Factors influencing provision of maternal health care services by traditional birth attendants in Nzega district

Abstract

A cross sectional descriptive study was conducted in Nzega district, which is one of the districts in Tabora region. Data was collected over a two-week period in July 2004. The main objective of the study was to look into the factors influencing the provision of maternal health care services by traditional birth attendants in Nzega district. The study was also done to fulfill part of the requirements for the award of the Master's of Public Health (MPH) degree of the University of Dar es Salaam. A total of 196 traditional birth attendants were interviewed using an interviewer administered questionnaire and another 25 participated in focus group discussions. The sample size was obtained through multistage cluster sampling i.e. from the district to the village level all traditional birth attendants in the study villages were identified and registered by using village health workers and every traditional birth attendant was given an equal chance to participate in the study by simple random sampling. The sample was obtained from 20 villages in Nyasa Division, Nzega District. Data was collected by one researcher (the author) with the assistance of four research assistants. The results showed that there were 10504 deliveries in the district in 2003. Among these 10366 were live births. Out of these deliveries 321 were reported by traditional birth attendants and it is most likely that they were assisted by trained traditional birth attendants. Also there were 20 (193/1 00,000) maternal deaths and 70 neonatal deaths reported. Rupture of the uterus, postpartum haemorrhage, puepural sepsis, EPH gestosis, eclampsia, anaemia, malaria and HfV were the causes of maternal

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deaths. Nzega district has a total of 878 traditional birth attendants among these, 95 had received training. Out of the 196 traditional birth attendants interviewed 23 (11.7%) were trained and 173 (88.3%) were untrained. Hygienic practices during delivery was noted to be common to both categories of traditional birth attendants but more with trained traditional birth attendants. This is shown by the use of clean gloves (78.3 vs 58.5%), new razor blade (95.7% vs 84.4%), soap (95.7% vs 90.1%), clean clothing or sheet (73.9% vs 46.5%) and clean water (95.7% vs 90.7%). Referral to a health facility was more common among trained traditional birth attendants i.e. 100% vs 73.9% respectively. It was observed that trained traditional birth attendants provide a wider range of maternal health care services compared to untrained traditional birth attendants. A higher proportion of trained traditional both attendant compared to untrained one reported that they provide family planning services (52.2% vs 18.1%), giving advice on infant and young child feeding (60.5% vs 12.7%) and examining pregnant women (30.4% vs 70.3%). These findings are statistically significant (P<0.005). Factors that hinder traditional birth attendants in Nzega in providing their services include being labelled witches (99.5%) and poor community support (88.3%). Traditional birth attendants mentioned that the following would improve their provision of mother and child health services that is being provide delivery supplies

xvi (100%), training (89.8%), recognition from the government (89.3%) and improved transport to the referral facility (72.4%). Among the recommendations of the study is that Council Health Management Team should plan training programmes for traditional birth attendants followed by frequent supportive supervision. Traditional birth attendants should also be provided with delivery supplies regularly.