Utilisation of maternity care services offered by trained Traditional Birth Attendants in Chongwe District

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Hazemba, Alice Ngoma
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It has been estimated that 53% of women in Zambia deliver outside the modern health care facilities. These deliveries were attended by either friends/neighbours, relatives and traditional birth attendants (TBAs), some of whom were trained. The training was intended to equip them with basic skills in providing clean and safe deliveries and subsequently contribute to a reduction in maternal mortality rate of 649/100,000 live births (ZDHS, 1996). However, the trained traditional birth attendants (TTBAs) were under-utilised. They attended only 5% of deliveries. Objectives:-Determine the services offered by TTBAs - Establish the level of utilisation of maternity care services offered by TTBAs - Determine the factors associated with utilisation of maternity care services offered by TBAs - Make recommendations for effective utilisation of TTBAs. Study Design: A cross sectional study was carried out. Study Site:Chongwe District. Subjects and Sampling: A total of 140 practicing TBAs, both trained and untrained were included in the study in order to determine factors associated with utilisation of TTBAs. There were 44 TTBAs and 96 UTTBAs. In addition 250 mothers who were the recipients of the maternity care services offered by TBAs were interviewed. About 13 mothers in the reproductive age range of 15-49 years, having delivered 6 months prior to the date of data collection from each of the health centres were interviewed. Main outcome measure: Utilisation of maternity care services offered by trained traditional birth attendants. Results:The study revealed that utilisation of the services offered by TTBAs was at 17.6% based on their availability and accessibility. Regarding the services offered, respondents who offered deliveries only were 77.0% less likely to be TTBAs compared to respondents who offered antenatal care (ANC), deliveries and postnatal care (PNC). As regards deliveries conducted, compared to respondents who conducted more than ten deliveries, respondents who conducted between 5 and 9 were 82% less likely to be TTBAs. Further, women interviewed indicated that long distance (36.0%) and lack of trained staff to attend to obstetrical emergencies (45.6%) were some of the problems that made it difficult for them to access the services of skilled attendants. Among the mothers interviewed 23.2% accessed the services of TTBAs and of those 75.9% utilised them because they were affordable (53.6%). In the event of complications occurring it was revealed that respondents who encountered post partum haemorrhage and infections were 2.25 times more likely to be attended by TTBAs. On further management 70% of TTBAs referred their clients to the health centres compared to 50% of UTTBAs who used unconventional methods such as herbs and bathing the women in cold water.The study further revealed that TTBAs maintained contact with health centre staff. Half of the TTBAs were visited by health centre staff while, 75.0% also indicated that they visited the health centres. In addition 70.5% received supplies to use when conducting deliveries, 59.1% had delivery kits and nearly 50% recommended that they should have been receiving supplies on regular basis. However, only 43.2% received remunerations, but they still felt that the community appreciated their services because they were affordable (45.5%) and the demand was high (40.9%). In conclusion, TTBAs were less utilised and their impact could not have been felt because they were less in number compared to the UTTBAs. Training of TBAs should therefore, be part of a broader strategy because skilled attendants alone cannot effectively reduce maternal mortality. However, this should be supported by a functioning referral system, backup professional support, improved supervision and supplies as well as well arranged remunerations.
Traditional Birth Attendants -- Zambia , Maternity Nursing -- Zambia , Midwives