A.I. Ayede
Department of Paediatrics, University College Hospital, Ibadan.
Abstract
Background and objective: One of the major factors responsible for high maternal and neonatal deaths in Nigeria and other developing countries is the use of Traditional Birth Attendants (TBAs). The current study was carried out to evaluate the attractive roles of the TBAs that make pregnant mothers persistently use them.
Methodology: The study was conducted in Ido and Lagelu local government areas of Oyo State in Nigeria. TBA basic demographic data were collected and were then followed up for a period of six months by trained Nurses and Doctors targeting a total of ten direct observations made per TBA per ANC/delivery.
Results: There were a total of 146 TBAs out of which 134 fulfilled the inclusion criteria and were recruited into the study. The Male to female ratio was 1/133 and age range was 22–68 years with 70.1 % above 40 years. Seventy two per cent of them had only elementary school and 72%, 30% and 38% had been re-trained by LGA, SMOH and National TBA associations respectively. Post- partum care, counseling services, tender care in labour, easy accessibility, accommodating other relations, installmental payment were observed in all TBAs while 60–98% of them did home visit, assisted in referral and arranged for USS and laboratory services.
Conclusions and Recommendations: These good practices should be incorporated into formal health sector and attitudinal change in the current health workers across all health care levels should be encouraged. CHEWs should also be primarily involved in home visit in pregnancy and post-natal care services.
Keywords: mission home, delivery, traditional birth attendants, attractive role
Correspondence:
Dr. A.I. Ayede
Department of Paediatrics,
University College Hospital,
Ibadan.
Introduction
Each year around four million newborns die in the first week of life, worldwide1,2 and an estimated 529,000 mothers die due to pregnancy-related causes2,3. In low and middle-income countries many deliveries still occur at home and without the assistance of trained attendants4-7. A recent review reported that around 20- 30% of neonatal mortality could be reduced by implementing skilled birth care services8. Attention to maternal health was demonstrated in 2000 when 147 heads of state and government and 189 nations in total signed the Millennium Declaration, in which the proportion of births assisted by trained birth attendants became an important indicator to measure the progress of improving maternal health (Millennium Development Goal 59-11. About 59,000 pregnant mothers die each year in Nigeria. Nigeria also ranks highest in Africa and 2nd highest worldwide in numbers of newborn deaths. In Nigeria alone, over a quarter of a million newborn dies annually and this account for about 24% of Nigerian’s under-5 mortality12.
One of the major factors responsible for high maternal and neonatal deaths in Nigeria and other developing countries is the use of unskilled birth attendants such as Traditional Birth Attendants and Voluntary Health Workers. The World Health Organization defines a traditional birth attendant (TBA) as a person who assists the mother during childbirth and who initially acquired her skills by delivering babies herself or through an apprenticeship to other TBAs13. Individual TBAs and their roles vary. However, certain characteristics are commonly seen across continents and regions14. TBAs tend to be older women, respected in the community for their knowledge and experience. They are often non-literate and have learned their skills through older more experienced TBAs. They may work independently, in collaboration with an individual provider or facility or they may be integrated into the health system. Their role may include, in addition to birth attendance, bathing and massage, domestic chores, and provision of care during the later postpartum or postnatal period.
TBAs may perform other roles depending on local custom, their own interests and expertise. The number of births TBAs attend each year ranges from a few births to as many as 120 births per year. Typically, TBAs attract clients by reputation and word-of-mouth. Usually they receive some remuneration for their services. Today, TBAs remain an important provider of maternity care in developing countries15. Despite various campaigns on the importance of facility delivery assisted by skilled birth attendants, up to 60% of deliveries are still attended to by these TBAs in some communities16. The pregnancy outcome effects are seen more in the morbidities and mortalities that are particularly associated with post-partum haemorrhage, prolonged obstructed labor, infection, eclampsia, prematurity, perinatal asphyxia and neonatal sepsis which are the leading causes of maternal and neonatal deaths in Nigeria12. The aim of this study was to look into the attractive role of TBAs that are for preference for their use in two periurban Local Government Areas of Oyo state.