Audit of childbirth emergency referrals by trained traditional birth attendants in Enugu, Southeast, Nigeria

Abstract

Background:The essence of training traditional birth attendants (TBAs) is to attend to women in uncomplicated labor and to refer them immediately to hospitals when complications develop.Aim:The aim was to audit childbirth emergency referrals by trained TBAs to a specialist hospital in Enugu, Nigeria.Subjects and Methods:A retrospective study of 205 childbirth emergencies referred to Semino Hospital and Maternity (SHM), Enugu by trained TBAs from August 1, 2011 to January 31, 2014. Data analysis was descriptive and inferential at 95% confidence level.Results:Most of the patients (185/205, 90.2%) were married and (100/205, 48.8%) had earlier booked for antenatal care in formal health facilities. There were obstetric danger signs or previous bad obstetric histories (pregnancies with unfavorable outcome) in 110 (110/205, 53.7%) women on admission at SHM. One hundred and fifteen (115/205, 56.1%) women walked into the hospital by themselves while 50 (50/205, 24.39%) could not walk. The fetal heart sounds were normal in 94 (94/205, 45.6%), abnormal in 65 (65/205, 31.8%) and absent in 42 (42/205, 20.4%) of the women on admission. Five healthy babies were delivered by the TBAs before referring their mothers. Delays of more than 12 h had occurred in 155 (155/205, 76.6%) of the women before referrals. Prolonged labor (100/205, 48.8%), obstructed labor (40/205, 19.5%), attempted vaginal birth after previous cesarean delivery (40/205, 19.5%) and malpresentation (30/205, 14.6%) were the common indications for referrals. The maternal mortality and perinatal mortality ratios were 610/100,000 live births and 228/1000 total births respectively.Conclusion:Delays at TBA centers are common before referral and most patients are referred in poor clinical state. Further training and re-training of the TBAs with more emphasis on recognition of obstetric danger signs and bad obstetric histories may help in screening high-risk patients for prompt referral to hospitals before complications develop.

Examining the roles of significant others of women in the uptake of health facility delivery in Northern Uganda: perspectives from the health belief model.

“…As cited from prior studies, some felt that they could rely on the knowledge and expertise of TBAs to help them detect a birth-related complication requiring the intervention of a health expert [16,17]. This assumption was found from previous studies to be misleading as it exposes the mother to the likelihood of experiencing adverse negative outcomes (such as; death, loss of the baby, psychological stresses, among others) because of the delays between transferring the mother from the TBA's place to the health facility, as most women are referred in poor clinical state [18]. A study in Nigeria that audited childbirth emergency referrals by trained TBAs to a specialist hospital found that delays of more than 12 hours had occurred in 76.6% of the women before referral [18].…”

“…This assumption was found from previous studies to be misleading as it exposes the mother to the likelihood of experiencing adverse negative outcomes (such as; death, loss of the baby, psychological stresses, among others) because of the delays between transferring the mother from the TBA's place to the health facility, as most women are referred in poor clinical state [18]. A study in Nigeria that audited childbirth emergency referrals by trained TBAs to a specialist hospital found that delays of more than 12 hours had occurred in 76.6% of the women before referral [18]. Much as some mothers cited husbands as their significant others, health workers on the contrary observed that some husbands did not necessarily support their partners during pregnancy, delivery and child birth.…”

The quality of and women’s satisfaction with maternal referral practices in Sub-Saharan African low and lower-middle income countries: A systematic review

“…Okafor, Arinze-Onyia [8] also reported that155 (75.6%) trained TBAs in Nigeria delayed referral for women who showed signs of difficulty in childbirth for more than 12 hours [8]. Poor skills of lower level doctors and midwives were reported in Ghana:…”

“…Study aim, context, methodology and relevant findings are summarised in table 1. Most studies (n=13) investigated the quality of referral from the perspective of healthcare providers either through interviews or audit of health facility records [1,8,[29][30][31][32][33][34][35][36][37][38][39]. Two studies explored women's experiences of maternal and newborn referral [40,41].…”

“…One study included both healthcare providers and women's perspectives [42] whilst one South Sudanese study included the perspectives of stakeholders from the local government sector, Faith-Based Organisations (FBOs), non-governmental organisations (NGOs), and community religious leaders in addition to healthcare providers [43]. Common conditions that prompted referral included premature rupture of membranes, obstructed labour and postpartum complications, such as haemorrhage and fistula [8,32,38,39,[41][42][43][44]. The outcomes identified in these studies are summarised in S2.…”