National Institute for Medical Research (NIMR), Headquarters, 2448 Barak Obama/Luthuli Road (former Luthuli/Ocean Road), P,O Box 9653, Dar es Salaam, Tanzania.
Int J Equity Health. 2013 Oct 14;12:83. doi: 10.1186/1475-9276-12-83.
Access to quality maternal health services mainly depends on existing policies, regulations, skills, knowledge, perceptions, and economic power and motivation of service givers and target users. Critics question policy recommending involvement of traditional birth attendants (TBAs) in emergency obstetric care (EmoC) services in developing countries.
This paper reports about knowledge and practices of TBAs on EmoC in Kigoma Rural District, Tanzania and discusses policy implications on involving TBAs in maternal health services.
157 TBAs were identified from several villages in 2005, interviewed and observed on their knowledge and practice in relation to EmoC. Quantitative and qualitative techniques were used for data collection and analysis depending on the nature of the information required.
Among all 157 TBAs approached, 57.3% were aged 50+ years while 50% had no formal education. Assisting mothers to deliver without taking their full pregnancy history was confessed by 11% of all respondents. Having been attending pregnant women with complications was experienced by 71.2% of all respondents. Only 58% expressed adequate knowledge on symptoms and signs of pregnancy complications. Lack of knowledge on possible risk of HIV infections while assisting childbirth without taking protective gears was claimed by 5.7% of the respondents. Sharing the same pair of gloves between successful deliveries was reported to be a common practice by 21.1% of the respondents. Use of unsafe delivery materials including local herbs and pieces of cloth for protecting themselves against HIV infections was reported as being commonly practiced among 27.6% of the respondents. Vaginal examination before and during delivery was done by only a few respondents.
TBAs in Tanzania are still consulted by people living in underserved areas. Unfortunately, TBAs' inadequate knowledge on EmOC issues seems to have contributed to the rising concerns about their competence to deliver the recommended maternal services. Thus, the authorities seeming to recognize and promote TBAs should provide support to TBAs in relation to necessary training and giving them essential working facilities, routine supportive supervision and rewarding those seeming to comply with the standard guidelines for delivering EmoC services.
获得优质的孕产妇保健服务主要取决于现有政策、法规、技能、知识、服务提供者和目标用户的观念以及经济实力和动力。批评者对政策提出质疑，即建议在发展中国家让传统接生员（TBA）参与紧急产科护理（EmoC）服务。
本文报告了坦桑尼亚基戈马农村地区 TBA 对 EmoC 的知识和实践，并讨论了在孕产妇保健服务中让 TBA 参与的政策意义。
2005 年，从几个村庄确定了 157 名 TBA，对他们在 EmoC 方面的知识和实践进行了访谈和观察。根据所需信息的性质，采用定量和定性技术进行数据收集和分析。
在所接触的 157 名 TBA 中，57.3%的年龄在 50 岁以上，而 50%的人没有接受过正规教育。11%的受访者承认在没有了解产妇完整妊娠史的情况下帮助产妇分娩。71.2%的受访者曾在产妇出现并发症时照顾过她们。仅有 58%的受访者对妊娠并发症的症状和体征表示有足够的了解。5.7%的受访者声称，在没有采取防护装备的情况下协助分娩时，可能会感染艾滋病毒。21.1%的受访者报告说，在成功分娩后共用同一副手套是一种常见做法。27.6%的受访者报告说，他们经常使用不安全的分娩材料，包括当地草药和布条，以防止感染艾滋病毒。
坦桑尼亚的 TBA 仍然受到服务不足地区居民的咨询。不幸的是，TBA 在紧急产科护理问题上的知识不足，这似乎导致人们对他们提供建议的孕产妇服务的能力产生了担忧。因此，当局似乎认识到并支持 TBA，应向 TBA 提供必要的培训和基本工作设施，并定期提供支持性监督，并奖励那些似乎遵守紧急产科护理服务标准指南的 TBA。
