 0.001) had statistically significantly higher transport related issues. Security difficulties faced by CMWs and a set of correlates such as formal training (p = 0.019), working experience (p = 0.001), longer duration of work (p = 0.023), 24 h of availability on call (p = 0.004), liaison with traditional birth attendants (TBAs) in the community (p = 0.002), and district of posting (p = 0.001) were statistically significantly different. Other issues like working experience (p = < 0.001) and Liaison with TBAs in the community (p = < 0.001) were found statistically significant.ConclusionFinancial, transportation and security related barriers were commonly reported by community midwives in the delivery of basic emergency obstetric and newborn care in rural Pakistan.

Effect of the Mamás del Río programme on essential newborn care: a three-year before-and-after outcome evaluation of a community-based, maternal and neonatal health intervention in the Peruvian Amazon

Despite remarkable progress in maternal and neonatal health, regional inequalities persist in Peru. In rural areas of Amazonian Loreto, access to quality care is difficult, home births are frequent, and neonatal mortality is high. We conducted a prospective before-and-after study to assess the effect after implementation and over time of a community-based intervention on essential newborn care (ENC). Mamás del Río consists of tablet-enhanced educational home visits by Community health workers (CHW) to pregnant women and mothers of newborns, with supportive training on ENC of traditional birth attendants and facility staff. The study area comprised 79 rural communities of three districts in Loreto. Primary outcomes were ENC practices in home births, secondary outcomes were ENC in facility births as well as healthcare seeking, measured at baseline before and at year 2 and year 3 after intervention implementation. Community censuses included questionnaires to women aged 15-49 years with a live birth. We calculated prevalence of outcomes at each time point and estimated adjusted prevalence differences (PD) between time points using post-estimation based on logistic regression. Following implementation early 2019, 97% of communities had a trained CHW. At year 2 follow-up, 63% (322/530) of women received a CHW visit during pregnancy. Seven out of nine ENC indicators among home births improved, with largest adjusted prevalence differences in immediate skin-to-skin contact (50% [95% CI: 42-58], p<0.0001), colostrum feeding (45% [35-54], p<0.0001), and cord care (19% [10-28], p=0.0001). Improvements were maintained at year 3, except for cord care. At year 2, among facility births only three ENC indicators improved, while more women gave birth in a facility. Sensitivity analyses showed ENC prevalence was similar before compared to after onset of Covid-19 lockdown. ENC practices in home births improved consistently and changes were sustained over time, despite the onset of the Covid-19 pandemic. A community-based approach for behaviour-change in home-based newborn care appears effective. Process evaluation of mechanisms will help to explain observed effects and understand transferability of findings. Grand Challenges Canada and Peruvian National Council of Science and Technology.

Assessment of Place of Delivery and Associated Factors among Pastoralists in Ethiopia: A Systematic Review and Meta-Analysis Evaluation.

Pastoralist communities rely on their livestock for at least 50% of their food supply and source of income. Home births raise the risk of maternal morbidity and death, whereas institutional births lessen the likelihood of difficulties during labor. Around 70% of labors in pastoralist regions of Ethiopia were assisted by traditional birth attendants. Studies done from January 2004 to January 2023, accessed in PubMed, EMBASE, Medline, and other search engines, were included. PRISMA guidelines and JBI critical appraisal checklist were used to assure the quality of the review. Ten articles were included in this review. Data were extracted with Excel and exported to STATA 16 for analysis. Heterogeneity of literatures was evaluated using I2 statistics and publication bias using the Egger regression asymmetry test and the Duval and Tweedie trim-fill analysis. Statistical significance was declared at p value less than 0.05. The pooled estimate of institutional delivery among the pastoralist community in Ethiopia is 21.2% (95% CI: 16.2-26.1). Husbands who were involved to decide place of delivery (OR = 3.47; 95% CI: 1.61, 7.50), women with good knowledge of MCH services (OR = 2.283; 95% CI: 1.51, 3.44), women who had a positive attitude towards MCH services (OR = 1.69; 95% CI: 0.79, 3.6), availability of health institutions (OR = 2.6; 95% CI: 0.95, 7.20), and women who had an ANC follow-up (OR = 2.78; 95% CI: 2.07, 3.73) were higher institutional delivery prevalence among pastoralist women. Moreover, institutional delivery among women who were educated above the college level was more than two times (OR = 2.56; 95% CI: 1.985, 3.304) higher than among women who were not educated. Pastoralist women in Ethiopia were found to be a disadvantaged group for institutional delivery at national level. Husband involvement, educational level, ANC visit, knowledge and attitude for MCH service, and health facility distance were identified to have significant association with institutional delivery.

“God Has Commanded Me”: A Spiritual Code of a Traditional Birth Attendance (TBA)

Abstract Many studies have demonstrated the significant involvement of Traditional Birth Attendants (TBAs) during pregnancy and delivery. In several countries, including Indonesia, the role of the TBA cannot be easily replaced by Skilled Birth Attendants (SBAs), reducing the capacity of the health sector to reduce the maternal mortality rate. The TBA has a religious and social connection with the community in her area which is often undervalued by the medically-trained SBA; this disconnect interferes with the provision of quality care. In this paper, with the use of a narrative approach, a TBA reveals her reflection and perspective as rooted in the community where she lives. This ethnography provides living evidence that the point of view of modern health professionals often fails when faced with the world view of the community. TBAs have social power that cannot be separated from the social context where they live. Therefore, an analysis of the religious aspects of a TBA’s practice should enrich the effort to decrease the maternal mortality rate. The religiosity of a community is closely connected with the community’s perspective on health.

Provision of emergency obstetric care: Midwives' knowledge and involvement in rural health facilities of Cross River State, Nigeria

BACKGROUND: Maternal Mortality (MM) in Nigeria is greatest in rural regions where access to emergency obstetric care (EmOC) services is hampered by a number of circumstances. Delay in obtaining prompt and proper care in obstetric emergency situations is a significant factor in poor mother outcomes. It is based on this premise that the researchers examined midwives' knowledge and involvement regarding provision of emergency obstetric care in rural health facilities of Cross River State. MATERIALS AND METHODS: The study adopted a cross-sectional descriptive design; a total population study of all ninety-four midwives who worked in maternal health care facilities in rural areas of CRS was utilised. Cross River state is a state in the South-South geopolitical zone of Nigeria, named after the Cross River, which passes through the state, located in the Niger Delta and occupies 20,156 square kilometers A self-developed and validated questionnaire was used for data collection. The instrument was pre-tested for reliability and result showed the reliability index ranging from 0.70 to 0.82. Quantitative data collected was analysed using Pearson product moment correlation test at 0.05 level of significance. RESULTS: The research findings revealed midwives' level of knowledge on emergency obstetric care in rural health facilities of CRS was significantly high, majority of the participants had provided some aspects of essential emergency obstetric care. The result of hypotheses revealed a significant relationship between knowledge and provision of EmOC amongst the midwives (P &lt; .05). CONCLUSION: Based on this, it was recommended that appropriate strategies such as on the job training\ supportive supervision, refresher training and mentorship should also be ensured to enhance midwives' capacity in emergency obstetric care. Finally, there is need for Community involvement/enlightenment, motivating traditional birth attendants and integrating them into maternal health care system.

Audit of obstructed labour cases managed in a rural specialist hospital in Enugu, south-east, Nigeria

Background: Labour is a physiological process through which the fetus and placenta are expelled from the vagina at term. It is a challenging and painful process that ends with the joy of a newborn. On many occasions, the process is complicated by obstruction arising from disproportion between the baby and the maternal pelvis. Such conditions if not detected on time, will lead to significant feto-maternal morbidities and mortality. This experience in the developing nations of the world is a recurrent one even though it is almost eliminated in the developed world due to their advancement in antenatal and intrapartum care. The condition is even more prevalent in the rural areas of the developing countries where scarcity of skilled birth attendants is the order of the day, hence, this 5-year review in a rural hospital. Aim: The aim of this study was to determine the prevalence, outcome and socio-demographic determinants of obstructed labour in a private rural hospital Methodology: This was a 5-year retrospective review of all cases of all cases of obstructed labour managed in a rural specialist hospital. The data was collected from delivery registers, theatre registers and patients’ case files using a specialized proforma. The data was analyzed using the Statistical Product and Service Solutions (SPSS) version 25.0 for windows. Results were presented using tables, frequencies, means, and percentages. Test of significance between class differences was by Pearson’s Chi-square test for categorical variables and student’s t-test for continuous variables. All P Result: From the data collected, records of 1,487 births in the centre over the 5-year period were reviewed. Out of these 123 were cases of obstructed labour giving a prevalence of 8.27%. The age distribution of the cases showed that majority of them (30.9%) were aged 30-35 years and the least were over 40 years (6.5%). In all, 75.6% were married and 22.8% were single; majority of them were in a monogamous relationship (65.9%). Those with primary education topped the list (42.3%) followed by those with secondary education (37.4%) while the least had tertiary education (1.6%). Forty eight percent of them were unemployed, followed by 46.3% who were petty traders and only 5.7% were civil servants. Almost all of them were Christians (83.7%) and 45.5% of their partners were artisans. Majority of them (60.2%) were para 3 or above and 64.2% were delivered at gestational ages of between 37 to 40 weeks whereas 32.8% were above 40 weeks. Fifty two percent were verbally referred to the centre and 1.6% had a written referral. Most of them 73.2% were referred from a Traditional Birth Attendant (TBA). They were all labouring outside of the facility and 69.9% were referred from a TBA homes. One hundred and seventeen (95.1%) had severe pain, 95.1% were dehydrated, 81% had edematous vulva, 24.4% presented in shock and 18.7% had vaginal bleeding. It also showed that 98.4% had significant moulding and caput, 84.6% fetal distress and 13.8% intrauterine fetal death. Many presented with a combination of these features. Almost all the parturients (98.4%) were rehydrated with intravenous fluids, 94.3% had analgesia, 92.7% had emergency caesarean delivery, 86.2% were transfused, 4.9% had destructive procedures, 5.7% were delivered vaginally, and 6.5% had hysterectomy. Majority of them (61.8%) had surgical site infections, 33.3% had PPH and 72.4% of the babies had birth asphyxia. In all, marital status, conjugal relationship and educational level had a significant relationship with obstructed labour with p-values less than 0.05. Conclusion: Obstructed labour was an important occurrence in the centre and all of them were referred cases. Marital status, type of conjugal relationship and educational qualification had significant influence on the condition and majority of the babies were asphyxiated at birth. Therefore, we recommend registration, training and retraining of TBAs in rural areas to recognize early signs of obstruction and make timely referrals. Secondly, policies to enhance girl child education and women empowerment should be encouraged. Finally, provision of health facilities to make Essential Obstetric Care available and affordable to the rural populace should be a priority of all regional governments

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&gt; 0.05), also showed a positive significant relationship between the level of education and the utilization of traditional birth attendant with a p-value &lt;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.

Why do women still give birth at home; perceptions of Pakistani women and decision-makers from marginalized communities.

In low- and middle-income countries (LMICs), maternal and newborn mortality is high due to the high prevalence of home births. Understanding the reasons behind this behavior is essential for improving maternal and newborn outcomes. Therefore, a qualitative exploratory study was conducted in a peri-urban community in Karachi, Pakistan to understand the perceptions of pregnant women who delivered at home despite receiving antenatal care and the perceptions of their decision-makers regarding this behavior. In-depth interviews were conducted with 15 randomly sampled women who chose to deliver at home after receiving antenatal care at a health facility, as well as 15 family members who were purposively identified as decision-makers by the women themselves. Thematic analysis was performed to explore the perceptions, myths, and cultural beliefs about homebirths as well as women's decision-making power related to childbirth. The three main themes identified showed that traditional beliefs and practices, poverty and gender inequality, and poor healthcare systems significantly influence the preference for childbirth. Traditional beliefs and practices, including religious and cultural beliefs, played a role in perceiving childbirth as a natural process best managed at home. The presence of traditional birth attendants who provide personalized care and emotional support further reinforced this preference. Gender inequalities, including limited access to mobile phones and women's caregiving roles, were identified as barriers to seeking formal healthcare at the time of delivery. Additionally, poor experiences with the formal healthcare system, such as the poor attitude of formal healthcare workers and fear of medical interventions, also contributed to the decision to deliver at home. The study highlighted the complex interplay between traditional/religious beliefs, gender inequalities, and healthcare experiences in shaping the decision to deliver at home despite receiving ANC services in marginalized settings. Addressing these factors is necessary for promoting facility-based delivery and improving maternal and neonatal outcomes in LMICs.

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.

Landscape Analysis of Traditional Tribal Healers and Their Healing Practices in the Tribal-dominated States of India

Tribal communities have a rich history as some of the earliest inhabitants of the Indian subcontinent, living in harmony with nature for thousands of years. These indigenous or ethnic groups are spread throughout India, with significant concentrations in states like Chhattisgarh (30.5%), Jharkhand (26.0%), Odisha (22.8%), Madhya Pradesh (21.0%), Gujarat (14.7%), Rajasthan (13.4%), and Maharashtra (9.3%). In the peninsular region, notable tribal groups include Bhils, Santhals, Gonds, Ho, Kondh, Kols, Mundas, and Kharia, while in the northeast region, the prominent ones are Nagas, Mizos, Mikris, and Kukis. However, their access to healthcare is hindered by limited infrastructure, illiteracy, poverty, unemployment, socio-economic challenges, and marginalization. As a result, tribal communities often turn to traditional healers and indigenous medicinal practices, giving preference to traditional healing over modern healthcare options. Tribal traditional healers lack formal medical degrees, but their deep connection with indigenous communities makes them a preferred choice for healthcare. They are easily accessible to tribal populations and offer cost-effective services. These healers rely on their extensive traditional knowledge and skills, utilizing locally available medicinal plants, animal, and mineral substances, and incorporating specific ritual practices in their treatment methods for patients. Tribal healers are integral components of the available local healthcare system and play a critical role in delivering primary care services. The primary objective of this landscape analysis was to conduct a comprehensive examination of the socio-economic status, healing practices, and knowledge transfer methods of tribal healers and folk practitioners. Additionally, it aimed to create an evidence-based roadmap for their integration into the mainstream through upskilling, certificating, and federating the tribal healers. The study was ethnographic descriptive cross-sectional research conducted between May 15th and September 30th, 2023. The study comprised 1649 participants, encompassing Herbalists, Spiritual Healers, Diviners, Bone Setters, and Traditional Birth Attendants hailing from 43 districts in 7 tribal dominated states predominantly inhabited by tribal communities, namely Chhattisgarh, Jharkhand, Odisha, Madhya Pradesh, Maharashtra, Assam, and Arunachal Pradesh. Data collection occurred across 43 districts situated within the aforementioned states. The selection of tribal healers was done using an Exponential non-discriminative snowball non-probability sampling approach. The research methodology encompassed ethnographic research, interviews with healers, and documentary analysis. The analysis showcased the diversity of traditional healers, representing about 240 tribes, and emphasized the rich cultural and regional variations in their healing practices. The study involved tribal healers with an average age of 52.6 years, of which 82.4% were above 40 years old. These healers had varied roles and expertise, such as general herbalists, bone setters, Ojhas, or Dondai, each employing distinct diagnostic methods and treatments for the indigenous population. About 53.9% of folk healers were skilled in indigenous medicine, using natural substances for healthcare. Additionally, 42.5% of religious practitioners integrated social, cultural, and religious beliefs into their treatments, including rituals and sacrifices. Knowledge transmission followed the traditional guru-shishya tradition, where tribal healers learned from experienced healers orally, without written texts. Certification was valued as a way to gain public trust, and NGOs and federations played pivotal roles in advocating for traditional healing practices. Successful integration into mainstream healthcare required collaboration, coordination, and mutual respect between traditional and modern healthcare providers. Despite deep-rooted connections with their own communities, traditional healers face several common challenges in their practice such as Stigmatization and lack of recognition, Limited resources and infrastructure, Lack of formal training and certification, Legal and regulatory challenges, Ethical and legal dilemmas, and economic challenges. In conclusion, the landscape analysis shed light on the diverse healing traditions within tribal communities, emphasizing the importance of preserving and respecting these practices to safeguard cultural heritage and wisdom. Integrating traditional healing into comprehensive healthcare systems can enhance inclusivity and provide holistic care for tribal populations.

Learning Through Play (LTP) Parenting Program: Capacity Building of Traditional Birth Attendants in Pakistan

The present study aimed to train Traditional Birth Attendants (TBAs) in a parenting program called Learning through Play (LTP) to improve their Knowledge, Attitude, and Practices regarding child development after completion of training, for them to be better able to support parents during their routine practice. Quasi experimental design was used. A total of 330 TBAs meeting study eligibility criteria were included and data was collected in a group setting. LTP training was comprised of weekly sessions delivered over 1 month. LTP includes knowledge about child development for children from 0 to 3 years. The Knowledge, Attitude, and Practices (KAP) questionnaire was used to measure change. Statistical analysis was done through Paired Sample T-test. There was a significant difference between pre-post scores t = -29.36 ( p &lt; .05). Capacity building of TBAs in LTP program and integrating LTP into existing health care systems may contribute to reducing the child development gaps in Pakistan.

Rethinking the role of Traditional Birth Attendants in South Africa as a Socio-economic Development Strategy: Maximizing the lessons from the COVID-19 pandemic

Rethinking the role of Traditional Birth Attendants in South Africa as a Socio-economic Development Strategy: Maximizing the lessons from the COVID-19 pandemic

The birthing experiences of mothers with clinical healthcare professionals and community birth attendants in rural northern Ghana

BackgroundThe use of non-professional birth attendants, such as untrained family members and traditional birth attendants, contributes to birth-related complications such as neonatal and maternal mortality. Strategies such as professionally conducted home births and placement of community health professionals close to homes to ensure easy access to skilled birth attendants aim to reduce complications. However, women in labour continue to access the services of unskilled birth attendants in developing settings. AimTo explore the experiences of women in labour who received care from professional birth attendants and community birth attendants to understand the reasons for continued use of non-professional community birth attendants. MethodsA qualitative approach was used to explore the birthing experiences of nine mothers, aged 20–45 years. In-depth face-to-face interviews were conducted to generate data with the help of an interview guide. A content analysis approach was used to organise and interpret the data. FindingsThe participants reported hostile interactions with professional birth attendants, imposition of birthing positions by professional birth attendants, high cost of birthing services by professional birth attendants, and safety risks with non-professional community birth attendants. ConclusionThere is a need for explicit health financing systems that ensure mothers are aware and adequately prepared for labour-related costs. Mothers wish to receive care from professional birth attendants, but feel compelled by negative experiences to choose family members and non-professional birth attendants instead. The adherence of health professionals to the fundamental principles of ‘Respectful Maternity Care’ could reduce their negative attitudes towards women in labour.

Two level logistic regression analysis of factors influencing skilled birth attendant during delivery among Bangladeshi mothers: A nationally representative sample.

In order to minimize the maternal and child mortality rate, the presence of skilled birth attendants (SBA) during delivery is essential. By 2022, 4th health, population and nutrition sector programme in Bangladesh aims to increase the percentage of deliveries performed by SBA to 65 percent. The objective of the present study was to determine the rate and associated factors of usage SBA among Bangladeshi mothers during their delivery. This study utilized secondary data that was collected by Bangladesh Demographic and Health Survey (BDHS) 2017-18. The usage of SBA was measured by a question to respondent, who assisted during your delivery? It was classified into two classes; (i) skilled birth attendant (qualified doctors, nurses, midwives, or paramedics; family welfare visitors, community skilled birth attendants, and sub-assistant community medical officers) (code 1), and (ii) unskilled birth attendant (untrained traditional birth attendants, trained traditional birth attendants, relatives, friends, or others) (code 0). Two logistic regression model was used to determine the associated factors of SBA after removing the cluster effect of the outcome variable. This study found 53.2% mothers were delivered by SBA in Bangladesh, among them 56.33% and 42.24% mothers were delivered by nurse/midwife/paramedic and doctor respectively. The two level logistic model demonstrated that geographical location (division), type of residence, religion, wealth index, mothers' body mass index, mothers' education level, mothers' occupation, total ever born children, mothers' age at first birth (year), number of ANC visits, husbands' education level and husbands' occupation were significant (p<0.01) predictors of SBA. Mothers' education and wealth index were the most important contributory factors for SBA in Bangladesh. This study revealed that still 46.8% mothers are delivered by unskilled birth attendant, this might be treated of Bangladesh Government to achieve SDGs indicator 3.1.2 by 2030. Counseling could be integrated during ANC to increase awareness, and should ensure for every Bangladeshi mothers visit ANC service during their pregnancy at least 4 times.

Maternal Health Service Satisfaction-Comparative Study of Mothers in Urban and Rural areas of Enugu State, South East Nigeria

Introduction: Assessing mothers’ satisfaction with maternal health service is very important. This is because it is critical and should be considered when making maternal health services more responsive to people’s needs. Objective: To assess and compare the maternal health service satisfaction of mothers in urban and rural areas of Enugu State, South East Nigeria. Methodology: This study was a community-based comparative, cross sectional study that assessed and compared the maternal health service satisfaction of mothers in urban and rural areas of Enugu State, South East Nigeria. The analysis was done according to the specific objectives using generated tables, ratios, frequency, percentage calculations and cross tabulations. Chi-square test of significance for test of comparison of qualitative categorical data, Student t-test for group comparison of means, Bi-variant, and Multivariate Analysis using logistic regression were used in the analysis of data at 95% confidence interval. P-value was set at 0.05. Results: 5.5% of mothers in the urban areas were satisfied with maternal health service they received when compared to mothers (79.2%) in the rural areas. Mothers in urban areas who had one pregnancy were 7.051 times less likely to be satisfied with the maternal health services when compared with other women. Mothers who obtained maternal health service from health post, Primary health care centres (PHC), district hospitals, tertiary facility, private hospital, and had less education were more satisfied with the services when compared with those who received care from Traditional Birth Attendants (TBAs) and spiritual homes. According to the mothers in both locations, the Factors that affect their utilization of maternal health include poor quality of maternal health service, high cost of obtaining the limited services, inadequate maternal information, in adequate staff, and bad attitude of health care workers attending to them. Conclusion/Recommendation: There is need to maintain this observed finding. However, there should be an improvement on health talk and health education given to mothers, to enable them have a better perception of their maternal expectations. This will enable the mothers to properly grade their satisfaction with maternal health services. Government should further train the health care workers including TBAs, and closely monitor the activities of spiritual homes.

Quantitative Assessment of The Perception and The Roles of Traditional Birth Attendants on Maternal Health Care among Women of Reproductive Age in Ifedore Local Government Area of Ondo State, Nigeria

The fifth development goals (NDGs) aims at improving maternal health with the target of reducing maternal mortality ratio (MMR) by 75% between 1990 and 2015, but much has not been achieved in this area from then to the present time. It is in the light of the above that this study quantitatively assessed the perception and roles of traditional birth attendants (TBAs) on maternal health among women of reproductive age in Ifedore local government area in ondo state. The study relied on the health belief theoretical model to explain the social and psychological health behaviour of women of reproductive age with respect to patronage and knowledge of the TBAs. A descriptive cross –sectional study design was used for the investigation. The sample consists of three hundred and seventy-nine (379) respondents comprising 242 women of reproductive age, 100 traditional birth attendants, 20 medical and paramedical personnel randomly selected from local communities within Ifedore local government using a multistage sampling technique. Data were collected through structured questionnaire and the results were analysed using descriptive statistics. The findings revealed that majority of the respondents have good perception of the roles of the TBAs in that area and that child-bearing women patronized them because they are cheaper than government’s hospitals services and closer to them than government-owned health facilities. The study concluded that the TBAs play vital roles in maternity health care delivery among women of reproductive age in Ifedore local government area. It is,therefore, recommended that the government should as a matter of necessity foster partnership with a view of improving their skills to meet the global best practices. Also, health care services should be made affordable in public health institutions to encourage patronage by the rural and semi-urban dwellers.

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.&#x0D; 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.&#x0D; Study Design: This study is a descriptive cross-sectional study which was conducted in Alanamu community of Ilorin, northern Nigeria, in the year 2019.&#x0D; 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.&#x0D; 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.&#x0D; The study showed statistical significance between the level of education of respondents and their patronage of TBAs with a P-value of .04.&#x0D; 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.

Study Of Selection Of Delivery Assistance By Tbas In Materials In Masadian Village, Menui Sub-District, Menui Islands, Morowali District

Backgroud: Nationally, indicators regarding the coverage of delivery services at health facilities have succeeded in achieving the objectives of the 2017 strategic plan, but in several provinces in Indonesia there are still significant differences regarding the coverage of delivery services, for example, Jakarta has the highest coverage at 102%, then Bali at 97.73 %. Meanwhile, Central Sulawesi Province only had an achievement of 76.18%. Objective: This study aims to find out the description of the selection of birth attendants by dukuns for mothers giving birth in Masadian Village, Menui District, Archipelago District, Morowali Regency. Method: This research has a type of quantitative design with a descriptive approach. The population in this study were all birth mothers assisted by traditional birth attendants in 2022, totaling 40 people. the sample in this study was a portion of mothers who were assisted by traditional birth attendants in 2020 as many as 29 respondents. The sampling technique in this study was purposive sampling. The research data was processed using descriptive statistical tests. Result: The results showed that 69% of the respondents had low education and 31% had higher education, 62.1% less knowledge of respondents and 37.9% good category, most of the respondents' economic status was 72.4% low economic and 27 high economic .6%, access to health services 100% access is not affordable, and husband/family support 51.7% do not receive family support and 48.3% receive family support. It is suggested to the puskesmas to provide education to the community which aims to increase the knowledge of mothers, husbands and other families so that they are ready and willing to give birth in midwivesKeywords: birth attendant, traditional birth attendant, knowledge, access, family support

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.

Trends in birth attendants in Sudan using three consecutive household surveys (from 2006 to 2014).

Improving maternal health and survival remains a public health priority for Sudan. Significant investments were made to expand access to maternal health services, such as through the training and deployment of providers with varying skills and competencies to work across the country. This study investigates trends in the coverage of different birth attendants and their relationship with the maternal mortality ratio (MMR). Trend analyses were conducted using data from the 2006, 2010, and 2014 Sudan Household surveys. Three categories of birth attendants were identified: (1) skilled birth attendants (SBA) such as doctors, nurse-midwives, and health visitors, (2) locally certified midwives, and (3) traditional birth attendants (TBA). Multivariable logistic regression models were used to examine trends in SBAs (vs. locally certified midwives and TBAs), locally certified midwives (vs SBAs and TBAs), and SBAs and locally certified midwives by place of birth (health facility and home). The analyses were adjusted for potential confounders. An ecological analysis was conducted to assess the relationship between birth attendants by place of birth and MMR at the state level. Births by 15,848 women were analysed. Locally certified midwives attended most births in each survey year, with their contribution increasing from 36.3% in 2006 to 55.5% in 2014. The contributions of SBAs and TBAs decreased over the same period. In 2014 compared with 2006, births were more likely to be attended by a locally certified midwife (aOR: 2.19; 95%CI: 1.82-2.63) but less likely to be attended by a SBA (aOR: 0.46; 95%CI: 0.37-0.56). The decrease in SBA was more substantial for births taking place at home (aOR: 0.17; 95%CI: 0.12-0.23) than for health facility births (aOR: 0.45; 95%CI: 0.31-0.65). In the ecological analysis 2014-2016, the proportion of births attended by SBA in health facilities correlated negatively with MMR at state level (rho -0.55; p: 0.02). This analysis suggests that although an improved coverage of maternal health with locally certified midwives has been observed, it has not provided the skill level reached by SBA. SBAs working in facility settings were a key correlating factor to reduced maternal mortality. Urgent action is needed to improve access to SBAs in health facilities, thereby accelerating progress in reducing maternal mortality.