DOCSLIB.ORG

The Trained Traditional Birth Attendant: a Study of Her Role in Two Cultures by L

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Trained Traditional Birth Attendant: a Study of Her Role in Two Cultures by L L.I. LARTSONETAL. Perspectives in Primary Care The Trained Traditional Birth Attendant: a Study of Her Role in two Cultures by L. I. Lartson*, MD, MSc, O. A. Sodipe*, MB, BS, MSc, G. J. Ebrahim*, FRCP, DCH, and R. Abel**, MD * Tropical Child Health Unit, Institute of Child Health, London ** Rural Unit for Health and Social Affairs, Vellore, India Downloaded from https://academic.oup.com/tropej/article/33/1/29/1672468 by guest on 29 September 2021 Summary The training of the traditional birth attendants in the national programme in Liberia and in the innova- tive health programme of RUHSA in south India has been evaluated. There has been an improvement in coverage with prenatal care and immunization with tetanus toxoid associated with a fall in the incidence of low birth weight and neonatal tetanus. The need for repeated refresher courses, for effective back-up in case of emergencies, and for close supervision to prevent risk-taking is stressed. Even though the per- formance of the trained traditional birth attendants (TTBA) improved with regard to the assessment of pregnancy and the identification of risk factors, the TTBA tended to handle complicated births, retained placenta, and prolonged labour by themselves. Whatever the reasons, it stresses the need for the super- visory back-up services to work closely with the TTBA. Introduction maternal and perinatal mortality rates remain high and have not altered much during the last decade. As It is estimated that between 60 and 80 per cent of a rough estimate, 500 000 women die of causes related births in the developing world are attended by tradi- to pregnancy each year—most of them preventable.6 tional birth attendants (TBA).1 Understandably, In a study of maternal mortality in Bangladesh, the there has been a desire to improve the quality of care rate was 7.7 per 1000 live births with 80 per cent of they provide and to upgrade their skills. In a world deaths being due to direct obstetric causes, and wide survey conducted under the auspices of the eclampsia was the most common cause.7 World Health Organization (WHO) 24 out of the 64 In all traditional societies, child bearing is firmly countries (38 per cent) surveyed were reported to have rooted in the cultural milieu and is surrounded with a existing training programmes for the TBA in 1972.2 variety of mystical beliefs and magico-religious prac- Since then case studies in utilization and training of tices.8 Hence, an indigenous practitioner like the TBA the TBA from seven countries have been published,3 from within the same culture is preferred to the skilled and the characteristics of the TBA as well as their professional. Upgrading of the TBA's skills and common practices during pregnancy, at the time of improving her knowledge through training will be a delivery, and in the postnatal period have been de- rational approach. Moreover, expansion of coverage scribed.4 Such studies have provided a momentum for with maternity care through trained professionals change so that the training and utilization of the TBA would mean expanding health services 3-4-fold which constitute a significant part of the national health no country can afford. On the other hand, 'articula- strategies of many countries. tion' of trained TBAs to the formal health service is Coverage with skilled care at delivery is low in most an achievable goal. Hence, a number of countries developing countries and varies from 29 per cent in have adopted such a strategy and developed curricula for the training of TBAs, and the Sudan is one such tropical Africa (Africa average 34 per cent) and 20 per 9 cent in southern Asia (Asia average 49 per cent) to 51 example. per cent in middle America (Latin America average The training of TBAs has to be related to specific 64 per cent).5 The number of pregnant women who problems. Since low birth weight and neonatal receive antenatal care is also low, varying from 5 to 48 tetanus are the two most common causes of neonatal per cent in countries where fewer than half the preg- mortality, their prevention must be stressed. Improve- nant women receive prenatal care to a range of 50-98 ment of maternal nutrition and motivation for immu- per cent in countries where more than half the preg- nization of the pregnant woman with tetanus toxoid nant women receive such care.5 Not surprisingly, are emphasized in most training programmes. Preven- Journal of Tropical Pediatrics Vol. 33 February 1987 © Oxford University Press 1987 29 L. I. LARTSON ET AL. tion of anaemia and the referral of high-risk preg- deliveries performed by TTBAs than UTTBAs. The nancies for more skilled care are the other skills women delivered recently by the two study groups taught to the TBA. Emergencies are likely to arise were traced and were also interviewed using a struc- unexpectedly and their early anticipation for prompt tured questionnaire so designed as to obtain addi- referral as well as simple relevant skills for handling tional evidence for testing the above hypotheses. In them must form part of the training.10 all, 100 mothers were interviewed, of whom 52 had In all traditional birth systems the relationship been delivered by TTBAs and 48 by UTTBAs. between the birth attendant and the 'client', is of a personalized nature. The TBA is treated more like an RUHSA programme, India elder who joins with the rest of the family in assisting The RUHSA programme is characteristic of the di- the woman in labour.11 She is rewarded in cash or lemma in all developing countries in that despite a kind, or both, according to the ability of the family. rising output of skilled professionals who largely Downloaded from https://academic.oup.com/tropej/article/33/1/29/1672468 by guest on 29 September 2021 There are no fixed charges. This relationship is differ- enter the private sector, the vast majority of the popu- ent from the professional-client relationship of the lation have little access to modern medical care on midwife or obstetrician. Because of the relationship account of poverty. In the population served by the and the system of reward, the services of the TBA are RUHSA programme 77 per cent are below the more accessible to the disadvantaged groups. Is the poverty line, and hence the need of a maternity service relationship likely to change after training? which is affordable. A national programme of train- The evaluation of training and of the performance ing the TBAs operates in the area in addition to of the trained TBA is necessary to assess the success RUHSA's own programme. The full content of or otherwise of the strategy of extending coverage RUHSA's training is given in Appendix 2. The study with maternity care through modernization of the was carried out in three villages constituting the main traditional systems. We report here on the perform- headquarters village, an intermediate village with a ance of the trained TBA in two cultural settings. One health facility, and a remote village with no health is a national programme in Liberia and our report is facilities. Comparable villages were selected from a part of the process of evaluation currently in progress neighbouring area outside RUHSA's boundary. The 11 in that country. The second is a relatively small-scale method of selection has been described previously. project as part of the RUHSA (Rural Unit for Health An interview based on a structured questionnaire was and Social Affairs) programme of the Christian Medi- conducted with all the TBAs in the six villages to cal College, Vellore.12 assess the size of their clientele, their knowledge and practices concerning prenatal, intrapartum, and post- natal care. Similar interviews were conducted with Methods and Materials mothers who had been delivered by the TBAs. In all Liberia 38 TBAs were interviewed, 28 being from the study The study was part of the national evaluation of the villages, 12 of whom were untrained. Out of the 10 in training of TBAs, and was carried out in four counties the comparison villages, 7 were untrained. In all 223 avoiding the areas where the national evaluation mothers were interviewed, 113 of whom were from teams were operating. Each of the four counties has a the study villages. training programme based on a curriculum formu- lated by the Ministry of Health and Social Welfare (see Appendix 1). Twelve towns were identified in Results which trained and untrained traditional midwives Liberia—national programme were practising. From amongst the trained TBAs who General characteristics of the traditional birth atten- had been identified by their supervisors, 26 were dants. There were no significant differences between selected for the study by the lottery method (TTBA). the TTBAs and the UTTBAs as regards age, literacy Untrained TBAs had to be identified with the help of rate, general education, years of experience, and the community leaders as being the only way since induction into the art of assisting with deliveries. The they are not registered with the midwifery board. A only difference was whether they had attended the group of 24 untrained TBAs (UTTBA) were selected training programme or not. In general, the traditional for the study by the lottery method. In both the birth attendants were between 35 and 55 years old, groups the birth attendants were operating from a were largely illiterate, had been in practice for more distance of 8 km radius from a health centre or district than 10 years, and had acquired their skills through hospital and 40 km radius from a regional hospital.
Load more

Recommended publications
  • WHO Safe Childbirth Checklist Implementation Guide Improving the Quality of Facility-Based Delivery for Mothers and Newborns
    BACKGROUND AND OVERVIEW WHO Safe Childbirth Checklist Implementation Guide Improving the quality of facility-based delivery for mothers and newborns WHO SAFE CHILDBIRTH CHECKLIST IMPLEMENTATION GUIDE 1 WHO Library Cataloguing-in-Publication Data WHO safe childbirth checklist implementation guide: improving the quality of facility-based delivery for mothers and newborns. 1.Parturition. 2.Birthing Centers. 3.Perinatal Care. 4.Maternal Health Services. 5.Infant, Newborn. 6.Quality of Health Care. 7.Checklist. I.World Health Organization. ISBN 978 92 4 154945 5 (NLM classification: WQ 300) © World Health Organization 2015 All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications—whether for sale or for non-commercial distribution—should be addressed to WHO Press through the WHO website (www.who.int/about/licensing/copyright_form/en/index.html). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organiza- tion concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned.
    [Show full text]
  • Out of Institution Birth Packet
    Out of Institution Birth Packet Revised 6/2021 511-1-3-05. Registration of Out of Institution Births 1. In any case where a birth occurs outside a hospital, or other recognized medical facility, without medical attendance and the birth certificate is filed by someone other than a health care provider, additional evidence in support of the facts of birth shall be completed and filed in the presence of the local Vital Records registrar in the county where the birth occurred. A birth certificate for a birth which occurs outside a recognized medical institution shall only be filed upon personal presentation of the following evidence by the individual(s) filing the certificate: (a) Proof of pregnancy: 1. Prenatal records; or 2. Statement from a physician or other licensed health care provider who is qualified to determine pregnancy; or 3. Prenatal blood analysis or positive pregnancy test results from a laboratory. (b) Proof of the mother’s residence on the date of the out of institution birth: 1. A valid driver’s license, or a state-issued identification card, which includes the mother’s current residence on the face of the license or card; or 2. A rent receipt which includes the mother’s name and address, and the name, address, and signature of the mother’s landlord. 3. A utility bill (e.g. electric bill, phone bill, or water bill) showing the address at child’s birth. (c) A copy of a bank statement showing the address at child’s birth. 2. An identifying document, with photograph, for the individual(s) personally presenting the evidence required to file the certificate.
    [Show full text]
  • Iutzi, Masters Thesis 1 EVALUATION of A
    EVALUATION OF A TRADITIONAL BIRTH ATTENDANT AND COMMUNITY HEALTH LEADER TRAINING AND MENTORING PROGRAM: MATAGALPA, NICARAGUA Cassie J. Iutzi A thesis submitted in partial fulfillment of the requirements for the degree of Masters in Public Health University of Washington June 2013 Committee: Wendy Johnson Christopher Dodd Program Authorized to Offer Degree: Global Health Iutzi, Masters Thesis 1 Abstract Evidence strongly shows that the risk of childbirth is best mitigated through giving birth at or near a health institution with emergency obstetrical services and receiving regular prenatal visits. These interventions have been shown to improve maternal morbidity and mortality. Many under-resourced areas of the world continue to have difficulty connecting poor rural women to these services. In Matagalpa, Nicaragua a pioneering project, “Destrezas para Salvar Vidas,” was implemented in August 2011 to provide training and mentorship to the traditional birth attendants and community health leaders to connect pregnant women in rural communities with the formal health sector. This project was evaluated at the one-year point through tests of knowledge both before and after an initial one-week training, records of activities conducted by participants, and interviews with program participants and mentors. The aggregate test scores of participants’ knowledge during the initial week of training increased from an average score of 59.5% to 79.9% (differences 21.4%, p<0.001). Of the pregnant women in contact with program participants, 93% delivered at an institution, compared to 81% of all pregnant women in Matagalpa. Participants performed an average of 51 home visits each over the year. Reciprocal trust and communication increased between community participants and health sector workers.
    [Show full text]
  • Pregnancy Intention and Utilization of Maternal And
    Jurnal Kesehatan Reproduksi, 9(1), 2018: 27-36 DOI: 10.22435/kespro.v9i1.891.27-36 PREGNANCY INTENTION AND UTILIZATION OF MATERNAL AND CHILD HEALTH CARE SERVICES IN INDONESIA Ika Saptarini1,2,*, Diahhadi Setyonaluri1 1Faculty of Economic and Business, University of Indonesia 2National Institute of Health Research and Development, Ministry of Health, Indonesia Submitted 31 May 2018; reviewed 3 June 2018; approved 30 June 2018 Abstrak Latar belakang: Antenatal care, persalinan oleh tenaga kesehatan, postnatal care serta imunisasi lengkap membantu meningkatkan kesehatan ibu dan anak. Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan antara perencanaan kehamilan dan pemanfaatan pelayanan kesehatan ibu dan anak. Metode: Penelitian ini menggunakan data dari Survei Kesehatan Demografi Indonesia 2012. Empat model regresi digunakan untuk mengidentifikasi hubungan antara perencanaan kehamilan dan pemanfaatan pelayanan kesehatan ibu dan anak. Hasil: Lebih dari seperlima (25,5%) responden menerima kelima jenis perawatan ibu dan anak. Lima belas persen wanita melaporkan bahwa kehamilan terakhir mereka tidak diinginkan. Perencanaan kehamilan berhubungan secara bermakna dengan penggunaan antenatal care yang memadai (OR: 0,53, 95% CI, 0,46-0,60), pemanfaatan antenatal care dan persalinan oleh tenaga kesehatan (OR: 0,62, 95% CI, 0,55-0,71), pemanfaatan antenatal care, persalinan oleh tenaga kesehatan dan postnatal care ( OR: 0,82, 95% CI, 0,72-0,93), namun tidak berhubungan secara signifikan dengan pemanfaatan antenatal care, persalinan oleh tenaga kesehatan, postnatal care hingga imunisasi lengkap (OR: 1,06, 95% CI, 0,91-1,22) setelah dikontrol menggunakan variabel sosiodemografi dan faktor obstetrik. Kesimpulan: Intervensi diperlukan untuk mengurangi kehamilan yang tidak diinginkan seperti meningkatkan akses ke layanan keluarga berencana.
    [Show full text]
  • Comprehensive Counseling for Reproductive Health—Participant’S Handbook © 2003 Engenderhealth
    From Comprehensive Counseling for Reproductive Health—Participant’s Handbook © 2003 EngenderHealth Appendix C Maternal Health Care Resource Materials Counseling duringMaternal Health Care 207 Phases of Counseling for PregnantWomen and Families 210 Postpartum Counseling Approaches for the Customer, Family, and Community 210 EngenderHealth Sexual and Reproductive Health Counseling—Participant's Handbook 205 AppendixC Counseling during Maternal Health Care Antenatal Counseling Approaches for the Customer, Family, and Community Some information and counseling is targeted to the pregnant woman individually for her per- sonal knowledge and behavioral change ("customerapproach"). Other information needs to be delivered to important decision-making family members, like the husband or mother-in-law, as well as to the pregnant woman, for effective implementation ("family approach"). In addition, such messagesare to be delivered to all strata of the communityto raise awareness and cooper- ation ("community approach"). Customer Approach: Information for the Pregnant Woman Diet during Pregnancy • From the daily normal diet list, eat an extra handful of food at every meal or eat one addi- tional meal every day. Additional food should include fruits and vegetables and foods rich in iron, such as beans, fish, meat, liver, kidney, eggs, and dark green, leafy vegetables. Drink plenty of clean (boiled) water. Rest and Activities • Rest after lunch and sleep at least six to eight hours at night. • Avoid long and tiresome journeys and avoid work that requires prolonged periods of stand- ing or sitting (i.e., more than four to five hours). • Make regular antenatal care visits to the health clinic. • Besides routine checkups, come to the health clinic at any time during the pregnancyor post- delivery periodif you feel unwell.
    [Show full text]
  • Introduction Aim Methodology Methodology TBA Interview
    Introduction Traditional Birth Attendants Traditional birth attendants (TBA) play a major role in and Their Role in the the delivery of healthcare services to women Delivery of Healthcare Their practice has continued to exist despite the availability of medical facilities such as clinics and Services to Women in hospitals Apam, Ghana It is important to understand the role that TBAs continue to play in the current healthcare environment. By: Elena Gore, MPH 2014 GE/NMF Scholar Medical University of South Carolina Mentor: Dr. Akye Essuman Aim Methodology To understand: Qualitative interviews with a convenience sample of 10 The scope of practice of TBAs TBAs in the Gomoa West District of Ghana TBAs’ current relationships with the local hospitals and Interviews ranged from 40 min to 1 hour 5 min clinics 4 (out of 7) qualitative interviews with trained midwives TBAs’ knowledge of the limits of their scope of practice of the Apam Hospital The healthcare community’s perceptions and attitudes Approx 10 min each towards TBAs 1 interview with Apam Hospital Medical Superintendent Approx 18 min Methodology Methodology TBA Interview Questions Midwife/physician interview Scope of practice How did you become a birth attendant? Who are your patients? questions What services do you offer? Perception of role of TBAs Relationship with hospital/clinics What do you think is the role of TBAs in the delivery of What relationship do you have with the hospital/clinic? healthcare services to women? Do you feel comfortable sending patients to
    [Show full text]
  • The Mistreatment of Women During Childbirth in Health Facilities Globally: a Mixed-Methods Systematic Review
    RESEARCH ARTICLE The Mistreatment of Women during Childbirth in Health Facilities Globally: A Mixed-Methods Systematic Review Meghan A. Bohren1,2*, Joshua P. Vogel2, Erin C. Hunter3, Olha Lutsiv4, Suprita K. Makh5, João Paulo Souza6, Carolina Aguiar1, Fernando Saraiva Coneglian6, Alex Luíz Araújo Diniz6, Özge Tunçalp2, Dena Javadi3, Olufemi T. Oladapo2, Rajat Khosla2, Michelle J. Hindin1,2, A. Metin Gülmezoglu2 1 Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America, 2 Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland, 3 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America, 4 Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada, 5 Population Services International, Washington, D. C., United States of America, 6 Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil OPEN ACCESS * [email protected] Citation: Bohren MA, Vogel JP, Hunter EC, Lutsiv O, Makh SK, Souza JP, et al. (2015) The Mistreatment of Women during Childbirth in Health Facilities Globally: A Mixed-Methods Systematic Review. PLoS Abstract Med 12(6): e1001847. doi:10.1371/journal. pmed.1001847 Academic Editor: Rachel Jewkes, Medical Research Council, SOUTH AFRICA Background Received: November 18, 2014 Despite growing recognition of neglectful, abusive, and disrespectful treatment of women Accepted: May 22, 2015 during childbirth in health facilities, there is no consensus at a global level on how these occurrences are defined and measured.
    [Show full text]
  • Learning Lessons from a Traditional Midwifery Workforce in Western Kenya
    Midwifery 27 (2011) 324–330 Contents lists available at ScienceDirect Midwifery journal homepage: www.elsevier.com/midw Learning lessons from a traditional midwifery workforce in Western Kenya Elaine Dietsch, PhD, MN(WH), RM, RN (Midwifery Courses Coordinator)a,n, Luc Mulimbalimba-Masururu, MD, ND (Medical Director)b a School of Nursing, Midwifery & Indigenous Health, Charles Sturt University, Locked Bag 588, Wagga Wagga, NSW 2678, Australia b Mission in Health Care and Development, PO Box 1844, Bungoma 50200, Kenya article info abstract Article history: Objective: to learn lessons from a traditional midwifery workforce in Western Kenya. Received 10 September 2010 Design: with the assistance of an interpreter, qualitative data was collected during in-depth individual Received in revised form and group interviews with traditional midwives. English components of the interviews were 4 November 2010 transcribed verbatim and the data thematically analysed. Accepted 26 January 2011 Setting: a rural, economically disadvantaged area of Western Kenya. Participants: 84 participants who practise as traditional midwives. Keywords: Findings: it was common for these traditional midwives to believe they had received a spiritual gift Traditional birth attendant which enabled them to learn the skills required from another midwife, often but not always their Skilled birth attendant mother. The participants commenced their midwifery practice by learning through an apprenticeship Learning or mentoring model but they anticipated their learning to be lifelong. Lifelong learning occurred Knowing through experiential reflection and reciprocal learning from each other. Learning in colleges, hospitals and through seminars facilitated by non-government organisations was also desired and esteemed by the participants but considered a secondary, though more authoritative source of learning.
    [Show full text]
  • Experiences of a New Cadre of Midwives in Bangladesh: Findings from a Mixed Method Study Rashid U
    Zaman et al. Human Resources for Health (2020) 18:73 https://doi.org/10.1186/s12960-020-00505-8 RESEARCH Open Access Experiences of a new cadre of midwives in Bangladesh: findings from a mixed method study Rashid U. Zaman1* , Adiba Khaled2, Muhammod Abdus Sabur3, Shahidul Islam4, Shehlina Ahmed5, Joe Varghese6, Della Sherratt7 and Sophie Witter8 Abstract Background: Bangladesh did not have dedicated professional midwives in public sector health facilities until recently, when the country started a nation-wide programme to educate and deploy diploma midwives. The objective of the findings presented in this paper, which is part of a larger study, was to better understand the experience of the midwives of their education programme and first posting as a qualified midwife and to assess their midwifery knowledge and skills. Methods: We applied a mixed method approach, which included interviewing 329 midwives and conducting 6 focus group discussions with 43 midwives and midwifery students. Sampling weights were used to generate representative statistics for the entire cohort of the midwives deployed in the public sector health facilities. Results: Most of the midwives were satisfied with different dimensions of their education programme, with the exception of the level of exposure they had to the rural communities during their programme. Out of 329 midwives, 50% received tuition fee waivers, while 46% received funding for educational materials and 40% received free accommodation. The satisfaction with the various aspects of the current posting was high and nearly all midwives reported that a desire to work in the public sector in the long run. However, a significant proportion of the midwives expressed concerns with equipment, accommodation, transport and prospect of transfers.
    [Show full text]
  • Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care
    Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care Sarah J. Buckley January 2015 Childbirth Connection A Program of the National Partnership for Women & Families About the National Partnership for Women & Families At the National Partnership for Women & Families, we believe that actions speak louder than words, and for four decades we have fought for every major policy advance that has helped women and families. Today, we promote reproductive and maternal-newborn health and rights, access to quality, affordable health care, fairness in the workplace, and policies that help women and men meet the dual demands of work and family. Our goal is to create a society that is free, fair and just, where nobody has to experi- ence discrimination, all workplaces are family friendly and no family is without quality, affordable health care and real economic security. Founded in 1971 as the Women’s Legal Defense Fund, the National Partnership for Women & Families is a nonprofit, nonpartisan 501(c)3 organization located in Washington, D.C. About Childbirth Connection Programs Founded in 1918 as Maternity Center Association, Childbirth Connection became a core program of the National Partnership for Women & Families in 2014. Throughout its history, Childbirth Connection pioneered strategies to promote safe, effective evidence-based maternity care, improve maternity care policy and quality, and help women navigate the complex health care system and make informed deci- sions about their care. Childbirth Connection Programs serve as a voice for the needs and interests of childbearing women and families, and work to improve the quality and value of maternity care through consumer engagement and health system transformation.
    [Show full text]
  • Namibia Country Profile for Demographic and Health Surveys, the Years Refer to When the Surveys Were Conducted
    WHO Director-General Roundtable with Women Leaders on Millennium Development Goal 5 Namibia Country profile For Demographic and Health Surveys, the years refer to when the Surveys were conducted. Estimates from the Surveys refer to three or five years before the Surveys. Namibia and the world 1. Maternal mortality ratio: global, regional and 2. Lifetime risk of maternal death (1 in N), 2005 country data, 2005 A maternal death is defined as the death of a woman while pregnant or The lifetime risk of maternal death is the estimated risk of an individual within 42 days of termination of pregnancy from any cause related to woman dying from pregnancy or childbirth during her adult lifetime the pregnancy or its management but not from accidental or incidental based on maternal mortality and the fertility rate in the country. The causes. The maternal mortality ratio is the number of maternal lifetime risk of dying from pregnancy-related causes in Namibia is 1 in deaths per 100 000 live births per year. The ratio in Namibia is 210 170, which is lower than the average of 1 in 22 in sub-Saharan Africa and per 100 000 live births versus an average of 900 per 100 000 live births in the global figure of 1 in 92. sub-Saharan Africa and an average of 400 per 100 000 live births globally. 1/20 1/22 1000 9/200 900 900 1/25 800 7/200 700 3/100 600 1/40 500 400 400 1/50 live births 300 3/200 210 1/92 200 1/100 Deaths per 100 000 1/170 100 Lifetime risk of death (1 in N) 1/2000 0 0 Namibia Sub-Saharan World Namibia Sub-Saharan World Africa Africa Source: Maternal mortality in 2005: estimates developed by WHO, UNICEF, UNFPA and the World Bank.
    [Show full text]
  • Evaluation of a Traditional Birth Attendant Training Programme in Bangladesh
    Midwifery 27 (2011) 229–236 Contents lists available at ScienceDirect Midwifery journal homepage: www.elsevier.com/midw Evaluation of a traditional birth attendant training programme in Bangladesh Tami Rowen, MD, MS (Resident Physician)a, Ndola Prata, MD, MSc (Assistant Adjunct Professor)b, Paige Passano, MPH (Associate Specialist in Maternal Health)c,Ã a University of California San Francisco School of Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, 505 Parnassus Avenue – Room 1483, Box 0556, San Francisco, CA 94143-0132, USA b Bixby Center for Population, Health, and Sustainability, School of Public Health, University of California, Berkeley, 229 University Hall, Berkeley, CA 94720-6390, USA c Bixby Center for Population, Health, and Sustainability, School of Public Health, 50 University Hall, University of California, Berkeley, Berkeley, CA 94720-6390, USA article info abstract Article history: Background and context: the 1997 Safe Motherhood Initiative effectively eliminated support for training Received 5 January 2009 traditional birth attendants (TBAs) in safe childbirth. Despite this, TBAs are still active in many countries Received in revised form such as Bangladesh, where 88% of deliveries occur at home. Renewed interest in community-based 21 May 2009 approaches and the urgent need to improve birth care has necessitated a re-examination of how Accepted 7 June 2009 provider training should be conducted and evaluated. Objective: to demonstrate how a simple evaluation tool can provide a quantitative measure of Keywords: knowledge acquisition and intended behaviour following a TBA training program. Traditional birth attendant Design: background data were collected from 45 TBAs attending two separate training sessions Training conducted by Bangladeshi non-governmental organization (NGO) Gonoshasthaya Kendra (GK).
    [Show full text]