WHO recommendation on partnership with Traditional Birth Attendants (TBAs)

Literature review on traditional birth attendants, who recommendation...

Therefore, it is likely clear to assume that integrating TBA training into the health care system could be an effective strategy to reduce perinatal mortality, but not maternal mortality ratio. Hospital births also increased over time in a study in Pakistan where EmOC provision was part of the intervention in a refugee population Purdin, Khan and Saucier, and in the culturally adapted birth model Gabrysch et al. Conclusion and Global Health Implications: Recent task shifting work has focused on the roles lay health workers including TBAs can assume.


Community and intersectoral participation was recommended to guide implementation. For the outcome of birth with a skilled birth attendant or facility birth, the quality of the evidence was rated as very low.

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Indeed, in the South Asia countries like Bangladesh, Bhutan, Nepal and Sri-Lanka, CHWs can help health care systems overcome both personnel and financial shortages by providing high quality and cost-effective services to people in their homes [ 11 ].

Inclusion criteria included articles that examined the role of traditional birth attendants as a factor influencing maternal health in Nigeria. Therefore, it is case study sweatshops clear to assume that integrating TBA training into the health care system could be an effective strategy to reduce perinatal mortality, but not maternal mortality ratio.

Healthcare resources in Timor-Leste Timor-Leste significantly faces some challenges in generating resources for health systems particularly human and physical resources such as facilities and equipment. Due to their cultural and social acceptability, knowledge and experience, TBAs can be considered an important ally for health education and social support and how to problem solving and decision making positive link between women, families, communities and the formal health fun creative writing ideas system.

In addition to performing home delivery and referral system for pregnancy complications, TBAs have also been engaged in some basic health care functions such as health promotion and disease prevention.

Most TBAs are middle-aged or older women and are highly respected in their roles as midwives to rural communities.

Specific areas of training for TBAs that were identified and recommended in review including: Eight manuscripts that were examined highlighted the role of TBAs in maternal health including outcomes of utilizing trained versus non-trained TBAs. Similarly, training of TBAs in hygienic practice during delivery does not prevent postpartum infections [ 21 ].

Maternal and child health situation in Timor-Leste Maternal height and pre-pregnancy weight has enormous influence over birth outcomes. It is recommended that supervision and direct observation of TBAs at work are critical for clarification of the most appropriate role of TBAs in reducing maternal mortality and morbidity in the poorest and most vulnerable settings.

  1. Four observational studies reported on this outcome.
  2. Remarks were added to clarify the recommendation, and aid implementation.

Lack of access to quality health care, lack of skilled health workers, education and poverty are structural pro/con essay on death penalty that have thesis for new england colonies to maternity mortality rates in Nigeria, especially in rural areas Odusola, Two studies show a trend towards more women reporting SBA over time: Open in a separate window Adapted from Lehmann and Sanders [ 8 ].

For example, in the rural settings of Gambia, Ghana, South Africa and Tanzania, CHWs fun creative writing ideas minimal additional training have played vital roles in delivering counseling, treatment and health education for such important diseases as malaria, HIV and tuberculosis for the local communities [ 10 ].

Statistics also show that 30 per cent of births are delivered by a skilled nurse or midwife, nearly 18 per cent of deliveries are carried out by TBAs and 49 per cent by a relative or some other people, which are relatively high [ 24 ]. Overall, the studies report improvements in use of SBA following implementation of the interventions compared with data in the period before the interventions were put in place.

In reviewing the evidence on which tasks could be assumed by lay health workers, trained TBAs were considered and defined as a person who assists the mother during childbirth and who initially acquired their skills by attending births themselves or through an apprenticeship to other TBAs. The IFC Framework was developed in response to analysis and global statements indicating that as well as strengthening services, MNH strategies need to improve the capacity of individuals, families and communities to provide appropriate care for pregnant women, mothers, and newborns in the home.

Implementation considerations Interventions to support countries to transition from birth with a TBA to birth with an SBA are particularly important in light of priority strategies to increase SBAs and the human resource challenges in achieving this goal.

WHO recommendation on partnership with Traditional Birth Attendants (TBAs) | RHL

A longitudinal panel survey Frankenberg et al. Exact costs are not available. Methods The recommendation was developed using standardized operating procedures in accordance with the process described in the "WHO handbook for guideline development", guided by the GRADE approach. In specific to TBAs, they have been widely defined as the community or family members normally females of old age groups who are a product of tradition in assisting mothers during home delivery [ 13 ].

It is clear that there may be settings such as in remote areas, humanitarian situations or overloaded health centres where TBAs attending births are considered necessary. It also addresses the reasons - over and above what happens in clinical services - why women do not reach good quality skilled care during pregnancy, childbirth and after birth.

Policies focused on improving access to health services and importantly, formal health education training to TBAs, are required to improve maternal health outcomes and underserved communities. Only one study Mullany et al. Whilst much have been done to build the capacity of the health sector service delivery, it is clear that the quality of services needs to be further enhanced.

In this paper, a purposive literature review examining the role of traditional birth attendants TBAs maternal health in Nigeria was conducted. The findings from a study that took place in a rural area of Bangladesh illustrated that although trained TBAs were likely to practice hygienic delivery, there was no significant difference in levels of postpartum infections when delivering births by trained TBAs and untrained TBAs [ 21 ].

1. Background and Objectives

Indeed, it seems likely that appropriate training and supervision should be provided for TBAs [ 15 ]. A greater number of public health studies have been undertaken to review and identify the explanations for continued existence of TBAs, hence their roles in delivering maternity care within the poorest communities.

TBAs are defined as providers who are traditionally independent of the health system, and are community-based providers of care during pregnancy, childbirth and the postnatal period.

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  • The IFC Framework was developed in response to analysis and global statements indicating that as well as strengthening services, MNH strategies need to improve the capacity of individuals, families and communities to provide appropriate care for pregnant women, mothers, and newborns in the home.

Background In the World Health Organization WHO published "Working with individuals, families and communities to improve maternal and newborn health", 2 the IFC framework that promotes integrating the health promotion approach set out in the Ottawa Charter 3 into national maternal and newborn health MNH strategies. Discussion of innovative study designs including different disciplines and methods in order to improve the breadth of the evidence base.

In contrast to those findings above, it is argued that trained TBAs without the support of skilled back-up services may not significantly reduce maternal mortality aluminium windows business plan [ 17 ].

WHO recommendation on partnership with Traditional Birth Attendants (TBAs)

A multifaceted approach is recommended to prepare TBAs and others for new roles, including the training of TBAs to strengthen their knowledge and skills to enable them to be able to assume new roles, the sample statement of the problem in thesis proposal pdf of health providers, communities, women and their families and TBAs to ensure mutually respectful dialogue and to establish trusting relationships, and the integration of other stakeholders to contribute to a support system for the transition period.

Nigeria has a high maternal mortality rate. When thesis salon rates training, such as clean practice of cutting umbilical cord clean labor practiceis available, these cadres of community health workers can serve as effective as readily available human resources in mobilizing communities, and delivering reproductive care to women in the poorest settings.

  • It seems likely that the inclusion of clean practice in TBA training program is ineffective to prevent postpartum infections.
  • Partnership for Maternal, Newborn, and Child Health.
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All four studies showed that postpartum visits to women increased over time following the implementation of a TBA intervention Fauveau et al. The need for systematic monitoring of interventions over time.

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The reported maternal mortality ratio was deaths perlive births Nigerian National Demographic and Health Survey, It is difficult to distinguish the effect of individual component s from the overall programmes or programme from existing safe motherhood initiative activities. The need for studies to explore and record the preferences articulated by those providing and receiving care in more detailed and rigorous ways.

The Ottawa Charter's health promotion components 3 were translated into MNH programme language and 12 promising interventions - identified through reviews of country experiences and the literature - were categorized into four priority areas. The most probable view on this would be that TBA training in hygienic practice does not seem to give impact to the improvement of women reproductive health; therefore, evaluation of the training program is rigorously required with special attention to measure the specific outcomes such as maternal morbidity due to postpartum infections.

Hospital births also increased over time in a study in Pakistan where EmOC provision was part of the intervention in essay on i want to become an automobile engineer refugee population Purdin, Khan and Saucier, and in the culturally adapted birth cover letter for finance and admin officer Gabrysch et al. This would ultimately be applicable to poorest settings where TBA training has not yet been considered as part of an innovative strategy to combat shortages of human resources in health systems.

The appropriate training simply means that it has to be practical-based training. GDG members discussed the balance between desirable and undesirable effects, overall quality of supporting master thesis software development, values and preferences of stakeholders, resource requirements, cost-effectiveness, acceptability, feasibility and equity, to formulate the recommendation.

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A recent cluster-randomized controlled trial study in Pakistan demonstrated that involving trained TBAs in reproductive care did not reduce maternal mortality, but instead it led to a reduction in perinatal mortality [ 19 ]. Also, TBA training was significantly associated with referral behavior and maternal service use by women with obstetric complications [ 16 ].

Two other studies, one in Peru and the other in Indonesia Gabrysch et al.

TBA training was found to be associated with significant increases in attributes such as TBA knowledge, attitude, behavior and advice for antenatal care [ 14 ] and pregnancy outcomes [ 15 ]. The health status at the community level remains low and for many children and women life remains a day-to-day struggle for survival. Background and Objectives Nigeria is comprised of local governments and ethnic groups, thus setting the stage for great variability in customs and traditions regarding childbirth and postnatal practices.

Despite of being known by different titles, some literatures reveal that the tasks performed by CHWs are essentially the same. Case studies of countries who have implemented policies to ban TBAs and the effect of these policies as well as those countries who have experience in implementing strategies but which may not yet be documented in the literature, such as in Latin America.

The GDG comprised of a group of independent experts, who used the evidence profiles to assess evidence on effects on the pre-specified outcomes.

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As stated in the original IFC framework concept and strategy paper, 2 while WHO and partners move ahead in the promotion of skilled birth attendants and skilled care for childbirth, the responsibility of TBAs in MNH in those countries and areas where they currently are providers of childbirth care must be specified.

A total of six studies were identified. Abstract Background and Objectives: While much of the country remains agrarian, a phenomenon of rapid urbanization has been reported where about 22 per cent of the population lives in the urban areas [ 25 ]. As noted above, interventions of interest for purposes of this review were those where TBAs were providers of childbirth care and efforts were made to increase childbirth with an SBA.

Following the years since the introduction of the Safe Motherhood Program, training of TBAs has been recognized as one of the interventions intended to reduce maternal mortality and morbidity rates as well as to improve the reproductive health essay on i want to become an automobile engineer women [ 14 ]. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Therefore, the roles of TBAs should be functioned by good referral system and sufficient health infrastructures, equipped with clean-birth kits after training sessions and supported from professionally trained health workers during regular supervision [ 21 ]. However, although TBA training may have been associated with reduction of a substantial proportion of maternal mortality and morbidity, the information and material about the training program should be improved and the effect of the training needs to be evaluated in order to develop a strong evidence base.

Those tasks performed by TBAs have included disseminating information about perinatal HIV transmission, identifying pregnant women in their communities and facilitating the use of available antenatal care and maternity care, ensuring routine HIV counseling for women and their partners, supervising treatment of mother and infant with nevirapine and offering advice to women on reducing the risk of HIV transmission [ 19 ].

Partnership for Maternal, Newborn, and Child Health. Additional research is required.