Oluwole Esther O, Oluwadumila Tolulope E, Okafor Ifeoma P, Temitayo-Oboh Abiola O
Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Lagos State, Nigeria.
Department of Community Medicine and Primary Care, Federal Medical Centre, Abeokuta, Ogun State, Nigeria.
PLoS One. 2024 Jun 13;19(6):e0304856. doi: 10.1371/journal.pone.0304856. eCollection 2024.
Unskilled delivery, particularly the use of traditional birth attendants, is a major threat to reducing maternal mortality in Africa. Despite the associated risks, there is insufficient evidence on the major reasons why pregnant women in Nigeria continue to use traditional birth attendant (TBA) services, especially in rural areas. This study, therefore, assessed the perception, reasons for use, and utilization of only TBA services in current pregnancy among rural-dwelling pregnant women in Lagos, Nigeria.
A descriptive cross-sectional study was conducted among 347 pregnant women recruited from traditional birth attendant facilities at Ikorodu Local Government Area, Lagos. Data were collected with an interviewer-administered questionnaire and analyzed using SPSS version 25. Bivariate and multivariate analyses were conducted with a significance level set at p<0.05. The outcome measures included perception, utilization of only TBA services in current pregnancy, and reasons for use. Positive perception refers to positive thought, belief, or opinion held by the participants towards the TBA.
All the respondents had a positive perception of TBAs, majority (70.3%) utilized TBA only while 29.7% combined TBA and healthcare facilities services in the current pregnancy. Recommendations from previous users (81.6%), welcoming and hospitable staff (77.2%), perceived spiritual protection (75.2%), and past use (68.6%), were some of the reasons cited by the respondents for utilizing only TBA services. Predictors of utilizing only TBA services were respondents' level of education, those with secondary (aOR = 0.261; 95% CI; 0.108-0.629) and tertiary (aOR = 0.352; 95% CI; 0.162-0.769) had lower utilization while the lack of health insurance coverage (aOR = 3.017; 95% CI; 1.476-6.166) were associated with higher utilization of TBAs.
Respondents in this study had a positive perception of TBA services. Continuous training and an effective monitoring system of TBAs by the government and other healthcare stakeholders to improve women's birthing experiences is recommended.
非专业接生，尤其是使用传统助产士接生，是非洲降低孕产妇死亡率的一大威胁。尽管存在相关风险，但关于尼日利亚孕妇，尤其是农村地区孕妇继续使用传统助产士（TBA）服务的主要原因，证据并不充分。因此，本研究评估了尼日利亚拉各斯农村地区孕妇对仅使用传统助产士服务的认知、使用原因及利用情况。
对从拉各斯伊科罗杜地方政府辖区的传统助产士机构招募的347名孕妇进行了描述性横断面研究。通过访谈式问卷收集数据，并使用SPSS 25版进行分析。进行了双变量和多变量分析，显著性水平设定为p<0.05。结果指标包括认知、当前孕期仅使用传统助产士服务的利用情况以及使用原因。积极认知是指参与者对传统助产士持有的积极想法、信念或观点。
所有受访者对传统助产士都有积极认知，大多数（70.3%）仅使用传统助产士服务，而29.7%在当前孕期将传统助产士服务与医疗机构服务相结合。受访者提到的仅使用传统助产士服务的一些原因包括既往使用者的推荐（81.6%）、热情好客的工作人员（77.2%）、感知到的精神保护（75.2%）以及过去的使用经历（68.6%）。仅使用传统助产士服务的预测因素是受访者的教育水平，接受中等教育（调整后比值比[aOR]=0.261；95%置信区间[CI]：0.108 - 0.629）和高等教育（aOR = 0.352；95% CI：0.162 - 0.769）的受访者使用率较低，而缺乏医疗保险覆盖（aOR = 3.017；�% CI：1.476 - 6.166）与更高的传统助产士使用率相关。
本研究中的受访者对传统助产士服务有积极认知。建议政府和其他医疗利益相关者对传统助产士进行持续培训并建立有效的监测系统，以改善妇女的分娩体验。
