Training Of Traditional Birth Attendants Research Articles

Gap identification for improvement in maternal and early infant health care practices among tribal pregnant women in an aspirational tribal district Sirohi, Rajasthan.

Sirohi is one of the aspirational districts of Rajasthan which is also tribal-dominated. The maternal and early infant health indicators are worrisome compared to regional or national statistics. First-trimester registration of pregnant women is 54% in district Sirohi, which is much less as compared to registration in the state of Rajasthan (63%) and India (59%). Four antenatal care (ANC) visits of pregnant women are 32% in district Sirohi, which is also much less as compared to ANC visits in the state of Rajasthan (39%) and India (51%). However, there was no tribal-specific data regarding maternal and early infant health. The study aims to identify gaps for improvement in maternal and early infant health care practices among tribal pregnant women in an aspirational tribal district of Sirohi, Rajasthan. It was a cross-sectional study conducted among 560 tribal pregnant women to assess the existing maternal, and early infant health care knowledge and practices through a pre-validated questionnaire in the tribal population of district Sirohi Rajasthan. Nineteen per cent (19.5%, n = 109) of tribal pregnant women got married between the age of 10 and 17 (less than the legal age of marriage of 18 years). There is a significant relationship between early age at marriage and low educational status P < 0.001, r = 0.241 among participants. Measurement of weight, blood pressure and urine examination was done in 32.5% (n = 181), 19.5% (n = 109) and 7.1% (n = 39), respectively, among tribal pregnant women. The majority (94.6%) of the pregnant tribal women (385/407) were anaemic. Approximately 60% (n = 337) of mothers were unaware of thermal protection (skin-to-skin care). Sixty per cent (n = 334) of tribal pregnant women preferred to seek consultation regarding antenatal and infant health care from doctors, while 40.1% (n = 224) were more comfortable seeking advice from traditional birth attendants (TBAs). The study finds inadequate knowledge and practice towards maternal and early infant care among tribal pregnant women. As TBAs influence tribal pregnant women, systematic training and involvement of TBAs in maternal and child health are indispensable.

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.

Maternal health in Sri Lanka: 75 years of national commitment towards excellence

Sri Lanka has a legacy of religious and cultural practices promoting health, and its rulers have been responsive to health needs of the populace. The healthcare milieu that prevailed in the pre-colonial and colonial periods favorably influenced the evolution of maternal health in the last 75 years. Since independence, maternal health in the country improved in many dimensions and directions, in the backdrop of multiple sociodemographic changes and geopolitical fluxes, while far-reaching advances in the medico-technological and communication fields were taking place at global level.By 1948, maternal health services were extensive with maternity hospitals, midwifery training school and functional health units in place. The establishment of a cadre of government-trained midwives instead of training traditional birth attendants (TBAs) was a key policy decision that brought long-term dividends. The WHO supported training primary health care workers even before opening their country office in 1952. In the early days, obstetricians relied mostly on their skills to conduct dexterous maneuvers with the generous use of rotational forceps rather than resorting to abdominal deliveries.The Family Planning Association was founded in 1953, which introduced family planning services to the country till the government took over the subject in 1958. A rigorous campaign (punchi pawla raththaran), promoting sterilization was conducted for population control in 1974, which resulted in the total fertility rate coming down significantly.Maternal Death Surveillance and Response system (MDSR) was established in 1981 which has been recognized globally as a success and is being upscaled to a confidential Inquiry status. Commitment and untiring efforts of the Ministry of Health: Family Health Bureau, professional organizations, development partners including the WHO, have contributed for the achievements in the area of women’s health.

Maternal Health in Sri Lanka: 75 years of national commitment towards excellence.

Sri Lanka has a legacy of religious and cultural practices promoting health, and its rulers have been responsive to health needs of the populace. The healthcare milieu that prevailed in the pre-colonial and colonial periods favorably influenced the evolution of maternal health in the last 75 years. Since independence, maternal health in the country improved in many dimensions and directions, in the backdrop of multiple sociodemographic changes and geopolitical fluxes, while far-reaching advances in the medico-technological and communication fields were taking place at global level. By 1948, maternal health services were extensive with maternity hospitals, midwifery training school and functional health units in place. The establishment of a cadre of government-trained midwives instead of training traditional birth attendants (TBAs) was a key policy decision that brought long-term dividends. The WHO supported training primary health care workers even before opening their country office in 1952. In the early days, obstetricians relied mostly on their skills to conduct dexterous maneuvers with the generous use of rotational forceps rather than resorting to abdominal deliveries. The Family Planning Association was founded in 1953, which introduced family planning services to the country till the government took over the subject in 1958. A rigorous campaign (punchi pawla raththaran), promoting sterilization was conducted for population control in 1974 ,which resulted in the total fertility rate coming down significantly. Maternal Death Surveillance and Response system (MDSR) was established in 1981 which has been recognized globally as a success and is being upscaled to a confidential Inquiry status. Commitment and untiring efforts of the Ministry of health: Family Health Bureau, professional organizations, development partners including the WHO, have contributed for the achievements in the area of women's health.

Factors that Influence Place of Delivery for Women of Reproductive Age in Narok South Sub County

Purpose: The main objective of this study was to explore the factors that influence the place of delivery for women of reproductive age in Narok South Sub County.&#x0D; Methodology: The study adapted a descriptive, cross sectional study design which focused on all women of reproductive age who delivered at home after antenatal hospital care visits in the last 24 months. The research was completed in Narok South Sub County, Narok County in Kenya. The target populace included all women with children below two years of age who gave birth at home yet attended antenatal care visits in a health facility in Narok North Sub-County. The study population included all women of reproductive age which were in the age bracket of 15 and 49 years from Narok south sub-county in Narok County. The study adapted two sampling techniques (purposive sampling and simple random sampling) first, purposive sampling was used to obtain women who have had delivered in the last 24 months and also key informants like TBAs and community elders. A sample of 30% of the targeted population was selected; this is coherent with the proposition by Mugenda and Mugenda (2009) that 30% of the population is deemed to be sufficient for statistical analysis in research. A semi structured questionnaire was utilized to gather data. The study utilized primary data only. The primary data was collected through semi structured questionnaires by visiting households with women of reproductive age who gave birth in the last 24 months in a non- hospital set up. Data was analyzed using excel and statistical package for social sciences SPSS version 22.0.&#x0D; Findings: The study found that emergencies during delivery are well handled in a hospital setup and will greatly improve delivery outcome, the health of the mother and baby. The extended walking distance nearest health facility, the lesser the expectation of mothers to make use of skilled and trained delivery service. The absence of trouble-free transportation service to the nearest health facility is also an essential significant convolution. Source of information on reproductive health matters and more so about pregnancy, labor, and place of delivery can highly influence decision-making on the place of giving birth. Majority of women in rural areas receive advice on reproductive health matters from their 'mothers-in-law and extended family members. When pregnant mothers attend ANC they are taught about delivery and how to prepare for it.&#x0D; Recommendations: County Education officers in liaison with social development officers to promote adult formal education to improve literacy levels, which will go a long way in influencing reproductive health decisions. County health management team, together with the reproductive health section to network with other relevant stakeholders to increase sensitization on utilization of hospital-based deliveries. Health education by all relevant stakeholders on the advantages of hospital delivery. Establish community health units and train community health volunteers and traditional birth attendants to be safe motherhood promoters.

Types, reporting and acceptability of community-based interventions for stillbirth prevention in sub-Saharan Africa (SSA): a systematic review

Community-based interventions are increasingly being implemented in Sub-Saharan Africa (SSA) for stillbirth prevention, but the nature of these interventions, their reporting and acceptability are poorly assessed. In addition to understanding their effectiveness, complete reporting of the methods, results and intervention acceptability is essential as it could potentially reduce research waste from replication of inadequately implemented and unacceptable interventions. We conducted a systematic review to investigate these aspects of community-based interventions for preventing stillbirths in SSA. In this systematic review, eight databases (MEDLINE(OvidSP), Embase (OvidSP), Cochrane Central Register of Controlled Trials, Global Health, Science Citation Index and Social Science Citation index (Web of Science Core Collection), CINAHL (EBSCOhost) and Global Index Medicus) and four grey literature sources were searched from January 1, 2000 to July 7, 2023 for relevant quantitative and qualitative studies from SSA (PROSPERO-CRD42021296623). Following deduplication, abstract screening and full-text review, studies were included if the interventions were community-based with or without a health facility component. The main outcomes were types of community-based interventions, completeness of intervention reporting using the TIDier (Template for Intervention Description and replication) checklist, and themes related to intervention acceptability identified using a theoretical framework. Study quality was assessed using the Cochrane risk of bias and National Heart, Lung and Blood Institute's tools. Thirty-nine reports from thirty-four studies conducted in 18 SSA countries were eligible for inclusion. Four types of interventions were identified: nutritional, infection prevention, access to skilled childbirth attendants and health knowledge/behaviour of women. These interventions were implemented using nine strategies: mHealth (defined as the use of mobile and wireless technologies to support the achievement of health objectives), women's groups, community midwifery, home visits, mass media sensitisation, traditional birth attendant and community volunteer training, community mobilisation and transport vouchers. The completeness of reporting using the TIDier checklist varied across studies with a very low proportion of the included studies reporting the intervention intensity, dosing, tailoring and modification. The quality of the included studies were graded as poor (n=6), fair (n=14) and good (n=18). Though interventions were acceptable, only 4 (out of 7) studies explored women's perceptions, mostly focusing on perceived intervention effects and how they felt, omitting key constructs like ethicality, opportunity cost and burden of participation. Different community-based interventions have been tried and evaluated for stillbirth prevention in SSA. The reproducibility and implementation scale-up of these interventions may be limited by incomplete intervention descriptions in the published literature. To strengthen impact, it is crucial to holistically explore the acceptability of these interventions among women and their families. Clarendon/Balliol/NDPH DPhil scholarship for UGA. MN is funded by a Medical Research Council Transition Support Award (MR/W029294/1).

Building referral mechanisms for neonatal care in humanitarian emergency settings: A systematic review.

During humanitarian emergencies, women and children are particularly vulnerable to health complications and neonatal mortality rates have been shown to rise. Additionally, health cluster partners face challenges in coordinating referrals, both between communities and camps to health facilities and across different levels of health facilities. The purpose of this review was to identify the primary referral needs of neonates during humanitarian emergencies, current gaps and barriers, and effective mechanisms for overcoming these barriers. A systematic review was performed using four electronic databases (CINAHL, EMBASE, Medline, and Scopus) between June and August 2019 (PROSPERO registration number CRD42019127705). Title, abstract, and full text screening were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The target population was neonates born during humanitarian emergencies. Studies from high-income countries and prior to 1991 were excluded. The STROBE checklist was used to assess for risk of bias. A total of 11 articles were included in the analysis; these were mainly cross-sectional, field-based studies. The primary needs identified were referrals from homes to health facilities before and during labour, and inter-facility referrals after labour to more specialised services. Some of the main barriers included a lack of roads and infrastructure for transport, staff shortages-especially among more specialised services, and a lack of knowledge among patients for self-referral. Mechanisms for addressing these needs and gaps included providing training for community healthcare workers (CHWs) or traditional birth attendants to identify and address antenatal and post-natal complications; education programmes for pregnant women during the antenatal period; and establishing ambulance services in partnership with local Non-Governmental Organizations. This review benefited from a strong consensus among selected studies but was limited in the quality of data and types of data that were reported. Based on the above findings, the following recommendations were compiled: Focus on local capacity-building programmes to address programmes acutely. Recruit CHWs to raise awareness of neonatal complications among pregnant women. Upskill CHWs to provide timely, appropriate and quality care during humanitarian emergencies.

Determinants of Antenatal Care Access and Utilization in Haiti

Several pregnancy-related complications resulting in maternal mortality in low-income countries may be due to inaccessible or under-utilized antenatal healthcare services. This study aims to assess the sociodemographic characteristics of Haitian women and how these may affect their access to and use of antenatal care services (ANC) during pregnancy. Multi-logistic regression was used to analyze sociodemographic factors associated with ANC access and use among a cross-section of Haitian women (N = 4890) from the Demographic and Health Survey Haiti (2016–2017). Approximately 18.2% of the women had no education, 40.2% had secondary education, and 4.0% had higher education. About 45.6% of women with no education, 95% with higher education, and 76% of urban dwellers made four or more ANC visits. Only 3% of those who used public sector ANC had a higher education, and over 64.2% of those who used private sector ANC lived in urban areas. Rich women (OR = 2.49, 95% CI = 2.02–3.08) vs. poor women and mature mothers (OR = 1.97, 95% CI = 1.42–2.73) vs. teenage mothers both had higher odds of using ANC services four or more times. Women with higher education (OR = 0.19, 95% CI = 0.12–0.30) and those who were rich (OR = 0.67, 95% CI = 0.5–0.89) had lower odds of using public sector ANC vs. private sector ANC. Wealth and education are protective of ANC access and use by Haitian women. As over half the population has home births, public health education interventions targeting traditional birth attendants are recommended. Interventions training traditional birth attendants to provide better ANC during pregnancy and at the time of birth and to access skilled help during emergency deliveries is recommended.

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

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

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

The role of traditional birth attendants and problem of integration with health facilities in remote rural community of West Omo Zone 2021: exploratory qualitative study

BackgroundMothers in rural Ethiopian communities prefer giving birth at home. In developing countries, traditional birth attendants play an important role in reducing the maternal mortality rate. In Ethiopia, however, their role during pregnancy, childbirth, the postnatal period, and their integration with health professionals is not clearly defined. This study aimed to explore the role of traditional birth attendants in feto-maternal care during pregnancy, childbirth, and the postnatal period, and integration with health professionals in the West Omo Zone, southern Ethiopia.MethodsA qualitative descriptive design was used with triangulation of methods and data sources. We conducted in-depth interviews with traditional birth attendants, key informant interviews with health care professionals and community or religious leaders, and two focus group discussions with multiparous pregnant women. Each interview and focus group discussion was tape-recorded and the data obtained were transcribed and translated into English for analysis. The analysis was done based on thematic analysis framework.ResultsTraditional birth attendants stated that they used herbal remedies to treat nausea and vomiting, decrease pain during labor, and increase pregnant women's desire to push. The absence of incentives for their work, shortage of logistics, and lack of training was mentioned as challenges to the continuity of their roles. All study participants explained the importance of training traditional birth attendants on maternal and child health in rural communities. However, health care professionals reported that few traditional birth attendants advised mothers about traditional practices such as milk tooth extraction and uvulectomy.Conclusion and recommendationTraditional birth attendants continued their roles despite the existing challenges. There was no integration between TBA and the formal health care system. The need for training traditional birth attendants has been emphasized by all study participants and its impact on reducing feto-maternal death was recognized by health care professionals. Therefore, the federal ministry of health should works better for the development of TBAs to scale up their skills across all regions in the country.

Enhancing Knowledge of Traditional Birth Attendants for the Identification of Selected Labor Emergencies

Objectives: In Nigeria, the number of professional midwives available for care of pregnant women and their babies is inadequate; hence, most pregnant women are attended to by Traditional Birth Attendants (TBAs). Studies show that TBAs have poor knowledge of how to identify obstetrics complications. Aim: To determine the effectiveness of a training program on enhancing the knowledge of TBAs in the identification of some selected labor emergencies. Materials and Methods: An experimental research design was conducted with probability sampling to select sample size (n = 111 TBAs). A modified, structured questionnaire from TBAs knowledge on identification of labor emergencies (TBAs-TPKI) was used for data collection. Data collected were analyzed using Statistical Packages for the Social Science (SPSS) software. Descriptive statistics were used to provide answers to the six research questions of the study while inferential statistics of paired t-test was used to test the hypothesis of the study at 0.05 level of significance. Results: The results show that the mean score on knowledge identification on prolonged labor increased from 4.88±2.54 to 11.56±1.48; obstructed labor from 4.18±2.18 to 5.73±1.26, cord presentation from 2.44 ±1.27 to 5.78 ± 0.74, cord prolapse from 2.79±1.45 to 6.60±0.84, placenta abruptio from3.83±1.99 to 9.08±1.16 and postpartum hemorrhage from 3.48±1.82 to 8.26±1.05. The overall mean score of TBAs on knowledge of identification increased from 21.59 ± 11.26 to 51.19 ± 6.54 post-intervention. There was a significant difference between pre- and post-intervention mean scores of knowledge of TBAs on the identification of all the selected labor emergencies (t = 32.208, p = 0.00). Conclusions: The Ministry of Health in each state should organize regular training for TBAs to target early identification of obstetrics emergencies in order to reduce maternal mortality in Nigeria.

Access to Maternal Health Services During the COVID-19 Pandemic: Experiences of Indigent Mothers and Health Care Providers in Kilifi County, Kenya.

COVID-19 has spread rapidly in Kenya and has not spared pregnant women. Evidence from Kenya shows that during the COVID-19 pandemic, health systems have been either stressed to their maximum capacity or are becoming overwhelmed. However, the population is advised not to attend hospital unless strictly necessary, and this advice seems to apply to all, including expectant mothers. There is a dearth of information on how poor expectant mothers with low bargaining power cope during COVID-19 in Kenya, which this study addresses for those in Kilifi County. This rapid qualitative study draws data from an extensive literature review and from interviews with 12 purposively selected mothers who were either expectant or had newborn babies during the pandemic in Kilifi County. Five matrons-in-charge of maternal health services and four traditional birth attendants were also interviewed via mobile phone. Data were analyzed thematically and are presented in a textual description. It emerged that expectant mothers feared attending hospitals for perinatal care due to the possibility of contracting COVID-19. Therefore, there was an increase in home deliveries with the assistance of traditional birth attendants (TBAs)/traditional midwives, who were also overwhelmed with women who sought their services. Since most causes of maternal morbidity and mortality can be prevented by prompt, suitable treatment by qualified health practitioners, the health officials interviewed recommended training and integration of TBAs in emergency healthcare responses to help during crises in MHS because they are trusted by their local communities. Notably, such integration of traditional midwives should be supported and should also include additional training and monetary incentives.

Attitude of People towards Non-Government Organizations Intervention with Reference to Health Awareness: A Post Crisis Analysis in Swat-Pakistan

This study conducted with the objective to measure the pre and post NGOs intervention regarding health awareness and people level of satisfaction. The sample size for this study was selected 230 from the total population of 450. The study concluded that NGOs intervention significantly lunching campaign against tobacco control, HIV/AIDS, immunization awareness, dengue virus awareness. In addition, there was an increase in health hygiene and nutrition education, training of traditional birth attendants and health worker trainings with new technologies. The government and NGOs extend their projects that are focusing on communicable diseases that ultimately lead to the control of various lives threatening disease. Preventive health efforts must be initiated by both public and private agencies at the community level. Health and hygiene-related material must be included in the textbooks of private and public school at all level.

Enhancing Traditional Birth Attendant Training in Guatemala

BACKGROUNDThis article describes the follow-up study to Simulation Learning Among Low Literacy Guatemalan Traditional Birth Attendants, published in the International Journal of Childbirth in 2017. This current study had two purposes: (a) to implement and evaluate the use of enhanced training modalities (active-learning strategies and use of technology in a remote area), and (b) to pilot training-of-trainer (ToT) methods. The current study builds upon the previous study in which we conducted and evaluated a simulation-based training among low-literacy Guatemala traditional birth attendants (TBAs).MATERIALS AND METHODSIn the current study, we conducted a focus group with experienced TBAs (n = 8) to elicit concepts and issues important to address in the training. The 60-hour training designed for low-resource settings, was enhanced with active-learning strategies, technology, and ToT modules. We assessed pre–posttest knowledge and attitudes by paper-pencil format, and pre–post skills by demonstration using simulation.RESULTSTraining participants (N = 31) included the eight experienced TBAs from the focus group. Knowledge, skills, and attitudes all improved, with statistical significance achieved in many parameters. Evaluation of the training was positive and enhancement strategies were noted as particularly helpful. Two participants participated in the additional ToT modules and are now collaborating to provide short educational programs to other TBAs in their regions.CONCLUSIONTraining enhancement strategies have the potential to increase safe practice among TBAs where skilled birth attendants are lacking. Adding ToT modules enhances sustainability and exemplifies the importance of locally prepared trainers in a time when global interaction is severely limited.

Antenatal interventions for preventing stillbirth, fetal loss and perinatal death: an overview of Cochrane systematic reviews.

Antenatal interventions for preventing stillbirth, fetal loss and perinatal death: an overview of Cochrane systematic reviews.

Epidemiologic Health Survey of a Rural Peasant Association in Southwestern Ethiopia

&#x0D; &#x0D; &#x0D; &#x0D; In many developing countries, health care is either severely inadequate or ineffective. This is especially true in Ethiopia where the rates of infant mortality, child mortality, and maternal mortality are approximately 10-100 times higher than those found in developed countries. However, reliable and comprehensive data on the incidence and prevalence of endemic diseases in many regions of the country are scarce. In the present study, we performed a cross-sectional census survey of a rural peasant association in the Jimma region in southwestern Ethiopia to (i) gather demographic and socioeconomic characteristics of the community and (ii) assess the primary health problems facing the children and women of childbearing age. Our data demonstrate that there was a significant lack of proper sanitation and personal hygiene: 90% of households shared living space with domestic animals, less than 10% of households were equipped with a latrine, and nearly 40% of all water was obtained from unprotected springs and rivers. Of the 166 women of childbearing age (15-49 years), only 13.8% had any knowledge of methods of contraception, and almost 90% had experienced a teenage pregnancy. Less than 2% of all deliveries were aided by trained traditional birth attendants or health professionals. The two-week period prevalence of acute childhood diarrhea was 26.3% and less than 10% of all diarrheal cases were treated with oral rehydration solution. Regarding the nutritional status of children under five years of age, 56.3% were suffering from moderate to severe protein-energy malnutrition based on weight for age, and 57% were moderately to severely stunted based on height for age measurements. Finally, over 90% of randomly chosen individuals were found to be positive for an intestinal parasitic infection. The results demonstrate that there is a great need for improvement in several basic health areas, including the environmental sanitary conditions of the community, as well as the fundamental health status of women and children. Our findings suggest that specific intervention programs must be initiated in order to address the basic health problems facing this rural community.&#x0D; &#x0D; &#x0D; &#x0D;

A Qualitative Exploration of the Determinants of Exclusive Breastfeeding (EBF) Practices in Wajir County, Kenya

BackgroundThe World Health Organization recommends exclusive breastfeeding for the first six months of life. A qualitative study was conducted to assess the factors that influence the practice of exclusive breastfeeding amongst mothers attending Wajir County Hospital, Kenya.MethodThis study was part of a cross-sectional study to compare the exclusive breastfeeding rates amongst primiparous and multiparous mothers with infants under 6 months old attending Wajir County Hospital. Focus group discussions and key informant interviews were conducted to collect information on exclusive breastfeeding and related factors. Four focus group discussions were conducted with mothers who exclusively breastfed and the same number with mothers who did not exclusively breastfeed their babies. Key informant interviews were conducted with nine healthcare providers. The data were transcribed, and a content analysis identified common themes and inferences.ResultsThe exclusive breastfeeding rate among the mothers in the larger study was 45.5%. There was no disparity between the practice of exclusive breastfeeding between primiparous and multiparous mothers. Despite the high knowledge and positive attitudes towards exclusive breastfeeding of most mothers, the practice of exclusive breastfeeding was unsatisfactory. The major hindrances identified were cultural barriers propagated by mothers-in-law and traditional birth attendants; the belief that babies cannot live without water; and a few unsupportive health workers. The uptake of exclusive breastfeeding was enhanced by Islamic teaching on breastfeeding, education from a few supportive healthcare providers; support from husbands; and positive deviance among some lactating mothers who practiced exclusive breastfeeding.ConclusionsDeeply rooted cultural factors were the major hindrance to the practice of exclusive breastfeeding. Most of the mothers did not practice exclusive breastfeeding, despite the majority being knowledgeable and having positive attitudes towards the practice. The influence of mother-in-law’s and traditional birth assistants were major barriers. Strengthening the Community Health Strategy through training traditional birth attendants on Infant Young Child Nutrition practices, designing mechanisms linking traditional birth assistants to existing health facilities for support, and capacity building and monitoring is critical in promoting exclusive breastfeeding. Behavior change and communication through multiple channels within the community should be utilized to maximize promotion of exclusive breastfeeding among all stakeholders.

Training traditional birth attendants on the use of misoprostol and a blood measurement tool to prevent postpartum haemorrhage: lessons learnt from Bangladesh.

A consensus emerged in the late 1990s among leaders in global maternal health that traditional birth attendants (TBAs) should no longer be trained in delivery skills and should instead be trained as promoters of facility-based care. Many TBAs continue to be trained in places where home deliveries are the norm and the potential impacts of this training are important to understand. The primary objective of this study was to gain a more nuanced understanding of the full impact of training TBAs to use misoprostol and a blood measurement tool (mat) for the prevention of postpartum haemorrhage (PPH) at home deliveries through the perspective of those involved in the project. This qualitative study, conducted between July 2009 and July 2010 in Bangladesh, was nested within larger operations research, testing the feasibility and acceptability of scaling up community-based provision of misoprostol and a blood measurement tool for prevention of PPH. A total of 87 in-depth interviews (IDIs) were conducted with TBAs, community health workers (CHWs), managers, and government-employed family welfare visitors (FWVs) at three time points during the study. Computer-assisted thematic data analysis was conducted using ATLAS.ti (version 5.2). Four primary themes emerged during the data analysis, which all highlight changes that occurred following the training. The first theme describes the perceived direct changes linked to the two new interventions. The following three themes describe the indirect changes that interviewees perceived: strengthened linkages between TBAs and the formal healthcare system; strengthened linkages between TBAs and the communities they serve; and improved quality of services/service utilization. The data indicate that training TBAs and CHW supervisors resulted in perceived broader and more nuanced changes than simply improvements in TBAs' knowledge, attitudes, and practices. Acknowledgeing TBAs' important role in the community and in home deliveries and integrating them into the formal healthcare system has the potential to result in changes similar to those seen in this study.

Factors influencing adoption of facility-assisted delivery - a qualitative study of women and other stakeholders in a Maasai community in Ngorongoro District, Tanzania

BackgroundTanzania’s One Plan II health sector program aims to increase facility deliveries from 50 to 80% from 2015 to 2020. Success is uneven among certain Maasai pastoralist women in Northern Tanzania who robustly prefer home births to facility births even after completing 4+ ANC visits. Ebiotishu Oondomonok Ongera (EbOO) is a program in Nainokanoka ward to promote facility births through a care-group model using trained traditional birth attendants (TBAs) as facilitators. Results to date are promising but show a consistent gap between women completing ANC and those going to a facility for delivery. A qualitative study was conducted to understand psychosocial preferences, agency for decision-making, and access barriers that influence where a woman in the ward will deliver.MethodsIn-depth interviews, focus group discussions and key-informant interviews were conducted with 24 pregnant and/or parous women, 24 TBAs, 3 nurse midwives at 3 health facilities, and 24 married men, living in Nainokanoka ward. Interviews and discussions were transcribed, translated, and analyzed thematically using a grounded theory approach.ResultsMost women interviewed expressed preference for a home birth with a TBA and even those who expressed agency and preference for a facility birth usually had their last delivery at home attributed to unexpected labor. TBAs are engaged by husbands and play a significant influential role in deciding place of delivery. TBAs report support for facility deliveries but in practice use them as a last resort, and a significant trust gap was documented based on a bad experience at a facility where women in labor were turned away.ConclusionsEbOO project data and study results show a slow but steady change in norms around delivery preference in Nainokanoka ward. Gaps between expressed intention and practice, especially around ‘unexpected labor’ present opportunities to accelerate this process by promoting birth plans and perhaps constructing a maternity waiting house in the ward. Rebuilding trust between facility midwives, TBAs, and the community on the availability of health facility services, and increased sensitivity to women’s cultural preferences, could also close the gap between the number of women who are currently using facilities for ANC and those returning for delivery.