The Nossal Institute for Global Health, The University of Melbourne, Melbourne, Australia.
Int J Gynaecol Obstet. 2011 Nov;115(2):127-34. doi: 10.1016/j.ijgo.2011.06.019. Epub 2011 Sep 14.
Forty years of safe motherhood programming has demonstrated that isolated interventions will not reduce maternal mortality sufficiently to achieve MDG 5. Although skilled birth attendants (SBAs) can intervene to save lives, traditional birth attendants (TBAs) are often preferred by communities. Considering the value of both TBAs and SBAs, it is important to review strategies for maximizing their respective strengths.
To describe mechanisms to integrate TBAs with the health system to increase skilled birth attendance and examine the components of successful integration.
A systematic review of interventions linking TBAs and formal health workers, measuring outcomes of skilled birth attendance, referrals, and facility deliveries.
Thirty-three articles met the selection criteria. Mechanisms used for integration included training and supervision of TBAs, collaboration skills for health workers, inclusion of TBAs at health facilities, communication systems, and clear definition of roles. Impact on skilled birth attendance depended on selection of TBAs, community participation, and addressing barriers to access. Successful approaches were context-specific.
The integration of TBAs with formal health systems increases skilled birth attendance. The greatest impact is seen when TBA integration is combined with complementary actions to overcome context-specific barriers to contact among SBAs, TBAs, and women.
四十年的母婴安全规划已经证明，孤立的干预措施不足以将产妇死亡率降低到足以实现千年发展目标 5 的程度。虽然熟练的接生员（SBAs）可以进行干预以拯救生命，但传统的接生员（TBAs）往往更受社区的欢迎。考虑到 TBAs 和 SBAs 的价值，重要的是要审查最大限度发挥其各自优势的策略。
描述将 TBAs 与卫生系统整合以增加熟练接生的机制，并研究成功整合的组成部分。
对将 TBAs 与正式卫生工作者联系起来的干预措施进行系统综述，衡量熟练接生、转诊和住院分娩的结果。
有 33 篇文章符合选择标准。用于整合的机制包括对 TBAs 的培训和监督、卫生工作者的协作技能、在卫生设施中纳入 TBAs、沟通系统以及明确界定角色。对熟练接生的影响取决于 TBAs 的选择、社区参与以及解决获得服务的障碍。成功的方法是具体情况具体分析的。
将 TBAs 与正规卫生系统整合可以增加熟练接生。当 TBA 整合与互补措施相结合，以克服 SBAs、TBAs 和妇女之间接触的特定于上下文的障碍时，效果最为显著。
