Unskilled Birth Attendants Research Articles

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

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

Trends and predictors of the use of unskilled birth attendants among Ethiopian mothers from 2000 to 2016

IntroductionPrevious studies have shown that home delivery assisted by unskilled individuals contributes to maternal and neonatal deaths in developing countries. It also increases the risks of long-term maternal morbidities such as uterine prolapse, pelvic inflammatory disease, fistula, incontinence and infertility. This study aimed to determine the trends and predictors of the use of unskilled birth attendants among Ethiopian mothers from 2000 to 2016. MethodsThis study USED used the Ethiopia Demographic and Health Survey data for the years 2000 (n = 10,873), 2005 (n = 9,861), 2011 (n = 11,654) and 2016 (n = 10,641) to estimate the trends in the use of unskilled birth attendants. Multinomial logistic regression models with adjustment for clustering and sampling weights were used to investigate the association between the independent and outcome outcome variables. ResultsThe analysis revealed that while births attended by Traditional Birth Attendants (TBAs) increased from 28% in 2000 to 42% in 2016, home deliveries decreased slightly from 94% to 73%. Rural residence is associated with increased odds of using unskilled birth attendants. High and middle household wealth, educational status of the women and their partners (>primary), four or more antenatal care (ANC) visits, having any form of employment and mass media engagement were significantly associated with decreased odds of unskilled birth attendant utilization during child birth in Ethiopia. ConclusionsThe results of this analysis show that the proportion of Ethiopian women giving birth without a skilled attendant is high. Interventions aiming to improve skilled attendance during childbirth should focus on the individual, community and need factors of Anderson’s behavioural model.

Determinants for choice of home birth over health facility birth among women of reproductive age in Tanzania: an analysis of data from the 2015-16 Tanzania demographic and health survey and malaria indicator survey

BackgroundWhile evidence has shown an association between place of birth and birth outcomes, factors contributing to the choice of home birth have not been adequately investigated in Tanzania while more than 30% of deliveries occur outside of health care facilities, and more than 95% of those deliveries are assisted by non-medical providers who are often unskilled. The use of unskilled birth attendants has been cited as a factor contributing to the high maternal and neonatal mortalities in low-resources countries. This study aimed to identify determinants of choice for home birth over health care facility birth in Tanzania.Method:This study used the 2015-16 Tanzania Demographic and Health Survey and Malaria Indicator Survey (2015-16 TDHS-MIS) dataset. A total of 2286 women of reproductive age (15–49 years) who gave birth within one year preceding the survey were included in the analysis. Both univariate and multivariable regression analyses were used to determine predictors for the choice of home-based childbirth over health care facility delivery.ResultsA total of 805 (35.2%) women had a home birth. After adjusting for confounders, the determinants for choice of home birth were: the level of education (primary education [AOR = 0.666; p = 0.001]; secondary and higher education [AOR = 0.417; p < 0.001]), in reference to no formal education; not owning a mobile phone (AOR = 1.312; p = 0.018); parity (parity 2–4 [AOR = 1.594; p = 0.004], parity 5 and above [AOR = 2.158; p < 0.001] in reference to parity 1); inadequate antenatal visits (AOR = 1.406; p = 0.001); wealth index (poorest (AOR = 9.395, p < 0.001); poorer (AOR = 7.701; p < 0.001); middle (AOR = 5.961; p < 0.001); richer (AOR = 2.557; p < 0.001)] in reference to richest women; and Zones (Southern Highlands, [AOR = 0.189; p < 0.001]; Southern, [AOR = 0.225; p < 0.001]; Zanzibar, [AOR = 2.55; p < 0.001]) in reference to Western zone.ConclusionsA large proportion of women birth at home. Unskilled providers such as traditional birth attendants (TBAs), relatives or friends attend most of them. Predictors for home-based childbirth included lack of formal education, poor access to telecommunication, poor uptake of antenatal visits, low socio-economic status, and geographical zone. Innovative strategies targeting these groups are needed to increase the use of health care facilities for childbirth, thereby reducing maternal and neonatal mortality in Tanzania.

Effectiveness of Community Based Interventions in Reducing Maternal Mortality in Sub-Saharan Africa: A Systematic Review

Background &amp; Aim: Maternal mortality ratio for sub- Saharan Africa in 2010 was estimated to be about 600 per 100,000 live births, which is approximately higher than what is obtainable in advanced countries. To this end, several community-based interventions have been put in place by governments and developmental partners in the region to address the situation. This review aimed to seek evidence from existing literature on the level of effectiveness of these interventions in improving maternal health outcomes in the region. The literature search process resulted in retrieval of six full text studies that were written in English, published between 2000 and 2019 and were focused on intervention based at the community level which resulted in the reduction of maternal deaths in some sub-Saharan African countries. The Critical Appraisal Skills Programme (CASP) tool was used to critically review retrieved literature.&#x0D; Findings: Findings from the articles reviewed show that community based interventions with direct reduction on maternal mortality were implemented in Ethiopia and Nigeria and were effective since maternal mortality declined by 64% and 43.5% respectively. Other community based interventions did not directly address reduction in maternal mortality but rather addressed leading causes of maternal mortality such as home and unskilled birth attendance, low Ante-Natal Care (ANC) &amp; Post-Natal Care (PNC) services utilization, Eclampsia, delay in accessing care and Postpartum Hemorrhage (PPH). Such interventions were implemented in Nigeria, Zambia, Tanzania and the Democratic Republic of Congo and were proved to be effective in reducing maternal mortality.&#x0D; Conclusions and Recommendations: Based on the literatures reviewed, it was concluded that community based interventions were effective in reducing maternal mortality in Sub-Saharan Africa. The following recommendations were made based on gaps observed in the implementation of some interventions. Introduction of emergency transport scheme in countries where they do not exist as despite the existence of maternity waiting homes and dedicated maternity ambulances in Zambia, many expectant mothers still had difficulty reaching the health facilities in time to deliver, Engagement and training of more health workers so as to avoid human resources challenges that may be associated with increased demand for health facility deliveries.

Factors Affecting Choice of Childbirth Place among Childbearing Age Women in Western Ethiopia: A Community-Based Cross-Sectional Study.

Background Access to proper medical attention and hygienic conditions during delivery can reduce the risk of complications and infections that may lead to serious illness or death or for the mother, baby, or both. In Ethiopia, the high maternal mortality rate with delivery by unskilled birth attendants shows low utilization of maternal health services. Objective This study was aimed at assessing factors determining the choice of childbirth place among women of childbearing age in Jimma Arjo District. Method A cross-sectional design was conducted in Jimma Arjo District, East Wollega Zone, Ethiopia, from March 20 to April 20, 2018. Multistage sampling technique was used to select a total sample of 506 participants. Data were collected using structured questionnaires to interview women of childbearing age with two trained data collectors. Data was entered into Epi Info and exported to SPSS software version 20 for analysis. Data was checked for its completeness, cleaned, entered, and analyzed accordingly. Bivariate and multivariable data analyses were used to examine factors affecting choice of childbirth place. Results A total of 506 women participated in this study, giving a response rate of 97.8%. The study investigated that home delivery was found to be 200 (39.5%)in the study area. Factors found to be statistically associated with choice of institutional delivery at p < 0.05 were history of obstetric difficulties (AOR = 6, 95%CI = (2.08, 17.60)), woman educational status (AOR = 4.4, 95%CI = (1.47, 13.42)), husband educational status (AOR = 4, 95%CI = (1.43, 11.60)), two or more ANC visits (AOR = 4, 95%CI = (1.95, 8.52)), and accessibility to vehicle transportation (AOR = 2.8, 95%CI = (1.23, 6.46)). Conclusion Preferring health facility as the birthplace in this study seems relatively better compared to other studies. It is shown that both mothers and their husbands attending secondary and greater educational level, history of obstetric difficulties, two or more ANC visits, and physical accessibility to health care facility have influenced mothers to prefer a health institution as the childbirth place. Therefore, any programs aimed at increasing the choice of institutional delivery should work on increasing ANC attendance and transportation facilities in the study area.

Socio-Economic and Cultural Determinants of Maternal and Neonatal Mortality in Pakistan

The current study analyzed socio-economic and cultural determinants of maternal and neonatal mortality in Pakistan. This research was conducted at PIMS, Islamabad, Pakistan. In the first phase of research, we used a survey method to collect data from 56 respondents (36 female doctors and 20 female nurses) and their perceptions were enumerated about the socioeconomic and cultural determinants of maternal mortality. In the second phase of the research, 200 mothers (who had a baby under 1-year) currently admitted at PIMS were sampled for in-depth interviews and they were asked about the multiple determinants of neonatal mortality. In both phases, we employed a purposive sampling technique with a special inclusion criterion. The study highlighted multiple reasons influencing mortality of mothers and neonates such as lack of awareness, lack of transportation facilities, illiteracy, poverty, lack of antenatal care services and deliveries handled by unskilled birth attendants at homes.

Prevalence, Trends, and Drivers of the Utilization of Unskilled Birth Attendants during Democratic Governance in Nigeria from 1999 to 2018.

Comprehensive epidemiological data on prevalence, trends, and determinants of the use of unskilled birth attendants (traditional birth attendants (TBAs) and other unskilled birth attendants) are essential to policy decision-makers and health practitioners, to guide efforts and resource allocation. This study investigated the prevalence, trends, and drivers of the utilization of unskilled birth attendants during democratic governance in Nigeria from 1999 to 2018. The study used the Nigeria Demographic and Health Surveys data for the years 1999 (n = 3552), 2003 (n = 6029), 2008 (n = 28,647), 2013 (n = 31,482), and 2018 (34,193). Multivariate multinomial logistic regression was used to investigate the association between socioeconomic, demographic, health-service, and community-level factors with the utilization of TBAs and other unskilled birth attendants in Nigeria. Between 1999 and 2018, the study showed that the prevalence of TBA-assisted delivery remained unchanged (20.7%; 95% CI: 18.0–23.7% in 1999 and 20.5%; 95% CI: 18.9–22.1% in 2018). The prevalence of other-unskilled-birth-attendant use declined significantly from 45.5% (95% CI: 41.1–49.7%) in 2003 to 36.2% (95% CI: 34.5–38.0%) in 2018. Higher parental education, maternal employment, belonging to rich households, higher maternal age (35–49 years), frequent antenatal care (ANC) (≥4) visits, the proximity of health facilities, and female autonomy in households were associated with lower odds of unskilled birth attendants’ utilization. Rural residence, geopolitical region, lower maternal age (15–24 years), and higher birth interval (≥2 years) were associated with higher odds of unskilled-birth-attendant-assisted deliveries. Reducing births assisted by unskilled birth attendants in Nigeria would require prioritized and scaled-up maternal health efforts that target all women, especially those from low socioeconomic backgrounds, those who do not attend antenatal care, and/or those who reside in rural areas.

Perinatal HIV Transmission Prevention: Challenges among Women Living with HIV in sub-Saharan Africa.

About 86 percent of the estimated 160,000 children newly-infected with the human immunodeficiency virus (HIV) live in sub-Saharan Africa. Despite global efforts to reduce perinatal HIV transmission, this phenomenon continues to be a public health problem in sub-Saharan Africa. This paper discusses challenges associated with perinatal HIV transmission prevention in sub-Saharan Africa and offers strategies for the way forward. These strategies include safe sex education and behavioral change, increased access to integrated antenatal care, training of unskilled traditional birth attendants into formal delivery systems, access to antiretroviral therapy, and investing in virologic testing.

Patterns of delivery assistance among adolescent mothers in Nigeria

ObjectiveThis study examined the sociodemographic and sociocultural factors associated with the pattern of birth assistance used among adolescent mothers aged 15–19 in Nigeria. DesignThe study used a quantitative design, using secondary data from the Nigeria Demographic and Health Surveys conducted between 2003 and 2013. SettingThe study was nationally representative and conducted across Nigeria. ParticipantsA weighted sample of 2,096 adolescent mothers aged 15–19. Measurements and findingsData were analysed using frequencies, chi square tests and multinomial logistic regression respectively. It was discovered that mothers aged 18 and above had lower odds of using traditional and skilled birth attendants (aORs = 0.68 (0.51–0.92); 0.63 (0.44–0.92)); Igbo mothers had lower odds of using TBAs (aOR = 0.03 (0.002–0.53)); and mothers in female-headed households were less likely to use SBAs (aOR = 0.40 (0.20–0.82)). Rich mothers were more likely to use SBAs (aOR = 2.21 (1.23–3.94)). Mothers whose partners had at least primary education were more likely to use SBAs (aOR = 1.73 (1.09–2.73); 1.64 (1.03–2.59)). Adolescent mothers in the North East (aOR = 5.79 (2.91–11.51)), North West (aOR = 8.24 (4.01–16.93)), South East (aOR = 69.70 (13.96–348.05)) and South South (aOR = 27.84(7.80–99.30)) were more likely to use TBAs, while mothers in the North East (aOR = 0.46 (0.28–0.76)) and North West (aOR = 0.50 (0.29–0.84)) were less likely to use SBAs. Mothers who used partial ANC were more likely to use SBAs (aOR = 5.73 (3.43–9.56)), while those who used full ANC were more likely to use SBA (aOR = 7.33 (4.76–11.29)). Key conclusionsHigher socioeconomic status mothers were more likely to use skilled birth attendance.Implications for practice: Interventions to increase SBA use among adolescent mothers in Nigeria must consider the continued preference for traditional and unskilled birth attendants and unassisted births, and design culturally sensitive programmes.

Traditional birth attendants’ roles and homebirth choices in Ethiopia: A qualitative study

BackgroundIn Ethiopia, it is encouraged that labour and delivery care are performed under the observation of skilled/trained midwifery or medical professionals. However, 70% of all births occur outside the healthcare system under the care of unskilled birth attendants, family members, or without any assistance at all. ObjectiveThis study aimed to assess the reasons for choosing homebirth and the role of traditional birth attendants in Arba Minch Health and Demographic Surveillance Site. MethodA qualitative, exploratory study was carried out between May and June 2017. Twenty-nine semi-structured interviews were conducted with various respondent groups such as traditional birth attendants, pregnant women, skilled birth attendants, and health extension workers. Data were transcribed and for analysis, structured as per the participants’ responses, sorted and categorized as per the topic guide, and presented in narrative form. FindingsThe study revealed that traditional birth attendants are actively engaged in assisting homebirths in the selected area. It was also found that many women still prefer traditional birth attendants for childbirth assistance. Reasons for choosing homebirth included lack of transport to health care facilities, distance to health care facilities, lack of respectful care at health care facilities, and the friendliness of traditional birth attendants. Lack of formal partnerships between traditional birth attendants and the health system was also observed. ConclusionsThere is a need to incorporate traditional birth attendants as a link between healthcare facilities and pregnant women; thereby, improving respectful care at the healthcare facilities.

The impact of monetary incentives on referrals by traditional birth attendants for postnatal care in Nigeria

BackgroundGaps in postnatal care use represent missed opportunities to prevent maternal and neonatal death in sub-Saharan Africa. As one in every three non-facility deliveries in Nigeria is assisted by a traditional birth attendant (TBA), and the TBA’s advice is often adhered to by their clients, engaging TBAs in advocacy among their clients may increase maternal and neonatal postnatal care use. This study estimates the impact of monetary incentives for maternal referrals by TBAs on early maternal and neonatal postnatal care use (within 48 h of delivery) in Nigeria.MethodsWe conducted a non-blinded, individually-randomized, controlled study of 207 TBAs in Ebonyi State, Nigeria between August and December 2016. TBAs were randomly assigned with a 50–50 probability to receive $2.00 for every maternal client that attended postnatal care within 48 h of delivery (treatment group) or to receive no monetary incentive (control group). We compared the probabilities of maternal and neonatal postnatal care use within 48 h of delivery in treatment and control groups in an intention-to-treat analysis. We also ascertained if the care received by mothers and newborns during these visits followed World Health Organization guidelines.ResultsOverall, 207 TBAs participated in this study: 103 in the treatment group and 104 in the control group. The intervention increased the proportion of maternal clients of TBAs that reported attending postnatal care within 48 h of delivery by 15.4 percentage points [95% confidence interval (CI): 7.9–22.9]. The proportion of neonatal clients of TBAs that reportedly attended postnatal care within 48 h of delivery also increased by 12.6 percentage points [95% CI: 5.9–19.3]. However, providers often did not address the issues that may have led to maternal and newborn postnatal complications during these visits.ConclusionsWe show that motivating TBAs using monetary incentives for maternal postnatal care use can increase skilled care use after delivery among their maternal and neonatal clients, who have a higher risk of mortality because of their exposure to unskilled birth attendance. However, improving the quality of care is key to ensuring maternal and neonatal health gains from postnatal care attendance.Trial registrationThe trial was retrospectively registered in clinicaltrials.gov (NCT02936869) on October 18, 2016.

Factors Associated with Compliance with Infection Control Guidelines in the Management of Labour by Healthcare Workers at Mulago Hospital, Uganda

Globally, infections acquired during childbirth contribute to one tenth of the maternal deaths annually [1] [2]. Factors predisposing to high risks of puerperal infections include non-compliance with Standard Precautions of Infection Control (SPIC), unhygienic births by unskilled birth attendants, multiple vaginal examinations, prolonged labour and premature rapture of membranes [1]. The main purpose of this study was to determine factors associated with compliance to standard precautions of infection control the management of labour by healthcare workers in Mulago Hospital to generate information, which may be used in infection control and prevention practices. A cross-sectional study utilizing a quantitative approach was conducted among 115 healthcare workers. Consecutive sampling was done to include respondents in the study. Data were collected by direct observation and researcher administered questionnaires. Data were coded and entered into the computer using SPSS version 20 with programmed quality control checks. Descriptive data analyses, frequencies, cross tabulations and logistic regression analysis were the major statistical methods used. 103 healthcare workers were involved in the study, where 74% were females. Overall compliance was at 52%, although it varied across domains. The majority of the healthcare workers (95.1%) did not comply with hand hygiene. Being a male was associated with low compliance scores a cross most domains. One of the hospital factors which was significantly associated with compliance to hand hygiene was having had an in-service training with p = 0.008 and p = 0.012 at multivariate analysis. Overall compliance to standard precautions of infection control was low compared to the Centre for Disease Control (CDC) recommendation. The findings in this study provide insight into individual and hospital related factors associated with compliance with standard precautions of infection control in the management of labour. There is an urgent need to put up interventions to improve on compliance with SPIC in management of labour among all healthcare workers.

Factors influencing decisions to homebirth among pregnant women in Mpongwe District, Zambia

Background: Homebirths have far-reaching consequences for the expectant mother and her baby as most of these are assisted by unskilled birth attendants. Reducing homebirths could lead to improved maternal and infant health. Aims: To determine factors influencing expectant women to have a homebirth. Methods: A descriptive cross-sectional study was conducted. A pre-tested, semi structured interview schedule was used to assess factors influencing homebirths among 80 expectant mothers attending an antenatal clinic. Findings: Overall, 60% of the respondents had their previous babies at home. Most (92%) of the respondents said that they would give birth to their next child at a health facility, and the majority (68%) preferred to have a female skilled birth attendant. Some 52% of the respondents had low levels of knowledge on the complications of labour and delivery. The study found that homebirths were significantly associated with the educational level of the woman and distance to the health facility. Conclusions: The majority of the expectant mothers had given birth at home before but had low knowledge on complications of homebirths. There is need to intensify community sensitisation on the dangers of homebirth to prevent maternal and neonatal mortality and morbidity.

Task shifting in active management of the third stage of labor: a systematic review

BackgroundActive management of the third stage of labor (AMTSL) describes interventions with the common goal to prevent postpartum hemorrhage (PPH). In low- and middle-income countries, implementation of AMTSL is hampered by shortage of skilled birth attendants and a high percentage of home deliveries. Task shifting of specific AMTSL components to unskilled birth attendants or self-administration could be a strategy to increase access to potentially life-saving interventions. This study was designed to evaluate the effect, acceptance and safety of task shifting of specific aspects of AMTSL to unskilled birth attendants.MethodsA systematic search was conducted in five databases in September 2015 to identify intervention studies of AMTSL implemented by unskilled birth attendants or pregnant women themselves. Quality of studies was evaluated with an adapted Cochrane Collaboration assessment tool.ResultsOf 2469 studies screened, 21 were included. All studies assessed implementation of uterotonics (misoprostol tablets or oxytocin injections), administered by community health workers (CHWs), auxiliary midwives, traditional birth attendants (TBAs) or self-administration at antenatal (home) visits or delivery. Task shifting for none of the other AMTSL components was reported. Task shifting of provision of uterotonics reduced the risk of PPH (RR 0.16 to 1) compared to standard care (13 studies, n = 15.197). The correct dose and timing was reported for 83.4 to 99.8% (5 studies, n = 6083) and 63 to 100% (9 studies, n = 8378) women respectively. Uterotonics were recommended to others by 80 to 99.7% (7 studies, n = 6445); 80 to 99.4% (5 studies, n = 2677) would use the drug at next delivery. Willingness to pay for uterotonics varied from 54.6 to 100% (7 studies, n = 6090).ConclusionTask shifting of AMTSL has thus far been evaluated for administration of uterotonics (misoprostol tablets and oxytocin injected by CHWs and auxiliary midwives) and resulted in reduction of PPH, high rates of appropriate use and satisfaction among users.In order to increase AMTSL coverage in low-staffed health facilities, task shifting of uterine massage or postpartum tonus assessment to unskilled attendants or delivered women could be considered. Task shifting of controlled cord traction is currently not recommended.

Tracking stillbirths by referral pattern and causes in a rural tertiary hospital in Southern Nigeria.

The burden of stillbirth is disproportionately more in rural areas of developing countries where unskilled birth attendants contribute a large quota in the management of pregnant women. Tracking stillbirth should include the pattern of referral from the primary institutions that take care of these women. This study evaluated the causes and determinants of stillbirth by the referral pattern in a rural area in southern Nigeria. This was a retrospective case-controlled study of stillbirth at the Madonna University Teaching Hospital, Elele, from 2010 to 2014. The lying-in, delivery and theatre registers were used to extract the relevant information. For each stillbirth, two controls were selected which were live births. Data analysis was performed using SPSS version 20. The confidence interval was 95% set at value of P = 0.05. During the study, a total of 1243 neonates were delivered at the hospital, the number of live births and stillbirths were 1025 and 218, respectively. This gives a stillbirth rate of 175/1000 deliveries. Only 179 neonates whose case files were retrieved were used in the analysis. There were 87 fresh and 92 macerated stillbirths. Intrapartum complications contributed 91 (51.40%) of the stillbirths with traditional birth attendants and maternity homes contributing 72%. Determinants include booking status, educational level, abruptio placentae, preeclampsia, ruptured uterus, prolonged labor and low birthweight. The study showed an unacceptably high rate of stillbirth in rural Nigeria. Early recognition of complications and prompt referral may reduce stillbirth rate.

Status of Respectful Maternal Care in Ndola and Kitwe Districts of Zambia

Background: The purpose of the assessment was to conduct an evaluation on the status of respectful maternal care Ndola and Kitwe districts in the Copperbelt Province. Methods: The assessment used a cross-sectional study design and captured quantitative data on self-reporting of experiences of respectful maternal care during child birth among women in the reproductive age group with a child below the age of 2 years. The study was conducted in two urban districts of the Copperbelt Province of Zambia specifically in Ndola and Kitwe districts. The sample size was 471 resident women of the selected 18 high volume health facilities. Cluster sampling was used to select the sampling units referred to as catchment areas of the health facilities. A structured interview questionnaire was used to conduct household interviews. Univariate and bivariate analysis were conducted on quantitative data to provide descriptive statistics. Chi-square analysis was performed to ascertain associations. Results: The study successfully visited and interviewed 470 women in household giving a 99% response rate. Findings show that 31% were aged between 20 to 24 years, three quarters (75%) were married/living with a partner, 4 in 10 (40%) had a basic education and two-thirds (66%) were not engaged in any form of employment or economic activity. The findings show that on average, 18% of the women had experienced physical abuse by a service provider during child birth. Prominent issues that led to ill-treatment included 43% of the women not provided comfort/pain-relief. On average 41% of the women received non-consented care from the service provider. Women (74%) indicated that the service provider did not allow women to assume position of choice during birth. The findings also show that about 22% of women’s right to confidentiality and privacy were not adhered to. Women (42%) also reported that there were no drapes or covering to protect their privacy and 19% indicated that there were no curtains or other visual barrier to protect woman during exams. Findings also show that on average 31% of women’s right to dignified care was not adhered to. Overall in the study, 13% of the women were discriminated based on specific attributes. The findings indicate that on average 39% of the women were abandoned or denied care. Key issues include, 65% of the women reported being left without care or unattended to and 28% service provider did not respond in a timely way. Further, only 6% of the women were detained in the health facility. Conclusion: The maternal outcomes observed such as home deliveries and deliveries by skilled and unskilled birth attendants mirror the quality of care in health facilities. Indications of non-adherence to the rights of child bearing women are a barrier to achieving quality of care for child bearing women. There is need to comprehensively train service providers in respectful maternal care and devise mechanisms for implementation and supportive supervision.

Re-Thinking Human Resource for Health and the Integration of Unskilled Birth Attendants for Increased PMTCT Uptake: Evidence from Nigeria

Re-Thinking Human Resource for Health and the Integration of Unskilled Birth Attendants for Increased PMTCT Uptake: Evidence from Nigeria Ms. Iboro Nelson Abstract The global community has adopted Prevention of Mother-To- Child Transmission (PMTCT) of HIV as the first entry point of care to eliminating new pediatric infections. In the absence of any intervention, the possibility of HIV transmission often runs between 15 - 45% and can be reduced to below 5% with effective PMTCT intervention. However, not much attention is given to analyze the human resource requirements to scale up PMTCT services. Meanwhile, WHO‘s Alma Ata Declaration states that ―primary health care shall rely, at local and referral levels, on health workers, including physicians, nurses, midwives, auxiliaries and community workers as applicable, as well as traditional practitioners as needed, suitably trained socially and technically to work as a health team and to respond to the expressed health needs of the community‖. Over the years, this has been neglected and the results have been continued shortage of needed manpower to deliver health services to the people where it matters most. Using disaggregated data of frontline healthcare workers, TBAs‘ distribution as well as service utilization data across the State of Akwa Ibom of Nigeria between 2010-2015, the paper seeks to demonstrate the effectiveness of integration of traditional birth attendants (TBAs) into healthcare service delivery. Key findings from the analysis show that while ANC attendance has increased over the period under review, facility deliveries within the same period dwindled while non-facility deliveries on the otherhand increased. Secondly, with a nurse to population ratio of 1:2,067 compared with TBAs to population ratio of 1:1,883, there is a great shortage of manpower to meet the universal professional and skilled birth delivery targets especially in the face of dwindling resources for health in developing countries including Nigeria. Thus, engaging TBAs is achievable and effective in improving MNCH services and increasing PMTCT uptake. Full Text: PDF DOI: 10.15640/jeds.v6n2a5

\u201cOnce the delivery is done, they have finished\u201d: a qualitative study of perspectives on postnatal care referrals by traditional birth attendants in Ebonyi state, Nigeria

BackgroundWhile 79% of Nigerian mothers who deliver in facilities receive postnatal care within 48 h of delivery, this is only true for 16% of mothers who deliver outside facilities. Most maternal deaths can be prevented with access to timely and competent health care. Thus, the World Health Organization, International Confederation of Midwives, and International Federation of Gynecology and Obstetrics recommend that unskilled birth attendants be involved in advocacy for skilled care use among mothers. This study explores postnatal care referral behavior by TBAs in Nigeria, including the perceived factors that may deter or promote referrals to skilled health workers.MethodsThis study collected qualitative data using focus group discussions involving 28 female health workers, TBAs, and TBA delivery clients. The study conceptual framework drew on constructs in Fishbein and Ajzen’s theory of reasoned action onto which we mapped hypothesized determinants of postnatal care referrals described in the empirical literature. We analyzed the transcribed data thematically, and linked themes to the study conceptual framework in the discussion to explain variation in TBA referral behavior across the maternal continuum, from the antenatal to postnatal period.ResultsDifferences in TBA referral before, during, and after delivery appear to reflect the TBAs understanding of the added value of skilled care for the client and the TBA, as well as the TBA’s perception of the implications of referral for her credibility as a maternal care provider among her clients. We also found that there are opportunities to engage TBAs in routine postnatal care referrals to facilities in Nigeria by using incentives and promoting a cordial relationship between TBAs and skilled health workers.ConclusionsThus, despite the potential negative consequences TBAs may face with postnatal care referrals, there are opportunities to promote these referrals using incentives and promoting a cordial relationship between TBAs and skilled health workers. Further research is needed on the interactions between postnatal maternal complications, TBA referral behavior, and maternal perception of TBA competence.

Factors associated with prelacteal feeding practices in a rural northern Nigerian setting

Introduction: Prelacteal feeding practice contravenes the recommendation of World Health Organisation that breastfeeding be initiated within an hour of childbirth. Consequently, the health, social, emotional and economic benefits of optimal breastfeeding are limited. Therefore, to break this vicious cycle of prelacteal feeding and suboptimal breastfeeding, factors associated with the practice must be identified.Objective: To assess prelacteal feeding practices and its associated factors in a rural community with the view to generate data for community-level interventions that will promote optimal breastfeeding.Methods: Data was collected during a community-based surveillance for maternal, newborn and child health project in Tsibiri, a rural community in north-western Nigeria. The survey questionnaire was uploaded into mobile devices running on an android operating system. Trained female interviewers collected the data over a period of one week in 2011.Results: A total of 270 out of 309 interviewed women had experienced childbirth and were included in the analysis. Majority (85.2%) of respondents utilised prelacteal feeds for their newborns. Plain water was the most common prelacteal feed (44.7%). Prelacteal feeding was associated with births assisted by unskilled birth attendants (AOR 5.322, 95%CI 1.634-17.333); while operative delivery reduced the likelihood of the practice (AOR 0.168, 95%CI 0.060-0.470). No statistically significant association was found between use of prelacteal feed and women’s age, education or access to income.Conclusion: The predominance of prelacteal feeding practices underscores the need for innovative strategies that create awareness among mothers and health care providers, with emphasis on health facility deliveries, advantages of breastfeeding and risks of prelacteal feeding.

Characteristic of Households with Women Using Unskilled Birth Attendants in Urban Slum of Kisumu East District Nyalenda Community Unit

Maternal and child mortalities can be reduced if all women deliveries are attended by trained and skilled birth attendants that can provide Emergency obstetric care. Community health strategy has been put in place as an intervention to reduce maternal mortalities. In the urban slum of Kisumu a third (34.7%) mothers still use unskilled attendant. This study set out to investigate characteristic of households with women using unskilled birth attendants in urban slum of Nyalenda, kisumu, Kenya. The study was comparative in design in which all the households with women who used unskilled attendants during their last delivery included in the study as cases, next nearest, neighboring households with women who used skilled attendants in the last delivery, included as controls, at a ratio of 1:1. Therefore, a total of 1033 cases and 1033 controls were analyzed with a total sample of 2066 as valid cases. The study showed age group 35 and above was higher among the mothers using unskilled delivery (14%) as compared to those using skilled attendants (10.3%), while mothers who had secondary and above level of education were less likely to have unskilled birth attendant odds ratio (OR) = 0.420 (95% CI=0.257- 0.685) as compared to mothers with primary level of education OR= 0.552 (95% CI=0.470- 0.649). Based on the study results, the odds ratio showed minimal difference on the household characteristic with only individual characteristic showing some significant results on, age, education level and ante natal clinic (ANC). The study found that older mothers do not go for skilled attendance, despite the fact that most young mothers go for skilled attendance, it is a concern that the older mothers who should attend skilled delivery tend not to go yet they are a risk factor in terms of delivery and childbirth, and hence they need to use maternity health care services from skilled health personnel.