Potential role of traditional birth attendants in neonatal healthcare in rural southern Nepal

Tina Y Falle, Luke C Mullany, Nandita Thatte, Subarna K Khatry, Steven C LeClerq, Gary L Darmstadt, Joanne Katz, James M Tielsch, Tina Y Falle, Luke C Mullany, Nandita Thatte, Subarna K Khatry, Steven C LeClerq, Gary L Darmstadt, Joanne Katz, James M Tielsch

Abstract

The potential for traditional birth attendants (TBAs) to improve neonatal health outcomes has largely been overlooked during the current debate regarding the role of TBAs in improving maternal health. Randomly-selected TBAs (n=93) were interviewed to gain a more thorough understanding of their knowledge, attitudes, and practices regarding maternal and newborn care. Practices, such as using a clean cord-cutting instrument (89%) and hand-washing before delivery (74%), were common. Other beneficial practices, such as thermal care, were low. Trained TBAs were more likely to wash hands with soap before delivery, use a clean delivery-kit, and advise feeding colostrum. Although mustard oil massage was a universal practice, 52% of the TBAs indicated their willingness to consider alternative oils. Low-cost, evidence-based interventions for improving neonatal outcomes might be implemented by TBAs in this setting where most births take place in the home and neonatal mortality risk is high. Continuing efforts to define the role of TBAs may benefit from an emphasis on their potential as active promoters of essential newborn care.

References

    1. Bhutta ZA, Darmstadt GL, Hasan BS, Haws RA. Community-based interventions for improving perinatal and neonatal health outcomes in developing countries: a review of the evidence. Pediatrics. 2005;115(Suppl 2):519–617.
    1. Parlato R, Darmstadt GL, Tinker A. Qualitative research to improve newborn care practices: a guide for program managers. Washington, DC: Save the Children-USA; 2004. p. 41 p..
    1. Narayanan I, Shaver T, Clark A, Cordero D, Faillace S. Entry into this world: who should assist? Birth attendants and newborn health. Arlington, Virginia: Basic Support for Institutionalizing Child Survival Project for United States Agency for International Development, 2004; 2004. p. 12 p..
    1. de Bernis L, Sherratt DR, AbouZahr C, Van Lerberghe W. Skilled attendants for pregnancy, childbirth and postnatal care. Br Med Bull. 2003;67:39–57.
    1. World Health Organization. Traditional birth attendants: a joint WHO/UNFPA/UNICEF statement. Geneva: World Health Organization; 1992. p. 18 p..
    1. Kamal IT. The traditional birth attendant: a reality and a challenge. Int J Gynaecol Obstet. 1998;63(Suppl 1):S43–52.
    1. Leedam E. Traditional birth attendants. Int J Gynaecol Obstet. 1985/9;23:249–74.
    1. Campbell OM, Graham WJ, Lancet Maternal Survival Series Steering Group Strategies for reducing maternal mortality: getting on with what works. Lancet. 2006;368:1284–99.
    1. United Nations Population Fund. Maternal mortality update 2002: a focus on emergency obstetric care. New York, NY: United Nations Population Fund; 2003. p. 40 p..
    1. Derman RJ, Kodkany BS, Goudar SS, Geller SE, Naik VA, Bellad MB, et al. Oral misoprostol in preventing postpartum haemorrhage in resource-poor communities: a randomised controlled trial. Lancet. 2006;368:1248–53.
    1. Walraven G, Blum J, Dampha Y, Sowe M, Morison L, Winikoff B, et al. Misoprostol in the management of the third stage of labour in the home delivery setting in rural Gambia: a randomised controlled trial. BJOG. 2005;112:1277–83.
    1. Nepal . Ministry of Health and Population. Population Division. Nepal demographic and health survey 2006. Kathmandu: Ministry of Health and Population, Government of Nepal; 2007. p. 417.
    1. Nepal . Ministry of Health. Department of Health Services. Family Health Division. Nepal family health survey 1996. Kathmandu: Ministry of Health, Government of Nepal; 1997. p. 250.
    1. Mullany LC, Darmstadt GL, Khatry SK, Katz J, LeClerq SC, Shrestha S, et al. Topical applications of chlorhexidine to the umbilical cord for prevention of omphalitis and neonatal mortality in southern Nepal: a community-based, cluster-randomised trial. Lancet. 2006;367:910–8.
    1. Rhee V, Mullany LC, Khatry SK, Katz J, LeClerq SC, Darmstadt GL, et al. Impact of maternal and birth attendant hand-washing on neonatal mortality in southern Nepal. Arch Ped Adol Med. 2008 [in press].
    1. Mullany LC, Katz J, Li YM, Khatry SK, LeClerq SC, Darmstadt GL, et al. Breastfeeding patterns, time to initiation, and neonatal mortality risk among newborns of southern Nepal. J Nutr. 2008;138:599–603.
    1. Tielsch JM, Darmstadt GL, Mullany LC, Khatry SK, Katz J, LeClerq S, et al. Newborn skin cleansing with a dilute chlorhexidine solution reduces neonatal mortality in southern Nepal: a community-based cluster-randomized trial. Pediatrics. 2007;119:e330–40.
    1. Tsu V. Nepal clean home delivery kit: evaluation of the health impact. Seattle, WA: PATH; 2000. p. 33 p..
    1. Osrin D, Tumbahangphe KM, Shrestha D, Mesko N, Shrestha BP, Manandhar MK, et al. Cross sectional, community based study of care of newborn infants in Nepal. BMJ. 2002;325:1063.
    1. Fikree FF, Ali TS, Durocher JM, Rahbar MH. Newborn care practices in low socioeconomic settlements of Karachi, Pakistan. Soc Sci Med. 2005;60:911–21.
    1. Manandhar DS, Osrin D, Shrestha BP, Mesko N, Morrison J, Tumbahangphe KM, et al. Effect of a participatory intervention with women's groups on birth outcomes in Nepal: cluster-randomised controlled trial. Lancet. 2004;364:970–9.
    1. Syed U, Asiruddin S, Helal MS, Mannan II, Murray J. Immediate and early postnatal care for mothers and newborns in rural Bangladesh. J Health Popul Nutr. 2006;24:508–18.
    1. Edmond KM, Zandoh C, Quigley MA, Amenga-Etego S, Owusu-Agyei S, Kirkwood BR. Delayed breastfeeding initiation increases risk of neonatal mortality. Pediatrics. 2006;117:e380–6.
    1. Darmstadt GL, Saha SK. Traditional practice of oil massage of neonates in Bangladesh. J Health Popul Nutr. 2002;20:184–8.
    1. Winch PJ, Alam MA, Akther A, Afroz D, Ali NA, Ellis AA, et al. understandings of vulnerability and protection during the neonatal period in Sylhet district, Bangladesh: a qualitative study. Lancet. 2005;366:478–85.
    1. Mullany LC, Darmstadt GL, Khatry SK, Tielsch JM. Traditional massage of newborns in Nepal: implications for trials of improved practice. J Trop Pediatr. 2005;51:82–6.
    1. Darmstadt GL, Mao-Qiang M, Chi E, Saha SK, Ziboh VA, Black RE, et al. Impact of topical oils on the skin barrier: possible implications for neonatal health in developing countries. Acta Paediatr. 2002;91:546–54.
    1. Darmstadt GL, Saha SK, Ahmed AS, Chowdhury MA, Law PA, Ahmed S, et al. Effect of topical treatment with skin barrier-enhancing emollients on nosocomial infections in preterm infants in Bangladesh: a randomised controlled trial. Lancet. 2005;365:1039–45.
    1. Darmstadt GL, Badrawi N, Law PA, Ahmed S, Bashir M, Iskander I, et al. Topically applied sunflower seed oil prevents invasive bacterial infections in preterm infants in Egypt: a randomized, controlled clinical trial. Pediatr Infect Dis J. 2004;23:719–25.
    1. Darmstadt GL, Saha SK, Ahmed ASMNU, Ahmed S, Chowdhury MAKA, Law P, et al. Effect of skin barrier therapy on neonatal mortality rates in preterm infants in Bangladesh: a randomized, controlled, clinical trial. Pediatrics. 2008;121:522–9.
    1. Prata N, Mbaruku G, Campbell M. Using the kanga to measure postpartum blood loss. Int J Gynaecol Obstet. 2005;89:49–50.
    1. Prata N, Mbaruku G, Campbell M, Potts M, Vahidnia F. Controlling postpartum hemorrhage after home births in Tanzania. Int J Gynaecol Obstet. 2005;90:51–5.
    1. Lawn JE, Tinker A, Munjanja SP, Cousens S. Where is maternal and child health now? Lancet. 2006;368:1474–7.
    1. Sibley LM, Sipe TA. Transition to skilled birth attendance: is there a future role for trained traditional birth attendants? J Health Popul Nutr. 2006;24:472–8.
    1. Ray AM, Salihu HM. The impact of maternal mortality interventions using traditional birth attendants and village midwives. J Obstet Gynaecol. 2004;24:5–11.
    1. Sibley L, Sipe TA. What can a meta-analysis tell us about traditional birth attendant training and pregnancy outcomes? Midwifery. 2004;20:51–60.
    1. Jokhio AH, Winter HR, Cheng KK. An intervention involving traditional birth attendants and perinatal and maternal mortality in Pakistan. N Engl J Med. 2005;352:2091–9.
    1. Nepal. Ministry of Health. Family Health Division. National neonatal health strategy. Kathmandu: Family Health Division, Ministry of Health, Government of Nepal; 2004. p. 45 p..
    1. Bang AT, Bang RA, Sontakke PG. Management of childhood pneumonia by traditional birth attendants. The SEARCH Team. Bull World Health Organ. 1994;72:897–905.
    1. Jokhio A, Winter H, Cheng KK, Khan K, MacArthur C. Strategies for reducing maternal mortality. Lancet. 2006;368:2122.

Source: PubMed

3
Se inscrever