Perceived Factors Enhancing Collaboration of Traditional Birth Attendants and Midwives’ Services in Selected PHC Clinics in Shiroro LGA
Chapter One
Purpose of the Study
The study is aimed at investigating the services and practices of TBAs in primary health care clinics in Southern Shiroro Local Government Area of Niger State.
Objectives of the study
The main objective of the study is to examine the perceived factors enhancing collaboration of traditional birth attendants and midwives’ services in selected PHC clinics in Shiroro LGA, Niger state
Objectives of the study are to
- Identify the maternal and neonatal services provided by TBAs in Southern Shiroro Local Government Area of Niger State
- Determine TBAs routine practices during antenatal, labour, delivery and postnatal Period
- Elicit the new born cord care practices used by TBAs in Southern Shiroro Local government area of Niger State.
- Ascertain the practices of TBAs with regards to management of obstructed labour, premature rupture of membrane, malpresentation, and post partum hemorrhage in Southern Shiroro Local Government Area, Niger State.
CHAPTER TWO
LITERATURE REVIEW
This chapter deals with related literature based on the topic. The literature was reviewed under the following broad headings;
- Conceptual Review
- Review of related theory
- Application of the theory to the study
- Empirical review
- Summary of reviewed literature
Conceptual review
The conceptual review was discussed under the following subheading.
- concept of traditional birth attendant
- services and practices of traditional birth attendants and midwives’ services
- Obstetric complications and traditional birth attendants and midwives’ services in developing countries
- Concept of maternal and neonatal health
Concept of Traditional Birth attendants and midwives’ services
Traditional birth attendant (TBAs) throughout history has been the main health care providers for women during childbirth in Africa (Bergstorm and Goodburn (2001). Ther e is little doubt that they play a significant role when it comes to cultural competence, consolation, empathy and psychological support during pregnancy and labour, with important benefits for the mother and the newborn child (Bergstorm and Goodburn, 2001). The World Health Organization (WHO) defines TBA as “a person who assists the mother during child birth and who initially acquired her skills by delivering babies herself or by working with other TBAs”. TBAs are often older women and are mostly illiterate (Bergstorm & Goodburn, 2001). They usually work in rural, remote and other medically underserved urban areas (WHO, 2010). They may not receive formal training in health care provision, and there are no specific professional requisites such as certification or licensure .TBAs may have been formally educated and has chosen not to register (UNPF, 2011). They often learn their trade through apprenticeship or are self-taught. Many traditional birth attendants and midwives’ services are also herbalists, or other traditional healers. They may or may not be integrated in the formal health care system. They sometimes serve as a bridge between the community and the formal health system, and may accompany woman to health facilities for delivery. In addition to attending deliveries, TBAs also help with initiating breastfeeding, providing health education on STIs, reproductive health and nutrition, visiting mothers during and shortly following delivery where they educate them on the associated danger signs; and accompanying referrals to the health facilities for complicated deliveries (Sibley, 2008).
TBAs are reinforced by rituals that are performed with traditional ceremonies which are intended to maintain the balance between the absence of ill-health and a state of ill-health (Kongnyuy, Mlava and Brock, 2009).They adhere rigidly to the dietary rules of their community and assumes an important role in the transmission of ideas concerning the nature and effect of food.
The main aspect of a traditional birth attendant in rural area is as previously stated, her association with the conduct of child birth. In some areas her services begins long before child birth and continuous throughout a stated period after child birth. Prenatal and postnatal care consists mainly of carrying out measures, considered appropriate to the local cultures that makes for ease of pregnancy and child birth and ensure the safety of the mother and her child.
Historically, TBAS have been trained since the 1800s in the U.K and from 1932 onwards, UNICEF has been providing delivery kits to TBAS. From 1978 with the Almata declaration, the WHO has also approved of training TBAS to be integrated into primary health care services (Sibley and Sipe, 2006). According to Sibley and Sipe (2006), nearly 85% of developing countries engaged in training of TBAS. This is a large number, even though their role has shifted from integrated with the modern sector as promoted by the WHO in 1992, to the present, where they are seen to be a link to skills birth attendance.
Types of Traditional Birth attendants and midwives’ services
Traditional Birth attendants and midwives’ services may be full time worker who can be called upon by anyone and who expect to be paid either in cash or kind. In others, she may be a woman’s elderly relatives or neighbor or close friend. She assist in child birth as a favour or good deed and does not expect or be paid, but may receive gift as a token of appreciation. A third type of TBAS is a family birth attendant who only delivers babies of her close relatives (Unicef, 2001). The four type of TBA is the trained TBAs who have received a short course of training through the modern health care sector to upgrade her skills (who, 2010). The period of actual training is normally not more than one month, although this may be spread over a longer time.
TBAs that undergo extensive training (six months to one year) could be employed as primary health care workers (who, 2010).
CHAPTER THREE
RESEARCH METHOD
This chapter discussed the research design, the area of study, population of study, sample, sampling procedure, instrument for data collection, validity and reliability of instrument, ethical consideration, and procedure for data collection and method of data analysis.
Research Design
The research design for this study is a descriptive survey. A descriptive survey aims at describing what already exists and may use questionnaire or interview guide to collect data. In a descriptive survey, the reseacher do not attempt to explain or predict what the situation might be in the future or how it might be changed (Aina, 2011).
Area of Study
The study area is Shiroro local government area of Niger State, Nigeria. Shiroro is a Local Government Area in Niger State, Nigeria. Its headquarters are in the town of Kuta.[1][2] It has an area of 5,015 square kilometres (1,936 sq mi) and a population of 235,404 at the 2006 census.
Population of Study
The study population comprises of all TBAs across the 36 communities that were sampled from the 17 wards across the LGA. The total numbers of TBAs in the LGA are not known. Both the trained and untrained TBAs who meet the inclusion criteria participated for the study. All TBAs identified through Snowball technique across the eight (8) selected communities participated in the study. TBAs both trained and untrained who had attended at least one delivery in the previous three months. TBAs who had been involved in antenatal, intrapartum and postnatal care were eligible for this study. Birth assistants who were only responsible for cutting of the cord or giving oil massage during or after delivery were not eligible for this study.
Sample
A sample size of 385(N= 385) trained and untrained TBAs participated for this study.
CHAPTER FOUR
Data Analysis and Presentation of Result
This chapter focuses on the presentation of analysed data. Data was analysed and interpreted on the basis of the research questions and the hypotheses postulated in the study.
Table 1 : Distribution of demographic characteristic of traditional Birth attendants and midwives’ services in Niger State
Table I: Showing demographical distribution of the Respondent
CHAPTER FIVE
DISCUSSION OF MAJOR FINDINGS
This chapter discusses the findings of the study in relation to the Research questions & hypotheses postulated in the study. It’s also presents the conclusion/summary, the implication for nursing practice, limitation of the study, recommendations based on the findings and suggestions for further studies.
Discussion of Major Findings Research question one.
What is the demographic data of TBAs in Southern Shiroro Local Government Area of Niger State?
The study revealed, that majority of TBAs were within the age range of 51 to 60years, which is in agreement with the study carried out by Ofili and Okjie (2008) in Oredo local government area of Edo state on assessing the practice and role of TBAs.
The study also reveal that majority of the TBAs believed in African religions, despite the fact that southern Nigerian are predominantly Christians, TBAs form the bulk of African worshipers, this study was not in agreement with the study carried out by Oshonwho et al, (2014) in Patani, Southern Nigeria, which reveals that majority of the TBAs where predominantly Christians. However it is in conformity with the study carried out by (Bergstorm & Goodburn, 2001).This shows that TBAs play an important role when it comes to cultureThe study revealed in 1 that majority of the TBAs were female, which is in conformity with the study done by Bergstorm & Goodbum, (2000) that TBAs are often older women in society. The study showed in that majority of TBAare illiterate, they had only primary education. This is in agreement with the study of (Burgstarm and Goodburn in 2001).
Conclusion/Summary
TBAs may prove a valuable partner to improve maternal and newborn outcome in Niger state as well as Nigeria as a whole if they are given needed support from government, health care personnel and other stakeholders. As revealed from this study, most of the trained TBAs could identify early signs of danger and make early referrals. It is therefore imperative to say that there is need to reinforce the knowledge of TBAs in maternal and newborn care. Furthermore, most practices of TBAs in maternal and newborn care especially in the aspect of managing complications are very poor, as revealed by the study. Therefore training of TBAs could be a big asset in preventing disease, promoting and maintaining the health of mothers and child as well as decreasing high rate of obstetrics complications in Niger state and Nigeria as a whole, since this will impact in them the needed knowledge to practice.
Recommendation
In view of the finding made from this study, the researcher thereby made the following recommendations.
- Government and non- governmental agencies should encourage TBAs through training, provision of enabling facilities and funds by the government in order to improve TBAs services and practices
- Government should also set up policies that will guide services and practices, so as to guide against the crude and dangerous practices, as this will prepare quality outcome, thereby improving maternal and neonatal outcomes.
- TBAs should be properly trained by orthodox health care practitioners in the area of identifying early signs of danger during the antenatal, intranatal and post –natal period.
- In addition to the policies that government should set up as recommended above, government should also setup monitoring team to go round and supervise as well as checkmate the services and practices of TBAs.
- Operators of TBAs centers should be encouraged and recognized to keep records of birth and mortality.
Implication for Nursing
The finding from above therefore, implies that TBAs despite the crude practices are not totally useless. They are useful in some areas as well as knowledgeable in certain areas. Therefore Nurses as well as other health care practitioners should not disregard them. It also implies that, nurses, midwives as well as other health care practitioner’s needs to make TBAs realize they have the same goals in preventing, promoting and maintaining the health of the people especially mothers and neonates in the community.
Limitation
The following are limitations faced by the researcher in the course of carrying out the study:
- Scarcity of local recent empirical literature on the topic.
- The terrain being a riverrine area made it difficult for the researcher and consumed finance due to the transportation system.
Suggestions for Further Studies
In the course of literature review on the topic, it was discovered that most studies used pure descriptive survey as the design for their study, thereby making it difficult for the researcher to compare the result from the hypothesis testing with other researcher. Therefore it is suggested that other researcher should look into this. furthermore, the researcher, in this study did not looked into the record keeping pattern of TBAs, therefore other researchers from the fields of study can as well look into this area, because it is a limitation in this study. In addition Niger state is made up of 8 LGA but the study was conducted in just selected communities. Therefore it could be replicated in other L.G.A.
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