The Experts below are selected from a list of 261 Experts worldwide ranked by ideXlab platform
Sandro Galea - One of the best experts on this subject based on the ideXlab platform.
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community and health system factors associated with facility delivery in rural tanzania a multilevel analysis
Health Policy, 2010Co-Authors: Margaret E Kruk, Peter C Rockers, Godfrey Mbaruku, Magdalena Paczkowski, Sandro GaleaAbstract:Objectives Tanzania, a country with high maternal mortality, has many primary health facilities yet has a low rate of facility deliveries. This study estimated the contribution of individual and community factors in explaining variation in the use of health facilities for childBirth in rural Tanzania.Methods A two-stage cluster population-based survey was conducted in Kasulu District, western Tanzania with women with a recent delivery. Random intercept multilevel logistic regression models were used to assess the association between individual- and village-level factors and likelihood of facility delivery.Results 1205 women participated in the study. In the fully adjusted two-level model, in addition to several individual factors, positive village perception of doctor and nurse skills (odds ratio (OR) 6.72, 95% confidence interval (CI): 2.47-18.31) and negative perception of Traditional Birth Attendant skills (OR 0.13, 95% CI: 0.04-0.40) were associated with higher odds of facility delivery.Conclusion This study suggests that community perceptions of the quality of the local health system influence women's decisions to deliver in a clinic. Improving quality of care at first-level clinics and communicating this to communities may assist efforts to increase facility delivery in sub-Saharan Africa.
I A Akintujoye - One of the best experts on this subject based on the ideXlab platform.
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perception and utilization of Traditional Birth Attendants by pregnant women attending primary health care clinics in a rural local government area in ogun state nigeria
International Journal of Women's Health, 2012Co-Authors: Olufunke M Ebuehi, I A AkintujoyeAbstract:BACKGROUND In developing countries, most childBirth occurs at home and is not assisted by skilled Attendants. This situation increases the risk of death for both mother and child and has severe maternal and neonatal health complications. The purpose of this study was to explore pregnant women's perceptions and utilization of Traditional Birth Attendant (TBA) services in a rural Local Government Area (LGA) in Ogun State, southwest Nigeria. METHODS A quantitative design was used to obtain information using a structured questionnaire from 250 pregnant women attending four randomly selected primary health care clinics in the LGA. Data were analyzed using Epi Info (v 3.5.1) statistical software. RESULTS Almost half (48.8%) of the respondents were in the age group 26-35 years, with a mean age of 29.4 ± 7.33 years. About two-thirds (65.6%) of the respondents had been pregnant 2-4 times before. TBA functions, as identified by respondents, were: "taking normal delivery" (56.7%), "providing antenatal services" (16.5%), "performing caesarean section" (13.0%), "providing family planning services" (8.2%), and "performing gynaecological surgeries" (5.6%). About 6/10 (61.0%) respondents believed that TBAs have adequate knowledge and skills to care for them, however, approximately 7/10 (69.7%) respondents acknowledged that complications could arise from TBA care. Services obtained from TBAs were: routine antenatal care (81.1%), normal delivery (36.1%), "special maternal bath to ward off evil spirits" (1.9%), "concoctions for mothers to drink to make baby strong" (15.1%), and family planning services (1.9%). Reasons for using TBA services were: "TBA services are cheaper" (50.9%), "TBA services are more culturally acceptable in my environment" (34.0%), "TBA services are closer to my house than hospital services" (13.2%), "TBAs provide more compassionate care than orthodox health workers" (43.4%), and "TBA service is the only maternity service that I know" (1.9%). Approximately 8/10 (79.2%) of the users (past or current) opined that TBA services are effective but could be improved with some form of training (78.3%). More than three-quarters (77.1%) opposed the banning of TBA services. Almost 7/10 (74.8%) users were satisfied with TBA services. CONCLUSION Study findings revealed a positive perception and use of TBA services by the respondents. This underlines the necessity for TBAs' knowledge and skills to be improved within permissible standards through sustained partnership between TBAs and health systems. It is hoped that such partnership will foster a healthy collaboration between providers of orthodox and Traditional maternity services that will translate into improved maternal and neonatal health outcomes in relevant settings.
Lynn M Sibley - One of the best experts on this subject based on the ideXlab platform.
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Traditional Birth Attendant training for improving health behaviours and pregnancy outcomes
Cochrane Database of Systematic Reviews, 2012Co-Authors: Lynn M Sibley, Theresa Ann Sipe, Danika BarryAbstract:Background Between the 1970s and 1990s, the World Health Organization promoted Traditional Birth Attendant (TBA) training as one strategy to reduce maternal and neonatal mortality. To date, evidence in support of TBA training is limited but promising for some mortality outcomes. Objectives To assess the effects of TBA training on health behaviours and pregnancy outcomes. Search methods We searched the Cochrane Pregnancy and ChildBirth Group's Trials Register (18 June 2012), citation alerts from our work and reference lists of studies identified in the search. Selection criteria Published and unpublished randomised controlled trials (RCT), comparing trained versus untrained TBAs, additionally trained versus trained TBAs, or women cared for/living in areas served by TBAs. Data collection and analysis Three authors independently assessed study quality and extracted data in the original and first update review. Three authors and one external reviewer independently assessed study quality and two extracted data in this second update. Main results Six studies involving over 1345 TBAs, more than 32,000 women and approximately 57,000 Births that examined the effects of TBA training for trained versus untrained TBAs (one study) and additionally trained TBA training versus trained TBAs (five studies) are included in this review. These studies consist of individual randomised trials (two studies) and cluster-randomised trials (four studies). The primary outcomes across the sample of studies were perinatal deaths, stillBirths and neonatal deaths (early, late and overall). Trained TBAs versus untrained TBAs: one cluster-randomised trial found a significantly lower perinatal death rate in the trained versus untrained TBA clusters (adjusted odds ratio (OR) 0.70, 95% confidence interval (CI) 0.59 to 0.83), lower stillBirth rate (adjusted OR 0.69, 95% CI 0.57 to 0.83) and lower neonatal death rate (adjusted OR 0.71, 95% CI 0.61 to 0.82). This study also found the maternal death rate was lower but not significant (adjusted OR 0.74, 95% CI 0.45 to 1.22). Additionally trained TBAs versus trained TBAs: three large cluster-randomised trials compared TBAs who received additional training in initial steps of resuscitation, including bag-valve-mask ventilation, with TBAs who had received basic training in safe, clean delivery and immediate newborn care. Basic training included mouth-to-mouth resuscitation (two studies) or bag-valve-mask resuscitation (one study). There was no significant difference in the perinatal death rate between the intervention and control clusters (one study, adjusted OR 0.79, 95% CI 0.61 to 1.02) and no significant difference in late neonatal death rate between intervention and control clusters (one study, adjusted risk ratio (RR) 0.47, 95% CI 0.20 to 1.11). The neonatal death rate, however, was 45% lower in intervention compared with the control clusters (one study, 22.8% versus 40.2%, adjusted RR 0.54, 95% CI 0.32 to 0.92). We conducted a meta-analysis on two outcomes: stillBirths and early neonatal death. There was no significant difference between the additionally trained TBAs versus trained TBAs for stillBirths (two studies, mean weighted adjusted RR 0.99, 95% CI 0.76 to 1.28) or early neonatal death rate (three studies, mean weighted adjusted RR 0.83, 95% CI 0.68 to 1.01). Authors' conclusions The results are promising for some outcomes (perinatal death, stillBirth and neonatal death). However, most outcomes are reported in only one study. A lack of contrast in training in the intervention and control clusters may have contributed to the null result for stillBirths and an insufficient number of studies may have contributed to the failure to achieve significance for early neonatal deaths. Despite the additional studies included in this updated systematic review, there remains insufficient evidence to establish the potential of TBA training to improve peri-neonatal mortality.
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does Traditional Birth Attendant training improve referral of women with obstetric complications a review of the evidence
Social Science & Medicine, 2004Co-Authors: Lynn M Sibley, Theresa Ann Sipe, Marge KoblinskyAbstract:This narrative and meta-analytic review of the effectiveness of Traditional Birth Attendant (TBA) training to improve access to skilled Birth attendance for obstetric emergencies produced mixed results. Among 16 studies that fit the inclusion criteria, there is a medium, positive, non-significant association between training and TBA knowledge of risk factors and conditions requiring referral; and small, positive, significant associations between TBA referral behavior and maternal service use. These results cannot be causally attributed to TBA training because of the overall quality of studies; moreover, in several studies TBA training was a component of integrated intervention packages. The effort and expense of more rigorous research focusing on TBA training to improve access to emergency obstetric care are difficult to justify. The referral process is complex; the real effects of TBA training on TBA and maternal behavior are likely to be small; and while the proportion of TBA-attended Births worldwide varies, it is, on average, quite low. The behavioral determinants and logistical barriers to care seeking for emergency obstetric care are generally well known. We suggest a more promising research agenda would reposition the questions surrounding referral into a broader ecological perspective.
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does Traditional Birth Attendant training increase use of antenatal care a review of the evidence
Journal of Midwifery & Women's Health, 2004Co-Authors: Lynn M Sibley, Theresa Ann Sipe, Marge KoblinskyAbstract:A combined narrative review and metanalytic review was conducted to summarize published and unpublished studies completed between 1970 and 2002 on the relationship between Traditional Birth Attendant (TBA) training and increased use of professional antenatal care (ANC). Fifteen studies (n = 15) from 8 countries and 2 world regions were analyzed. There are, to varying degrees, positive associations between TBA training and TBA knowledge of the value and timing of ANC services, TBA behavior in offering advice or assistance to obtain ANC, and compliance and use of ANC services by women cared for by TBAs or living in areas served by TBAs. There is a serious lack of information about TBA training program characteristics. Although the findings cannot be causally attributed to TBA training, the results suggest that training may increase ANC attendance rates by about 38%. This magnitude of improvement could contribute to a reduction in maternal and perinatal mortality in areas where women have access to quality antenatal and emergency obstetric care. There is an urgent need to improve capacity for evaluation and research of the effect of TBA training programs and other factors that influence women's use of ANC services.
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what can a meta analysis tell us about Traditional Birth Attendant training and pregnancy outcomes
Midwifery, 2004Co-Authors: Lynn M Sibley, Theresa Ann SipeAbstract:Abstract Objective: to summarise the available published and unpublished studies on Traditional Birth Attendant (TBA) training effectiveness. Design: a meta-analysis. Study sample: sixty studies ( n =60) spanning 1971–1999 from 24 countries and three regions. Measurements: the effect size index, Cohen's h for each outcome; the variance-weighted mean effect size and 95% confidence interval for sub-group of outcomes; homogeneity tests on the distribution of the weighted mean effect sizes; and sensitivity analysis to detect the presence of publication bias. Findings: TBA training was associated with significant increases in attributes such as TBA ‘knowledge' (90%), ‘attitude' (74%), ‘behaviour' (63%) and ‘advice' (90%) over the untrained TBA baseline. Results for ‘behaviour' and ‘advice' in specific content areas related to peri-neonatal health outcome, however, reveal sources of variability and underscore the conflicting evidence on TBA training. TBA training was also associated with small but significant decreases in peri-neonatal mortality (8%) and Birth asphyxia mortality (11%). Incomplete reporting limited the assessment of neonatal mortality due to tetanus and acute respiratory infection, maternal mortality, as well as assessment of the relationship between intervention characteristics and outcomes. The quality of studies included in the meta-analysis lack sufficient rigour to address the question of causality. Thus, while the data suggest that TBA training is effective in terms of the outcomes measured, we are unable to demonstrate that it is a cost-effective intervention. Implications: skilled attendance at Birth is a distant reality in many developing countries and effective community-based strategies are needed to help reduce high levels of mortality. Given the magnitude of peri-neonatal mortality, the associations observed between TBA training peri-neonatal and Birth asphyxia mortality, and TBA attributes in content relevant to peri-neonatal survival, we suggest that these strategies may usefully include TBA training in appropriate settings. If TBAs are to be trained, however, it is imperative that their training be adequately evaluated in order to develop the strong evidence base that is lacking to-date and that is necessary for sound policy and programming.
Margaret E Kruk - One of the best experts on this subject based on the ideXlab platform.
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community and health system factors associated with facility delivery in rural tanzania a multilevel analysis
Health Policy, 2010Co-Authors: Margaret E Kruk, Peter C Rockers, Godfrey Mbaruku, Magdalena Paczkowski, Sandro GaleaAbstract:Objectives Tanzania, a country with high maternal mortality, has many primary health facilities yet has a low rate of facility deliveries. This study estimated the contribution of individual and community factors in explaining variation in the use of health facilities for childBirth in rural Tanzania.Methods A two-stage cluster population-based survey was conducted in Kasulu District, western Tanzania with women with a recent delivery. Random intercept multilevel logistic regression models were used to assess the association between individual- and village-level factors and likelihood of facility delivery.Results 1205 women participated in the study. In the fully adjusted two-level model, in addition to several individual factors, positive village perception of doctor and nurse skills (odds ratio (OR) 6.72, 95% confidence interval (CI): 2.47-18.31) and negative perception of Traditional Birth Attendant skills (OR 0.13, 95% CI: 0.04-0.40) were associated with higher odds of facility delivery.Conclusion This study suggests that community perceptions of the quality of the local health system influence women's decisions to deliver in a clinic. Improving quality of care at first-level clinics and communicating this to communities may assist efforts to increase facility delivery in sub-Saharan Africa.
K K Deora - One of the best experts on this subject based on the ideXlab platform.
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childBirth practices in rural rajasthan india implications for neonatal health and survival
Journal of Perinatology, 2008Co-Authors: S D Iyengar, Kirti Iyengar, Jose Martines, K Dashora, K K DeoraAbstract:In a rural community of Rajasthan in north India, we explored family, community and provider practices during labor and childBirth, which are likely to influence newborn health outcomes. A range of qualitative data-gathering methods was applied in two rural clusters of Udaipur district. This paper reports on the key findings from eight direct observations of labor and childBirth at home and in primary health facilities, as well as 10 focus group discussions, 18 case interviews with recently delivered women and 39 key informant interviews carried out within the community. Although most families preferred home delivery, health-facility deliveries were preferred for first Births, especially among adolescents. A team of Birth Attendants led by a Traditional Birth Attendant or an elder female relative took decisions and performed key functions during home childBirth. Modern providers were commonly invited to administer intramuscular oxytocin injections to hasten home delivery, whereas health staff tended to do the same during facility deliveries. The practice of applying forceful fundal pressure, stemming from overriding concern about the woman's inability to deliver spontaneously, was near universal in both situations. In both facilities and homes, monitoring of labor was largely restricted to repeated unhygienic vaginal examinations with little or no monitoring of fetal or maternal well-being. Babies born at home remained lying on the wet floor till the placenta was delivered. The cord was usually tied using available twine or ceremonial thread and cut using a new blade. In facility settings, drying and wrapping of the baby after Birth was delayed and preparedness for resuscitation was minimal. Families believed in delaying breast-feeding till 3 days after Birth, when they believed breast milk became available. Even hospital staff discharged the mother and newborn without efforts to initiate breast-feeding. A combination of Traditional and modern practices, rooted in the concept of inducing heat to facilitate labor, occurred in both home and facility delivery settings. Programs to improve neonatal survival in such rural settings will need to invest both in strengthening primary health services provided during labor and delivery through training and monitoring, and in community promotion of improved newborn care practices.