COMPLETE SCHOOL PROJECT TOPICS & MATERIALS :
CHAPTERS: Chapter 1-5
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ABSTRACT
Traditional Birth Attendants are traditional, independent non-formally trained and community based provider of care during pregnancy, labour and post partum period. Despite the important role TBAs play, some of their services and practices are very crude and ineffective. This analytical descriptive survey was therefore carried out to investigate the services and practices of TBAs in selected communities of Southern Ijaw local government area of Bayelsa State. The study population comprises of 385 TBAs who met the inclusion criteria. Four objectives and four research question where sket up. Also two hypotheses were postulated to test relationship between variable. A researcher self developed questionnaire was used to collect data between 13thJuly to 27th august 2015. The data collected were analyzed using the Statistical Package for the Social Sciences (SPSS) version 20. Descriptive statistics in form of frequency and percentage table as well as bar chart, were used to summarize the data. The Pearson chi-square(X2) was used to test for relationship between variables. Major finding from the study showed that, there is a significance relationship between TBAs age and their routine practices for antenatal care as the chi-square competed Xc2 = 740.85 is ≥ the chi-square critical X2 = 41.38. There was also a significant relationship between age of TBAs and their practices during labour (Xc2 = 846.45 ≥ X12 = 36.42). Also there is a significant relationship between TBAs age and their routine practices during delivery. There is also a significant TBAs age and their routine practices for post partum care. The study also showed that there is a significance relationship between educational attainment of TBAs and their hygiene practices (Xc2 = 318.614 ≥ X12 = 36.30). The study reveals that most TBAs render delivery services, most of them encouraged their clients to engage in food taboos during pregnancy. Also most of the TBAs know the important of hand washing before and after a procedure. Most TBAs massage the abdomen of pregnant women during pregnancy. The study also showed that, most TBAs see referral as their last resort when they are face with complications and most of the TBAs lack the knowledge of early danger signs in expectant mothers. Based on these findings, it is therefore recommended that TBAs should be properly trained by orthodox health care practitioners in the area of identifying early signs of complications during antenatal, intranatal and the post-partum period.
CHAPTER ONE
INTRODUCTION
Background to the Study
Millennium Development Goals (MDGs) 4 and 5 call for countries to reduce by two thirds the mortality rate of children under five and to reduce maternal mortality by 75% by the year 2015 (United Nations 2000) . Each year, about four million neonatal deaths occur globally, accounting for 38% of under 5 mortality, 95% of these deaths occur in low and middle income countries, and over half occur in home deliveries without skilled attendants (Martins et al, 2005). Approximately 50% of the deaths occur within the first 24 hours of life, highlighting the need to address the immediate care of the new born. It is also estimated that between 60 – 80% of all deliveries in the developing countries occur outside modern healthcare facilities with a significant proportion of the deliveries attended by Traditional Birth Attendants (WHO, UNICEF/UNFPA, 2010).In an Eastern Nigerian study, it was found that although 93% of rural women who had a childbirth or spontaneous abortion registered for prenatal care 49% delivered at home under the care of TBAs. (Nwakoby & Roy 2011). Also, in a study of 377 women who delivered before arrival at the hospital in Ogbomosho South Western Nigeria, 65% of the mothers had been delivered by a TBA, while 73.7% had sought help from TBAs for retained placenta with bleeding (MacAuthur, 2009).
Up to two-thirds of maternal and neonatal deaths are preventable with low-cost, low-technology community interventions (Darmstadt et al, 2005). These deaths extend from pregnancy, through childbirth and the neonatal period, and beyond (Darmstadt et al, 2005, and Martines et al 2005,).
The majority of estimated 529,000 annual maternal deaths also occur in low and middle income countries. Most of the deaths are due to severe bleeding, hypertensive disorders and infections (Khan et al 2006), which are often a result of delays in recognizing danger signs, deciding to seek care, reaching an appropriate health facility in good time, and receive quality care (Khan et al 2006). While interventions to prevent maternal deaths may be complex, many are feasible for a wide range of community health workers (WHO, UNICEF/UNFPA, 2010). However, the place of delivery is one of the determinants of maternal and neonatal or child morbidity and mortality in Africa.
Traditional birth attendants (TBAs) have often been defined by WHO as Traditional, independent non-formally trained and community based providers of care during pregnancy, child birth and the postnatal period (WHO 2004). Traditional Birth Attendants are professionals as old as birthing process in the human species. They are either males or females and continue to play an important role in providing services during antenatal care, assistance during labour, delivery, and initial post partum care in many developing countries. They are easy to access in community setting and their services cost less. In some settings where skilled care is available, services are still under-utilized due to cultural barriers, poor access, perception of poor quality, higher cost, and a preference for care within the community. Services and practice of TBAs often varies in various countries and geographical locations. However, the services and practice of TBAs in Nigeria is similar to other developing countries in the world.
In Nigeria 37% deliveries take place in health facilities while over 58% of deliveries take place at home (Inem, Kanu, Atere, 2009).These deliveries that take place at home are conducted by traditional birth attendants. Nigeria has a shortage of skilled birth attendants, particularly midwives who are also unevenly distributed geographically (UNICEF, 2006). TBAs often fill this gap, and are found not only in the rural areas but in urban centres too, despite the abundance of orthodox medical services in cities (Itina, 1997).
It is being increasingly recognized that TBAs have a role to play in improving health outcomes in developing countries because of their access to communities, and the relationships they share with women in local communities, especially if women are unable to access skilled care (WHO, 2010). The role of TBAs in newborn health care has been considered and studies have shown the potential for TBAs to improve maternal and neonatal outcomes if properly trained. In India, a 44% reduction in neonatal pneumonia deaths was attributed to training TBAs in the management of pneumonia (fauveau, 2007). In Pakistan, a Cluster randomized controlled trial of a TBA training intervention was conducted and the results indicated a statistically significant (30%) reduction in perinatal mortality and a 29% reduction in perinatal mortality in the TBA training group compared with the control group (Jokhio et al, 2005).
TBAs may not have any formal training on how to attend to pregnant women, many TBAs are experienced in well women care including how to recognize and respond appropriately to complications of pregnancy. However, due to the lack of education in some TBAs, the way many attend to delivery could be risky for women and their babies, leading to poor health outcomes and even death (WHO, 2010). In some countries training institutes and non governmental agencies are initiating efforts to train TBAs in basic and emergency obstetric care, family planning and other maternal health topics. This is done in order to enhance the links between modern health care services and the community, and to improve the chances for better health outcomes among mothers and babies (WHO, 2010). There are some findings that targeted interventions for training TBAs can lead to reduced prenatal mortality (Wadinga, 2009).
In Ghana 57 traditional birth attendants were identified and trained by the Defa project in rural
Ghana in an effort to improve maternal and child health practices and promote family planning
(WHO, 2013). A small scale training programme for birth attendants in a remote area of Burkina Faso was evaluated two years after it had been started. The findings showed that the programme had been moderately successful in impacting knowledge and overcoming cultural inhibitors about assisted deliveries. However, there is little evidence of large scale effectiveness of such programme, as evidence have rarely integrated within a general strategy for improving maternal and child care (Mac-Arthur, 2009). This study is aimed at assessing the role of TBAs in maternal and neonatal health care in southern Ijaw Local Government area of Bayelsa state.
Statement of the Problem
Maternal, infant and neonatal mortality rates in Bayelsa State remains high at 509 per 100,000 live births, (for maternal mortality)15 per 1000 live births (for infant mortality) and 20 per 1000 live births (neonatal mortality) respectively (Bayelsa State Ministry of Health, 2011). Improved education and health systems have expanded access to care, but 50% of deliveries in Bayelsa State still occur at home (BSMH, 2011). In spite of the high patronage of TBAS, and their relative contribution in birth assistance, many of their practices during child birth have been found to adversely affect the health of mothers’ .Several morbidities affecting mother and child during and after child birth have been linked to poor birth hygiene and harmful traditional practices (Ofili and Okojie, 2005). One of such in the neonate is neonatal tetanus; neonatal tetanus is a leading cause of neonatal death in rural areas of Bayelsa State (BSMH, 2011) Okojie, 2005).
From personal experience where the researcher visited a TBA centre in Amassoma community at Bayelsa State in 2011, it was observed that TBAs do not observe proper hand washing technique before and after a procedure. At Niger Delta University Teaching Hospital where the researcher worked from 2009 to 2010 it was observed that 5 out of 8 mothers that visited the maternity ward with complications related to premature rupture of membrane and antepartum haemorhage have visited the TBAs for massage or other services. With the high maternal mortality ratio, rising prevalence of HIV/AIDS, and the high level of utilization of the services of TBAs, there is need to assess what the TBAs in southern Ijaw local government area of Bayelsa State, do or practice in maternal and neonatal health care programmes.
Purpose of the Study
The study is aimed at investigating the services and practices of TBAs in maternal and neonatal health care in Southern Ijaw Local Government Area of Bayelsa State.
Objectives
Objectives of the study are to
- Identify the maternal and neonatal services provided by TBAs in Southern Ijaw Local
Government Area (SILGA) of Bayelsa State
- Determine TBAs routine practices during antenatal, labour, delivery and postnatal Period
- Elicit the new born cord care practices used by TBAs in Southern Ijaw Local government area of Bayelsa State.
- Ascertain the practices of TBAs with regards to management of obstructed labour, premature rupture of membrane, malpresentation, and post partum hemorrhage in
Southern Ijaw Local Government Area, Bayelsa State.
Research Questions
- What are the services provided by TBAs in Southern Ijaw Local Government Area of
Bayelsa State?
- What are the routine practices of TBAs for antenatal, intranatal and postnatal care?
- What are the newborn cord care practices of TBAs in Southern Ijaw Local Government
Area of Bayelsa State?
- What are the practices of TBAs in the management of maternal complications such as obstructed labour, premature rupture of membrane, malpresentation, and post partum hemorrhage?
Hypothesis
- There will be no significant relationship between TBA’s age and their routine practices for antenatal, labour, delivery and post partum care.
- There will be no significant relationship between TBAs educational attainment and practices during antenatal, labour and postnatal period.
Significance of Study
The information and facts gathered from this study will create empirical evidence on the services and practices of TBAs which includes both positive and negative effects in maternal and neonatal health care.
It will provide information into assessment, diagnosis, planning, interventions, monitoring and evaluation of maternal and neonatal health care programes. It will also be supplemental in other related spheres such as human relation and human resources management to promote proficiency in maternal and child health issues.
The information gotten from this study shall as well be vital to government and to stakeholders in the health care industry in organizing seminar training programs for TBAs, monitoring their interventions and sensitizing women in places that cannot access quality midwifery and obstetric care . It is hoped that the study will create a data base for future researchers within the circle of maternal and child health or traditional birth attendant practices.
Scope of the Study
The scope covers traditional birth attendants; also cover the services and practices of TBAs in maternal and neonatal health care in selected communities, in Southern Ijaw Local Government Area of Bayelsa State.
Operational Definition
Traditional Birth Attendants: They are women/men who reside within the community, who may have obtained their skill through apprenticeship or by inheritance and provide antenatal, intranatal and postnatal care to mothers and care for the newborn in Southern Ijaw Local Government Area of Bayelsa State.
Services of TBAs: This has to do with those intangible commodities such as antenatal, intranatal and postnatal care provided by TBAs in Southern Ijaw Local Government Area of
Bayelsa State.
Maternal and neonatal health care: These are activities such as caring for the expectant mothers, delivery of baby, massage, use of herbs, health education, infection control etc. that are done to improve the health, wellness and quality of life of women and neonates in selected communities in Southern Ijaw Local Government Area of Bayelsa State.
Practices of TBAs: This has to do with customary or habitual way in which TBAs use in carrying out their care activities in selected communities of Southern Ijaw Local Government Area of Bayelsa State.
Practices: This has to do with the way and manner TBAs carry out their customary and habitual activities while caring for the expectants mothers and neonates.
Antenatal care: This is care giving to expectant mothers by TBAs in selected communities in Southern Ijaw Local Government Area of Bayelsa state.
Intranatal care: This is the care giving to women by TBAs during labour in selected communities of Bayelsa State.
Post partum care: This is the care giving to mothers by TBAs during the first 6 weekss of delivery in selected communities of Bayelsa State.