The effectiveness of continuing training for traditional birth attendants on their reproductive health-care knowledge and performance (original) (raw)
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The impact of training traditional birth attendants on the utilisation of maternal health services
Journal of Epidemiology & Community Health, 1979
The impact of training traditional birth attendants (TBAs) on the utilisation of maternal health services at a rural health training centre in India has been studied. Records of the utilisation of the services for two periods of six months each (one before training and one after) have been analysed. A marked improvement in the registration of antenatal cases at an earlier date in pregnancy has been observed. The average number of visits to antenatal clinics, the immunisation against tetanus, and the presence of trained personnel at the time of delivery all showed considerable improvement after the local TBAs had been trained and motivated. The differences observed in the two series were statistically significant.
Tanzania Journal of Health Research, 2013
This paper presents discussion on impact of training traditional birth attendants (TBAs) on overall improvement of reproductive health care with focus on reducing the high rate of maternal and newborn mortality in rural settings in sub-Saharan Africa. The importance of TBAs for years has been denied by professional western trained health practitioners and other scientists until during the late 1980s, when World Health Organization through Safe motherhood 1987 found TBAs have a significant role in reducing maternal and newborn mortality. Trained TBAs in sub-Sahara Africa can have positive impact on reducing maternal and newborn mortality if the programme is well implemented with systematic follow-up after training. This could be done through joint meeting between health workers and TBAs as feed and learning experience from problem encountered in process of providing child delivery services. TBAs can help to break socio-cultural barriers on intervention on reproductive health programmes. However projects targeting TBAs should not be of hit and run; but gradually familiarize with the target group, build trust, transparency, and tolerance, willing to learn and creating a better relationship with them. In this paper, some case studies are described on how trained TBAs can be fully utilized in reducing maternal and newborn mortality rate in rural areas. What is needed is to identify TBAs, map their distribution and train them on basic primary healthcare related to child deliveries and complications which need to be referred to conventional health facilities immediately.
The effect of traditional birth attendant training on maternal and neonatal care
International Journal of Gynecology & Obstetrics, 2012
To determine whether traditional birth attendants (TBAs) trained via the "SMART Dai" method were superior to untrained TBAs in knowledge and practice regarding maternal and newborn care. In a cluster-randomized trial in the Dera Ghazi Khan District of Punjab, Pakistan, 120 rural communities each with a population of approximately 5000 were randomly assigned to a community-based intervention (CBI) or a health systems intervention (HSI). In the CBI communities, 288 TBAs underwent an innovative 8-day training course on maternal and newborn care, initially evaluated by pre- and post-tests. After an average of 19 months post-training, 277 TBAs, together with 257 comparably chosen untrained TBAs from the HSI communities, were tested and interviewed. Patients from both referred and non-referred deliveries were also interviewed. Characteristics of TBAs in the two groups were similar. The TBAs were evaluated according to various measures of knowledge, skill, and practice (including referral), with patient reports on practice compared with TBA reports. By most measures, trained TBAs outperformed untrained ones, often to significant degrees. SMART Dai training seemed to be an important factor in the significant reduction in perinatal mortality in the CBI areas. Properly trained TBAs can substantially contribute to improved delivery outcomes.
Does traditional birth attendant training increase use of antenatal care? a review of the evidence
Journal of Midwifery & Womens Health, 2004
A combined narrative review and metanalytic review was conducted to summarize published and unpublished studies completed between 1970 and 2002 on the relationship between traditional birth attendant (TBA) training and increased use of professional antenatal care (ANC). Fifteen studies (n ϭ 15) from 8 countries and 2 world regions were analyzed. There are, to varying degrees, positive associations between TBA training and TBA knowledge of the value and timing of ANC services, TBA behavior in offering advice or assistance to obtain ANC, and compliance and use of ANC services by women cared for by TBAs or living in areas served by TBAs. There is a serious lack of information about TBA training program characteristics. Although the findings cannot be causally attributed to TBA training, the results suggest that training may increase ANC attendance rates by about 38%. This magnitude of improvement could contribute to a reduction in maternal and perinatal mortality in areas where women have access to quality antenatal and emergency obstetric care. There is an urgent need to improve capacity for evaluation and research of the effect of TBA training programs and other factors that influence women's use of ANC services.
The impact of traditional birth attendant training on delivery complications in Ghana
Health Policy and Planning, 2000
In their efforts to reduce maternal and neonatal morbidity and mortality, many national and international agencies make considerable investments in training traditional birth attendants (TBAs). The value of TBA training is controversial, and plausible arguments are made both for and against. Numerous process evaluations are reported in the literature and the results are mixed, though generally positive. Outcome evaluations, however, are scarce. This article describes an outcome evaluation of TBA training conducted in two districts of Brong-Ahafo Region, Ghana, during 1996. Design and methods: Data from a random sample survey of 1961 clients of TBAs were subjected to logistic regression modelling to determine the effect of training on maternal outcomes, controlling for other independent variables. Results: Of eight outcomes modelled, three were associated with training and five were not. Three additional outcomes were not modelled, primarily due to low prevalence. Conclusions: Despite some inherent design limitations, this study found that the evidence for a beneficial impact of TBA training was not compelling. Training sponsors should consider alternative health investments and, where TBA training remains the intervention of choice, be realistic about expectations of impact.
Training traditional birth attendants on the WHO Essential Newborn Care reduces perinatal mortality
Acta Obstetricia et Gynecologica Scandinavica, 2012
Objectives. To evaluate the impact of birth attendant training using the World Health Organization Essential Newborn Care (ENC) course among traditional birth attendants, with a particular emphasis on the effect of acquisition of skills on perinatal outcomes. Design. Population-based, prospective, interventional pre-post design study. Setting. 11 rural clusters in Chimaltenango, Guatemala. Population. Health care providers. Methods. This study analyzed the effect of training and implementation of the ENC health care provider training course between September 2005 and December 2006. Outcome measures. The primary outcome measure was the rate of death from all causes in the first seven days after birth in fetuses/infants ≥1500g. Secondary outcome measures were overall rate of stillbirth, rate of perinatal death, which included stillbirths plus neonatal deaths in the first seven days in fetuses/infants ≥1500g. Results. Perinatal mortality decreased from 39.5/1000 pre-ENC to 26.4 post-ENC (RR 0.72; 95%CI 0.54-0.97). This reduction was attributable almost entirely to a decrease in the stillbirth rate of 21.4/1000 pre-Essential Newborn Care to 7.9/1000 post-ENC (RR 0.40; 95%CI 0.25-0.64). Seven-day neonatal mortality did not decrease (18.3/1000 to 18.6/1000; RR 1.05; 95%CI 0.70-1.57). Conclusion. Essential Newborn Care training reduced stillbirths in a populationbased controlled study with deliveries conducted almost exclusively by traditional birth attendants. Scale-up of this intervention in other settings might help assess reproducibility and sustainability.
Developing Country Studies, 2013
Maternal and newborn morbidity and mortality continue to be a problem with a huge disparity between developed and developing countries. About 99% of maternal and newborn deaths occur in low and middle income countries, globally amounting to about 500 000 maternal deaths and 8 million peri-neonatal deaths per year. In this settings Traditional Birth Attendants (TBAs), who are mostly women embedded in the community and its socio-cultural frame with no formal medical training and no connection to the formal health system, play a major role around childbirth. TBAs exist since centuries and still continue to be the major providers of care for families, in poor and remote areas where they assist up to 50-80% of deliveries. This paper therefore examine the role Traditional Birth Attendants play in maternal and child health in remote communities in the Yendi District of the Northern Region of Ghana and to come out with some policy recommendations that will help in achieving the MDGs 4 and 5. Introduction: Rites, special places, special caretakers and tools for childbirth can be identified back to prehistory of mankind (Beausang 2000). Nowadays Traditional Birth Attendants (TBAs), who are community members with no formal medical training, still continue to provide numerous services around childbirth all over developing countries as traditional practitioners. They are mentioned in literature back to mid 19th century (Lang 2005) and have been involved in national and international health programs since that time, with a peak of interventions in the 1970s and 1980s. The enthusiasm declined in the 1990s with a debate on their cost-effectiveness and the missing impact of TBAs training to reduce maternal mortality. By 1997, senior policy makers decided to shift priorities on the provision of "Skilled Birth Attendants" (SBA). The definition of SBA excluded TBAs and resulted in subsequent withdrawal of funding for TBA training and exclusion of TBAs in policies and programs worldwide (Kruske & Barclay 2004). Data from the World Health Organization (Proportions of births attended by a skilled health worker. WHO 2008) show, that worldwide 34% of births, i.e. 45 million births, occur at home assisted by a TBA or family member or nobody at all. This scenario we find especially in developing, poor and remote areas. In some countries (Afghanistan,
Traditional birth attendants and birth outcomes in low-middle income countries: A review
Seminars in Perinatology, 2019
Traditional birth attendants (TBAs) have provided delivery care throughout the world prior to the development of organized systems of medical care. In 2016, an estimated 22% of pregnant women delivered with a TBA, mostly in rural or remote areas that lack formal health services. Still active in many regions of LMICs, they provide care, including support and advice, to women during pregnancy and childbirth. Even though they generally have no formal training and are not