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Maternal mortality issues have become a major cause for concern especially in developing counties as they struggle to attain the Sustainable Development Goals 3.1 and 3.2. Traditional Birth Attendants (TBAs) have played a significant role in providing maternal health services, especially in rural Africa. Health service providers have done a lot to provide maternal health services to pregnant women in Ghana yet most women, especially in rural areas, still, patronize the services of (TBAs). The aim of this paper is to determine the factors that influence women in the Tolon district of Ghana to patronize the services of TBAs. The paper employed a mixed research approach and adopted the cross-sectional survey design to collect and analyse data. The study involved 360 women who have sought the services of TBAs within the last five years. Data were collected with the use of questionnaires containing both open-ended and closed-ended questions. The factors that influenced the patronage of TBAs included the fact that TBA services are cheaper, more culturally accepted, nearer to the homes of pregnant women than the hospital, TBAs being more caring than orthodox health workers and being the only maternity care that women know. It is recommended that since the factors that influence the patronage of TBA services cannot easily be abolished the health authorities should integrate TBA services in mainstream maternal health care delivery. Keywords: TBA, Maternal mortality, Midwives, Health service, Health workers, Hospitals, Maternal and child health
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... In Tolon, it has been reported that each community has more than two TBAs. 34 Yendi was also selected because of the number of TBAs in the district and had served as a district for the training of TBAs in the region in the past. As a result, the district has more than 30 TBAs across various communities. ...
... Similarly, a study in Northern Ghana has shown that women refused to patronize facility-based delivery because of poor quality and maltreatment during labour. 34 The findings of this study underscore the need for nurses to change their attitude towards clients that seek healthcare. ...
Background: Skilled delivery reduces maternal and neonatal mortality. Ghana has put in place measures to reduce geographical and financial access to skilled delivery. Despite this, about 30% of deliveries still occur either at home or are conducted by traditional birth attendants. We, therefore, conducted this study to explore the reasons for the utilization
of the services of traditional birth attendants despite the availability of health facilities.
Method: Using a phenomenology study design, we selected 31 women who delivered at facilities of four traditional birth attendants in the Northern region of Ghana. Purposive sampling was used to recruit only women who were resident at a place with a health facility for an in-depth interview. The interviews were recorded and transcribed into
Microsoft word document. The transcripts were imported into NVivo 12 for thematic analyses
Results: The study found that quality of care was the main driver for traditional birth attendant delivery services. Poor attitude of midwives, maltreatment, and fear of caesarean section were barriers to skilled delivery. Community
norms dictate that womanhood is linked to vaginal delivery and women who deliver through caesarean section do not receive the same level of respect. Traditional birth attendants were believed to be more experienced and understand the psychosocial needs of women during childbirth, unlike younger midwives. Furthermore, the inability of women to procure all items required for delivery at biomedical facilities emerged as push factors for traditional birth attendant delivery services. Preference for squatting position during childbirth and social support provided to mothers by traditional birth attendants are also essential considerations for the use of their services.
Conclusion: The study concludes that health managers should go beyond reducing financial and geographical access to improving quality of care and the birth experience of women. These are necessary to complement the efforts at increasing the availability of health facilities and free delivery services.
... Total volatile basic nitrogen (TVB-N) was quantified by Pearson's method (Li et al., 2019). Thiobarbituric acid reactive substances (TBA; mg malondialdehyde [MDA] kg-1 sample) were assessed according to some methods (Allou, 2018). ...
Background: In recent years, rainbow trout roe has become a valuable and popular product among consumers. In this study, the quality and health status of this product were studied during the salting and refrigeration process. Objectives: This study aimed to compare the effects of salting rainbow trout roe on its shelf life, volatile nitrogen, and changes in fatty acid profile during refrigerated storage. Methods: After the first wash, we grouped the fish roe into the raw roe (control group) and the salted roe (1.5% pure salt). The groups were kept in the refrigerator for 0, 15, and 30 days and analyzed for chemical, microbial, organoleptic, and fatty acids. Results: The results showed that salt content affected the fatty acid profile during the salting of the fish roe, but no significant differences were observed between the two treatments. Total bacterial counts increased during refrigerated storage, but the salted fish roe had lower total bacterial counts than the raw roe. Total volatile basic nitrogen in raw roe increased from 5.97 to 30.00 mg/kg and in salted roes from 6.05 to 23.18 mg/kg. Conclusion: Salting (1.5%) fish roe is a good way to increase its shelf life while preserving its high quality. After salting, the amount of fatty acid decreased, but no change was observed during storage.
... A systematic scoping review by Mekonnen et al. showed that most women within the sub-Saharan regions patronize home-based parturition other than conventional deliveries and this is ascribed to various individual, interpersonal, organizational and system level factors . A case in point is Ghana where most women preferential utilization of home delivery are dictated by their educational background, cultural predilection, cheaper services, satisfaction of antenatal care services, tender nature of traditional birth attendants (TBAs) compared to orthodox health professionals as well as their closer proximity to TBAs other than health facilities . ...
Background: Access to skilled delivery services are crucial in reducing maternal mortality, however, the prevalence of women with assisted deliveries in our health facilities remains low with reasonable disparities between rural and urban Ghana. This study examined the utilization of skilled delivery by pregnant women and its associated factors in the Wa Municipality of Ghana.
Methods: The study employed a community-based cross-sectional study. A simple random sampling was used to recruit two rural and two urban sub-districts and subsequently four communities selected from each of the respective sub-districts. Thirty-three eligible women of reproductive age (15- 49 years) who had delivered within the last one-year prior to the commencement of the study were selected from each community. A structured questionnaire was used to collate information on respondents socio-demographic, geographic and cultural factors that affect the utilization of skilled delivery services. Data was analyzed using Stata Statistical Software (version 12), frequencies and percentages were used to summarize data and associations between variables investigated with multiple regression analyses at a significance of p<0.05.
Results: Out of the 527 women interviewed, 481 (91.6%) had a skilled delivery. Mothers were aged between 15 and 45 years with mean (± SD) age of 26.4 ± 9.4 years. After statistical adjustment, rural residence (AOR=2.7, 95% CI 0.8 – 8.9, p=0.036 compared with urban residence), never attended antenatal care (AOR=101, 95% CI 10.2 – 1017, p<0.001), health facility delivery (AOR=0.1, 95% CI 0.1 – 0.6, p<0.001), time taken to nearest health facility (≥31 minutes AOR=11.7, 95% CI 3.6 – 38.6, p<0.001), and no Husband’s consent (AOR=4.6, 95% CI 1.8 – 11.6, p<0.001) were significantly associated with uptake of skilled delivery services.
Conclusion: The findings of this study demonstrate adequate utilization of skilled delivery services among women in the Municipality. Efforts towards improvement of skilled delivery coverage should focus on health education, especially among rural women together with the expansion of healthcare services.
The underutilization of formal, evidence-based maternal health services continues to contribute to poor maternal outcomes among women living in rural Africa. Women’s choice of the type of maternal care they receive strongly influences their utilization of maternal health services. There is therefore a need to understand rural women’s preferred choices to help set priorities for initiatives attempting to make formal maternal care more responsive to women’s needs. The aim of this review was to explore and identify women’s preferences for different sources of childbirth and postnatal care and the factors that contribute to these preferences.
A systematic literature search was conducted using the Ovid Medline, Embase, CINAHL, and Global Health databases. Thirty-seven studies that elicited women’s preferences for childbirth and postnatal care using qualitative methods were included in the review. A narrative synthesis was conducted to collate study findings and to report on patterns identified across findings.
During the intrapartum period, preferences varied across communities, with some studies reporting preferences for traditional childbirth with traditional care-takers, and others reporting preferences for a formal facility-based childbirth with health professionals. During the postpartum period, the majority of relevant studies reported a preference for traditional postnatal services involving traditional rituals and customs. The factors that influenced the reported preferences were related to the perceived need for formal or traditional care providers, accessibility to maternal care, and cultural and religious norms.
Review findings identified a variety of preferences for sources of maternal care from intrapartum to postpartum. Future interventions aiming to improve access and utilization of evidence-based maternal healthcare services across rural Africa should first identify major challenges and priority needs of target populations and communities through formative research. Evidence-based services that meet rural women’s specific needs and expectations will increase the utilization of formal care and ultimately improve maternal outcomes across rural Africa.
Background: This study was designed to assess the determinants of utilization of Traditional Birth Attendants (TBAs) services by pregnant women in different communities in Ogbomoso, Nigeria.Methods: This was a community- based cross-sectional study. Fisher's formula was used to calculate the sample size and a total of 270 eligible pregnant women were enrolled for the study using multistage sampling technique. Data was collected using pretested structured interviewer-administered questionnaire. Data analysis was done using SPSS version 20 and results were presented in frequencies and percentages.Results: Factors found to have a significant influence on the utilization of TBA services in this study include: low educational status (p <0.001), lower socioeconomic status (p <0.001), and compassionate care given by the TBAs (p=0.004). Other factors include service proximity and lower cost of TBA services.Conclusions: The impact of TBAs and their services cannot be overemphasized in the present state of maternal and child health in Nigeria. Lower educational status among others has been found to be a strong predictor of utilization of TBA services. There is, therefore, the need to improve the educational and socioeconomic status of women in order to allow them to access quality health care services that will safeguard their well-being. Inculcating compassionate care into orthodox healthcare delivery will go a long way to improve patronage and discourage TBA utilization.
Sub–Saharan Africa and Southern Asia lag behind other regions in the provision of antenatal care and skilled attendance at birth (although typically attended by a family member or villager) and over 32 million of the 40 million births not attended by skilled health personnel in 2012 occurred in rural areas. Overall, one–quarter of women in developing nations still birth alone or with a relative to assist them.
Background and objectives:
Although Bangladesh has made significant progress in reducing maternal and child mortality in the last decade, childbirth assisted by skilled attendants has not increased as much as expected. An objective of the Bangladesh National Strategy for Maternal Health 2014-2024 is to reduce maternal mortality to 50/100,000 live births. It also aims to increase deliveries with skilled birth attendants to more than 80% which remains a great challenge, especially in rural areas. This study explores the underlying factors for the major reliance on home delivery with Traditional Birth Attendants (TBA) in rural areas of Bangladesh.
This was a qualitative cross-sectional study. Data were collected between December 2012 and February 2013 in Sunamganj district of Sylhet division and data collection methods included key informant interviews (KII) with stakeholders; formal and informal health service providers and health managers; and in-depth interviews (IDI) with community women to capture a range of information. Key questions were asked of all the study participants to explore the question of why women and their families prefer home delivery by TBA and to identify the factors associated with this practice in the local community.
The study shows that home delivery by TBAs remain the first preference for pregnant women. Poverty is the most frequently cited reason for preferring home delivery with a TBA. Other major reasons include; traditional views, religious fallacy, poor road conditions, limited access of women to decision making in the family, lack of transportation to reach the nearest health facility. Apart from these, community people also prefer home delivery due to lack of knowledge and awareness about service delivery points, fear of increased chance of having a caesarean delivery at hospital, and lack of female doctors in the health care facilities.
The study findings provide us a better understanding of the reasons for preference for home delivery with TBA among this population. These identified factors can inform policy makers and program implementers to adopt socially and culturally appropriate interventions that can improve deliveries with skilled attendants and thus contribute to the reduction of maternal and neonatal mortality and morbidity in rural Bangladesh.
Background: Despite the policy change stopping traditional birth attendants (TBAs) from conducting deliveries at home and encouraging all women to give birth at the clinic under skilled care, many women still give birth at home and TBAs are essential providers of obstetric care in rural Zambia. The main reasons for pregnant women’s preference for TBAs are not well understood. This qualitative study aimed to identify reasons motivating women to giving birth at home and seek the help of TBAs. This knowledge is important for the design of public health interventions focusing on promoting facility-based skilled birth attendance in Zambia.
Methods: We conducted ten focus group discussions (n = 100) with women of reproductive age (15–45 years) in five health centre catchment areas with the lowest institutional delivery rates in the district. In addition, a total of 30 in-depth interviews were conducted comprising 5 TBAs, 4 headmen, 4 husbands, 4 mothers, 4 neighbourhood health committee (NHC) members, 4 community health workers (CHWs) and 5 nurses. Perspectives on TBAs, the decision-making process regarding home delivery and use of TBAs, and reasons for preference of TBAs and their services were explored.
Results: Our findings show that women’s lack of decision- making autonomy regarding child birth, dependence on the husband and other family members for the final decision, and various physical and socioeconomic barriers including long distances, lack of money for transport and the requirement to bring baby clothes and food while staying at the clinic, prevented them from delivering at a clinic. In addition, socio-cultural norms regarding childbirth, negative attitude towards the quality of services provided at the clinic, made most women deliver at home. Moreover, most women had a positive attitude towards TBAs and perceived them to be respectful, skilled, friendly, trustworthy, and available when they needed them.
Conclusion: Our findings suggest a need to empower women with decision-making skills regarding childbirth and to lower barriers that prevent them from going to the health facility in time. There is also need to improve the quality of existing facility-based delivery services and to strengthen linkages between TBAs and the formal health system.
The Community-based Health Planning and Services (CHPS) initiative is a major government policy to improve maternal and child health and accelerate progress in the reduction of maternal mortality in Ghana. However, strategic intelligence on the impact of the initiative is lacking, given the persistant problems of patchy geographical access to care for rural women. This study investigates the impact of proximity to CHPS on facilitating uptake of skilled birth care in rural areas.
Data from the 2003 and 2008 Demographic and Health Survey, on 4,349 births from 463 rural communities were linked to georeferenced data on health facilities, CHPS and topographic data on national road-networks. Distance to nearest health facility and CHPS was computed using the closest facility functionality in ArcGIS 10.1. Multilevel logistic regression was used to examine the effect of proximity to health facilities and CHPS on use of skilled care at birth, adjusting for relevant predictors and clustering within communities. The results show that a substantial proportion of births continue to occur in communities more than 8 km from both health facilities and CHPS. Increases in uptake of skilled birth care are more pronounced where both health facilities and CHPS compounds are within 8 km, but not in communities within 8 km of CHPS but lack access to health facilities. Where both health facilities and CHPS are within 8 km, the odds of skilled birth care is 16% higher than where there is only a health facility within 8km.
Where CHPS compounds are set up near health facilities, there is improved access to care, demonstrating the facilitatory role of CHPS in stimulating access to better care at birth, in areas where health facilities are accessible.
According to the World Health Organization (WHO), current estimates of maternal mortality ratios are at more than 1000 per 100,000 live births in most African countries. Despite the ex-istence of modern health facilities in Nigeria, over 58% of deliveries take place at home whe-reas only 37% take place in hospitals. The outcome of pregnancies and their sequelae are purely left to providence in many rural communities. The place of delivery is one of the determinants of maternal and child morbidity and mortality. And with shortage of skilled birth attendants, particularly who are also unevenly distributed geographically; traditional birth attendants tend to fill in the gap. A simple random sampling technique was used to select 420 women within the reproductive age (18 - 45 years) meeting the inclusion criteria for the study. Results from the study indicated a high rate (88.8%) of knowledge of Traditional Birth Attendants (TBAs) but a poor (51.1%) perception about these practices. A significant relationship was shown between the age (P<0.05), education status (P<0.05) and the frequency of patronage of TBAs Services. Although, perception about TBAs practices is poor, the practice of Traditional Birth Attendants (TBAs) in the improvement of women’s health (Maternal and child health) in rural Nigeria cannot be ignored. TBAs remain major health resources in rural communities in the developing countries as well as some parts of the urban areas. Efforts need to be harnessed for training of TBAs through the ministry of health and closer primary health care facilities close to their area of practices.
The burden of maternal mortality in sub-Saharan Africa is enormous. In Ghana the maternal mortality ratio was 350 per 100,000 live births in 2010. Skilled birth attendance has been shown to reduce maternal deaths and disabilities, yet in 2010 only 68% of mothers in Ghana gave birth with skilled birth attendants. In 2005, the Ghana Health Service piloted an enhancement of its Community-Based Health Planning and Services (CHPS) program, training Community Health Officers (CHOs) as midwives, to address the gap in skilled attendance in rural Upper East Region (UER). The study determined the extent to which CHO-midwives skilled delivery program achieved its desired outcomes in UER among birthing women.
We conducted a cross-sectional household survey with women who had ever given birth in the three years prior to the survey. We employed a two stage sampling techniques: In the first stage we proportionally selected enumeration areas, and the second stage involved random selection of households. In each household, where there is more than one woman with a child within the age limit, we interviewed the woman with the youngest child. We collected data on awareness of the program, use of the services and factors that are associated with skilled attendants at birth.
A total of 407 households/women were interviewed. Eighty three percent of respondents knew that CHO-midwives provided delivery services in CHPS zones. Seventy nine percent of the deliveries were with skilled attendants; and over half of these skilled births (42% of total) were by CHO-midwives. Multivariate analyses showed that women of the Nankana ethnic group and those with uneducated husbands were less likely to access skilled attendants at birth in rural settings.
The implementation of the CHO-midwife program in UER appeared to have contributed to expanded skilled delivery care access and utilization for rural women. However, women of the Nankana ethnic group and uneducated men must be targeted with health education to improve women utilizing skilled delivery services in rural communities of the region.
Reproductive health and Family Planning (FP) services have been of global concern especially in developing countries where fertility rates are high. Traditionally FP services had always targeted females with little or no attention given to males. To ensure equitable distribution of health services, Ministry of Health (MOH), Ghana adopted the Community-Based Health Planning and Services (CHPS) as a nationwide health policy with the aim of reducing obstacles to physical and geographical access to health care delivery including FP services. However, not much is known about the extent to which this policy has contributed to male involvement in FP services. This qualitative descriptive study was therefore designed to explore male involvement in FP services in communities with well functioning CHPS and those with less or no functioning CHPS structures. The study further solicited views of the community on the health status of children.
This was a qualitative descriptive study and adapted the design of an ongoing study to assess the impact of male involvement in FP referred to as the Navrongo experiment in Northern Ghana. Twelve focus group discussions were held with both male and female community members, six in communities with functional CHPS and six for communities with less/no-functional CHPS. In addition, fifty- nine (59) in-depth interviews were held with Community Health Officers (CHOs), Community Health Volunteers (CHVs) and Health Managers at both the districts and regional levels. The interviews and discussions were tape recorded digitally, transcribed and entered into QSR Nvivo 10(C) for analysis.
The results revealed a general high perception of an improved health status of children in the last ten years in the communities. These improvements were attributed to immunization of children, exclusive breastfeeding, health education given to mothers on childcare, growth monitoring of children and accessible health care. Despite these achievements in the health of children, participants reported that malnutrition was still rife in the community. The results also revealed that spousal approval was still relevant for women in the use of contraceptives; however, the matrilineal system appears to give more autonomy to women in decision-making. The CHPS strategy was perceived as very helpful with full community participation at all levels of the implementation process. Males were more involved in FP services in communities with functioning CHPS than those without functioning CHPS.
The CHPS strategy has increased access to FP services but spousal consent was very important in the use of FP services. Involving males in reproductive health issues including FP is important to attain reproductive health targets.
Skilled attendants during labor, delivery, and in the early postpartum period, can prevent up to 75% or more of maternal death. However, in many developing countries, very few mothers make at least one antenatal visit and even less receive delivery care from skilled professionals. The present study reports findings from a region where key challenges related to transportation and availability of obstetric services were addressed by an ongoing project, giving a unique opportunity to understand why women might continue to prefer home delivery even when facility based delivery is available at minimal cost.
The study took place in Ethiopia using a mixed study design employing a cross sectional household survey among 15–49 year old women combined with in-depth interviews and focus group discussions.
Seventy one percent of mothers received antenatal care from a health professional (doctor, health officer, nurse, or midwife) for their most recent birth in the one year preceding the survey. Overall only 16% of deliveries were assisted by health professionals, while a significant majority (78%) was attended by traditional birth attendants. The most important reasons for not seeking institutional delivery were the belief that it is not necessary (42%) and not customary (36%), followed by high cost (22%) and distance or lack of transportation (8%). The group discussions and interviews identified several reasons for the preference of traditional birth attendants over health facilities. Traditional birth attendants were seen as culturally acceptable and competent health workers. Women reported poor quality of care and previous negative experiences with health facilities. In addition, women’s low awareness on the advantages of skilled attendance at delivery, little role in making decisions (even when they want), and economic constraints during referral contribute to the low level of service utilization.
The study indicated the crucial role of proper health care provider-client communication and providing a more client centered and culturally sensitive care if utilization of existing health facilities is to be maximized. Implications of findings for maternal health programs and further research are discussed.
In developing countries, most childbirth occurs at home and is not assisted by skilled attendants. This situation increases the risk of death for both mother and child and has severe maternal and neonatal health complications. The purpose of this study was to explore pregnant women's perceptions and utilization of traditional birth attendant (TBA) services in a rural Local Government Area (LGA) in Ogun State, southwest Nigeria.
A quantitative design was used to obtain information using a structured questionnaire from 250 pregnant women attending four randomly selected primary health care clinics in the LGA. Data were analyzed using Epi Info (v 3.5.1) statistical software.
Almost half (48.8%) of the respondents were in the age group 26-35 years, with a mean age of 29.4 ± 7.33 years. About two-thirds (65.6%) of the respondents had been pregnant 2-4 times before. TBA functions, as identified by respondents, were: "taking normal delivery" (56.7%), "providing antenatal services" (16.5%), "performing caesarean section" (13.0%), "providing family planning services" (8.2%), and "performing gynaecological surgeries" (5.6%). About 6/10 (61.0%) respondents believed that TBAs have adequate knowledge and skills to care for them, however, approximately 7/10 (69.7%) respondents acknowledged that complications could arise from TBA care. Services obtained from TBAs were: routine antenatal care (81.1%), normal delivery (36.1%), "special maternal bath to ward off evil spirits" (1.9%), "concoctions for mothers to drink to make baby strong" (15.1%), and family planning services (1.9%). Reasons for using TBA services were: "TBA services are cheaper" (50.9%), "TBA services are more culturally acceptable in my environment" (34.0%), "TBA services are closer to my house than hospital services" (13.2%), "TBAs provide more compassionate care than orthodox health workers" (43.4%), and "TBA service is the only maternity service that I know" (1.9%). Approximately 8/10 (79.2%) of the users (past or current) opined that TBA services are effective but could be improved with some form of training (78.3%). More than three-quarters (77.1%) opposed the banning of TBA services. Almost 7/10 (74.8%) users were satisfied with TBA services.
Study findings revealed a positive perception and use of TBA services by the respondents. This underlines the necessity for TBAs' knowledge and skills to be improved within permissible standards through sustained partnership between TBAs and health systems. It is hoped that such partnership will foster a healthy collaboration between providers of orthodox and traditional maternity services that will translate into improved maternal and neonatal health outcomes in relevant settings.
Trained birth attendants at delivery are important for preventing both maternal and newborn deaths. West Java is one of the provinces on Java Island, Indonesia, where many women still deliver at home and without the assistance of trained birth attendants. This study aims to explore the perspectives of community members and health workers about the use of delivery care services in six villages of West Java Province.
A qualitative study using focus group discussions (FGDs) and in-depth interviews was conducted in six villages of three districts in West Java Province from March to July 2009. Twenty FGDs and 165 in-depth interviews were conducted involving a total of 295 participants representing mothers, fathers, health care providers, traditional birth attendants and community leaders. The FGD and in-depth interview guidelines included reasons for using a trained or a traditional birth attendant and reasons for having a home or an institutional delivery.
The use of traditional birth attendants and home delivery were preferable for some community members despite the availability of the village midwife in the village. Physical distance and financial limitations were two major constraints that prevented community members from accessing and using trained attendants and institutional deliveries. A number of respondents reported that trained delivery attendants or an institutional delivery were only aimed at women who experienced obstetric complications. The limited availability of health care providers was reported by residents in remote areas. In these settings the village midwife, who was sometimes the only health care provider, frequently travelled out of the village. The community perceived the role of both village midwives and traditional birth attendants as essential for providing maternal and health care services.
A comprehensive strategy to increase the availability, accessibility, and affordability of delivery care services should be considered in these West Java areas. Health education strategies are required to increase community awareness about the importance of health services along with the existing financing mechanisms for the poor communities. Public health strategies involving traditional birth attendants will be beneficial particularly in remote areas where their services are highly utilized.
The potential for traditional birth attendants (TBAs) to improve neonatal health outcomes has largely been overlooked during the current debate regarding the role of TBAs in improving maternal health. Randomly-selected TBAs (n=93) were interviewed to gain a more thorough understanding of their knowledge, attitudes, and practices regarding maternal and newborn care. Practices, such as using a clean cord-cutting instrument (89%) and hand-washing before delivery (74%), were common. Other beneficial practices, such as thermal care, were low. Trained TBAs were more likely to wash hands with soap before delivery, use a clean delivery-kit, and advise feeding colostrum. Although mustard oil massage was a universal practice, 52% of the TBAs indicated their willingness to consider alternative oils. Low-cost, evidence-based interventions for improving neonatal outcomes might be implemented by TBAs in this setting where most births take place in the home and neonatal mortality risk is high. Continuing efforts to define the role of TBAs may benefit from an emphasis on their potential as active promoters of essential newborn care.
To examine the social costs to women of skilled attendance at birth in rural Ghana.
Ethnographic data were obtained through participant observation, interviews, case histories, and focus groups and were analyzed alongside data from a birth cohort of 2878 singletons born in the Kintampo study district between July 2003 and June 2004.
Most women delivered at home. Home delivery raises a woman's status in her community, while seeking skilled attendance lowers it. Women feel that seeking assistance in childbirth wastes other people's time and they value secrecy in labor. Negative treatment by health providers and expensive supplies needed for delivery also act as barriers.
The social costs of obtaining skilled attendance at birth must be offset by community level strategies such as mobilization of older women and husbands, and ensuring health providers extend professional, humane care to laboring women.
The fast approach of the end of the Millennium Development Goals (MDGs) by the end of 2015 has driven many countries to accelerate their efforts at achieving the goals. In line with the proposed means of measuring the success of the MDG 5 by World Health Organisation (WHO): to reduce country maternal mortality ratios and achieve universal reproductive health, Ghana has been implementing the Community based Health Planning Services (CHPS) strategy to address the MDG 4 and 5. This study sought to assess the contribution of the CHPS to the attainment of the MDG5 using the indicators of antenatal care, delivery services, postnatal care and community participation components of CHPS. Adopting qualitative and quantitative study approach and the cross sectional research design, the Tamale Metropolitan Area (TaMA) was brought into focus to have a snap shot view on the contribution of CHPS to maternal health. Three hundred and ninety five women of child bearing age (15-49 years), 31 Traditional Birth Attendants (TBAs) and six health professionals in the CHPS zones provided information for the study through questionnaire administration, focused group discussions and interviews respectively. The results revealed that, 80.8percent of the women attended antenatal clinic in their respective CHPS compound. All the CHPS in the study did not provide delivery services for the women due to lack of midwives. Further, 89 percent of the women were delivered by TBAs at home whilst the rest delivered in either a health centre or hospital because of complications in pregnancy. All respondents received the first 24 hours postnatal care from either TBAs, or nurses who worked in their respective CHPS compound and midwives in the health centres or hospitals. All respondents accessed general health services in their zonal CHPS. The study concludes that, for full implementation of the CHPS to effectively contribute to the achievement of the MDG5, the District Director of Health Services should post midwives to the CHPS compound to ensure that skilled delivery services are provided.
In order to understand factors influencing choice of delivery sites in Rakai district of south-western Uganda, eight focus group discussions based on the Attitudes-Social influence-Self efficacy model were held with 32 women and 32 men. Semi-structured interviews were also held with 211 women from 21 random cluster samples who had a delivery in the previous 12 months (from 2 June 1997). Forty four percent of the sample delivered at home, 17% at traditional birth attendant's (TBA) place, 32% at public health units, and 7% at private clinics. Among the factors influencing choice of delivery site were: access to maternity services; social influence from the spouse, other relatives, TBAs and health workers; self-efficacy; habit (previous experience) and the concept of normal versus abnormal pregnancy. Attitudinal beliefs towards various delivery sites were well understood and articulated. Attendance of ante-natal care may discourage delivery in health units if the mothers are told that the pregnancy is normal. In order to make delivery safer, there is need to improve access to maternity services, train TBAs and equip them with delivery kits, change mother's self-efficacy beliefs, and involve spouses in education about safe delivery.
The paper presents the maternal mortality rates in St. Mary's Hospital Urua Akpan from the period of 1979-1985 excluding (1981 Author on leave). 70% of maternal deaths were among unbooked local Annang women who lived within a radius of 15-20 miles from the hospital. They had been attended to by traditional birth attendant (TBAs) and referred too late. The maternal rate decreased from 10/1000 in 1979 to 4/1000 in 1985. The main causes of maternal death during this period include ruptured uterus, septicemia, hepatitis, hemorrhage, eclampsia, and hypertension/nephritis. A community survey (190 interviewed women) revealed that up to 50% of women still prefer to deliver at home and are attended to by TBAs. A training program for TBAs in the Local Government Area (LGA) was started in June 1983. Each course lasted 3 months in which basic instruction in hygiene, simple antenatal care, labor and its complications, and care of mother and child was given. Since starting the program, the TBAs have referred 320 patients with medical pregnancies, vacuum, and symphysiotomy. From 1983-1986, there were 38 perinatal deaths and 2 maternal deaths among the TBAs referrals. Since 1983, the maternal death rate and morbidity have fallen especially among women from the LGA; maternal mortality declined 50% among these women which account for only 30% of the total hospital births/year. Furthermore, 16,000 children have been vaccinated. The beneficial aspects of TBA training include observing the principles of hygiene, early referral of patients to hospital, encouraging village children to come for vaccinations and generally using their influence in the cultural, ritual and religious life of traditional society to become good health educators. author's modified
In India various programs have been launched to provide primary health care to women and children, particularly in the rural areas. However, the impact of these programs has not been significant. Though there is a provision of a trained dai (traditional birth attendant) in every village in the national program, most of the deliveries in rural areas are still conducted at home by untrained dais. This study was undertaken to find out about the decision of pregnant women in rural areas as regards the place of delivery and the nature of assistance received at delivery. Four villages in the Jawan Block, District of Aligarh, were randomly selected. All the villages were covered by the Integrated Child Development Services Scheme (ICDS). A total of 212 pregnant women were registered and each of them was contacted to inquire about the type of assistance received at delivery. 96.7% of the women were Hindus; 93.0% were illiterate and 68.5% were poor; 33.5% were high caste, 30.2% were low caste, and 30.2% were scheduled caste. Out of 212 deliveries, 205 (96.6%) were conducted at home. Assistance received at delivery (N = 212) was as follows: untrained dais (traditional birth attendants) 190 (89.6%); trained dais 0 (0.0%); prenatal care assistants 11 (5.2%); doctors 9 (4.2%); and relatives 2 (1.0%). The utilization of existing prenatal care services was meager, as the majority of pregnant women were illiterate and poor. As many as 205 (96.6%) deliveries were done at home. The finding that 89.6% deliveries were conducted by untrained dais assumes considerable significance in light of the fact that these villages of Jawan Block were among one of the first 3 ICDS blocks in Uttar Pradesh. This shows that there is still a wide gap between provision and utilization of maternal care services. Since most of the deliveries are conducted at home by untrained traditional birth attendants, the people must be educated to utilize the services of trained personnel.
National Family Planning Coordinating Board, Ministry of Health, ORC Macro: Indonesia Demographic and Health Survey
Badan Pusat Statistik-Statistics Indonesia (BPS), National Family Planning Coordinating Board, Ministry of Health, ORC Macro: Indonesia Demographic
and Health Survey 2007, BPS and ORC Macro, Calverton, Maryland, 2008.
Perceived factors influencing the utilization of traditional birth attendants' services in Akinyele Local Government
M T Ogunyomi
C M Ndikom
M.T. Ogunyomi, C.M. Ndikom, Perceived factors influencing the utilization of traditional birth attendants' services in Akinyele Local Government,
Ibadan, Nigeria, J Community Med. Prim. Health Care 28 (2) (2016) 40-48.