The impact of using a modified Ministry of Health Traditional birth attendant training curriculum on the infection prevention knowledge, practice and attitute of trained traditional birth attendants in Chongwe District of Zambia
Chanda, Dorothy O.
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Introduction:Poor infection prevention practices have been reported among Traditional Birth Attendants (TBAs) in Lusaka province in Zambia. High maternal and infant infection rates of 20% and 27.3%, respectively, among deliveries by TBAs were reported in Chongwe. Meanwhile, in Mpanshya, maternal and infant infection rates were 21% and 27%, respectively. These infection rates can be reduced if TBAs are well-trained. The objectives of the study were to determine the impact of a modified Ministry of Health TBAs training curriculum on the infection prevention knowledge, practice and attitude of TBAs on the infant and maternal infection rates before and after the intervention in Chongwe District.Material and Methods:The study design was a quasi-experimental study. Both qualitative and quantitative data were collected. Focus group discussions were used to collect qualitative data, while a semi- structured interview schedule was used to collect quantitative data. The study was conducted between 31st January 2008 and 6th March 2009. Data analyses included running frequencies, determining associations using the Pearson’s Chi-square, and conducting a multivariate logistic regression analysis. The level of statistical significance was set at 5%.Results:Totals of 238 study participants at baseline and 207 during the intervention phases were enrolled into the study. Results showed that approximately 98 (41.1%) of the study participants were aged 30-43 years. The study showed that 36 (30.3%) and 66 (55.5%) of the participants in Mpanshya and Chongwe, respectively, attained secondary education during baseline (P<0.001), while 33 (33%) in Chongwe compared to 19 (17.8%) in Mpanshya attained secondary education during the training phase (p=0.032).At pre-course, a higher proportion of participants 38 (31.9%) in Chongwe had inadequate knowledge than 2 (1.7%) in Mpanshya (p=0.001). However, after the post course, a higher proportion of participants in Chongwe 76 (76.0%) had excellent (62-82 correct responses) infection prevention knowledge compared to 0 (0%) in Mpanshya (p=0.001).At pre-course, a higher proportion of participants in Mpanshya had satisfactory practice than in Chongwe (p=0.017). However, after the post course, a higher proportion 32 (32%) of participants in Chongwe had significantly (p=0.001) excellent practice (49-59 correct responses) more than the participants in Mpanshya where no participants had excellent practice.At both pre and post course all the study participants had good attitudes (measured by scoring 4-8 correct responses) towards the care of the mothers and the babies and after the intervention only 1 (0.9%) of participants in Mpanshya had poor attitude while the rest in Mpanshya and all of them in Chongwe had good attitude. During pre-intervention, 32 (26.7%) of the 120 babies in Mpanshya had infections compared to 18 (27.3%) of the 66 babies in Chongwe. However, during the monitoring and evaluation phase, 2 (1.5%) of the 131 babies in Mpanshya had infections (p<0.001), while no infections were recorded among 147 babies in Chongwe (p<0.001).About 1 in 5 mothers in both sites had infections before the intervention 25 (20.8%) of 120 mothers in Mpanshya, and 13 (19.7%) of 66 mothers in Chongwe). However, during the monitoring and evaluation phase, the maternal infection rates reduced to 23 (17.5%) of 131 mothers in Mpanshya (p=0.618), and to 9 (6.1%) of 147 mothers in Chongwe (p=0.006).Conclusion: The increase in infection prevention knowledge, good practices and attitudes among the intervention TBAs may have been due to the impact of the training intervention. The infant infection rates reduced in both sites during the study. While no significant change in rates of maternal infection before and after the intervention was observed in Mpanshya, there was a significant reduction in maternal infection rate in Chongwe. This may have been due to the impact of training the intervention TBAs using the modified MoH TBA training curriculum. Although training the intervention TBAs using the modified MoH TBA training curriculum reduced maternal and infant morbidity rates in Chongwe district, it remains to be seen how it would perform in other settings
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