Department of Obstetrics, Gynecology and Reproductive Sciences, University of California-San Francisco School of Medicine, 505 Parnassus Avenue, San Francisco, CA 94143-0132, USA.
Midwifery. 2011 Apr;27(2):229-36. doi: 10.1016/j.midw.2009.06.003. Epub 2009 Jul 24.
the 1997 Safe Motherhood Initiative effectively eliminated support for training traditional birth attendants (TBAs) in safe childbirth. Despite this, TBAs are still active in many countries such as Bangladesh, where 88% of deliveries occur at home. Renewed interest in community-based approaches and the urgent need to improve birth care has necessitated a re-examination of how provider training should be conducted and evaluated.
to demonstrate how a simple evaluation tool can provide a quantitative measure of knowledge acquisition and intended behaviour following a TBA training program.
background data were collected from 45 TBAs attending two separate training sessions conducted by Bangladeshi non-governmental organization (NGO) Gonoshasthaya Kendra (GK). A semi-structured survey was conducted before and after each training session to assess the TBAs' knowledge and reported practices related to home-based management of childbirth.
two training sessions conducted in Vatshala and Sreepur in rural Bangladesh.
45 active TBAs were recruited for this training evaluation.
there were significant improvements following the training sessions regarding how TBAs reported they would: (a) measure blood loss, (b) handle an apneic newborn, (c) refer women with convulsions and (d) refer women who are bleeding heavily. A greater degree of improvement, and higher scores overall, were observed among TBAs with no prior training and with less birth experience. KEY CONCLUSIONS AND RECOMMENDATIONS FOR PRACTICE: as the Safe Motherhood community strives to improve safe childbirth care, the quality of care in pregnancy and childbirth for women who rely on less-skilled providers should not be ignored. These communities need assistance from governments and NGOs to help improve the knowledge and skill levels of the providers upon which they depend. Gonoshasthaya Kendra's extensive efforts to train and involve TBAs, with the aim of improving the quality of care provided to Bangladeshi women, is a good example of how to effectively integrate TBAs into safe motherhood efforts in resource-poor settings. The evaluation methodology described in this paper demonstrates how trainees' prior experiences and beliefs may affect knowledge acquisition, and highlights the need for more attention to course content and pedagogic style.
1997 年安全孕产倡议有效地消除了对传统助产妇（TBA）进行安全分娩培训的支持。尽管如此，TBA 在孟加拉国等许多国家仍然活跃，88%的分娩都是在家里进行的。对基于社区的方法的重新关注以及迫切需要改善生育护理，使得有必要重新审视如何进行和评估提供者培训。
展示如何使用简单的评估工具来衡量 TBA 培训计划后获取知识和预期行为的定量指标。
从参加由孟加拉国非政府组织（NGO）Gonoshasthaya Kendra（GK）举办的两次单独培训的 45 名 TBA 中收集背景数据。在每次培训前后进行半结构化调查，以评估 TBA 在家中管理分娩方面的知识和报告实践。
孟加拉国农村的 Vatshala 和 Sreepur 举办了两次培训。
为这次培训评估招募了 45 名活跃的 TBA。
培训后，TBA 在以下方面有显著改善：（a）测量出血量，（b）处理呼吸暂停的新生儿，（c）转介抽搐的妇女，以及（d）转介大量出血的妇女。没有先前培训和生育经验较少的 TBA 表现出更大程度的改善和更高的总体得分。实践的主要结论和建议：随着安全孕产界努力改善安全分娩护理，不应忽视依赖技能较低的提供者的妇女在妊娠和分娩期间的护理质量。这些社区需要政府和非政府组织的协助，以帮助提高他们所依赖的提供者的知识和技能水平。Gonoshasthaya Kendra 广泛努力培训和参与 TBA，旨在提高向孟加拉国妇女提供的护理质量，这是如何在资源匮乏的环境中有效地将 TBA 纳入安全孕产工作的一个很好的例子。本文描述的评估方法表明，学员的先前经验和信念可能会影响知识获取，并强调需要更加关注课程内容和教学风格。
