Effectiveness of strategies incorporating training and support of traditional birth attendants on perinatal and maternal mortality: meta-analysis

Abstract

Objective To assess the effectiveness of strategies incorporating training and support of traditional birth attendants on the outcomes of perinatal, neonatal, and maternal death in developing countries.Design Systematic review with meta-analysis.Data sources Medline, Embase, the Allied and Complementary Medicine database, British Nursing Index, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, BioMed Central, PsycINFO, Latin American and Caribbean Health Sciences Literature database, African Index Medicus, Web of Science, Reproductive Health Library, and Science Citation Index (from inception to April 2011), without language restrictions. Search terms were "birth attend*", "traditional midwife", "lay birth attendant", "dais", and "comadronas". Review methodsWe selected randomised and non-randomised controlled studies with outcomes of perinatal, neonatal, and maternal mortality. Two independent reviewers undertook data extraction. We pooled relative risks separately for the randomised and non-randomised controlled studies, using a random effects model. ResultsWe identified six cluster randomised controlled trials (n=138 549) and seven non-randomised controlled studies (n=72 225) that investigated strategies incorporating training and support of traditional birth attendants. All six randomised controlled trials found a reduction in adverse perinatal outcomes; our meta-analysis showed significant reductions in perinatal death (relative risk 0.76, 95% confidence interval 0.64 to 0.88, P<0.001; number needed to treat 35, 24 to 70) and neonatal death (0.79, 0.69 to 0.88, P<0.001; 98, 66 to 170). Meta-analysis of the non-randomised studies also showed a significant reduction in perinatal mortality (0.70, 0.57 to 0.84, p<0.001; 48, 32 to 96) and neonatal mortality (0.61, 0.48 to 0.75, P<0.001; 96, 65 to 168). Six studies reported on maternal mortality and our meta-analysis showed a non-significant reduction (three randomised trials, relative risk 0.79, 0.53 to 1.05, P=0.12; three non-randomised studies, 0.80, 0.44 to 1.15, P=0.26). ConclusionPerinatal and neonatal deaths are significantly reduced with strategies incorporating training and support of traditional birth attendants.

Factors influencing the utilization of maternal health care services by nomads in Sudan

“…TBAs are regarded as an alternative to cover the shortage of skilled birth attendants and improve maternal and neonatal care. TBAs are feasible, socially acceptable and an available option for women in developing countries (Wilson et al 2011). Evidence shows that training and support for TBAs can reduce maternal deaths in areas with low coverage of skilled birth attendants Sibley et al 2007).…”

“…New roles for TBAs: There is a critical shortage of skilled birth attendants in developing countries due to geographical, political and social reasons (Wilson et al 2011). TBAs are regarded as an alternative to cover the shortage of skilled birth attendants and improve maternal and neonatal care.…”

“…Evidence shows that training and support for TBAs can reduce maternal deaths in areas with low coverage of skilled birth attendants Sibley et al 2007). The effective use of TBAs should incorporate training, linkage to health care services, continuous in-service training and skills development, access to clean delivery kits, resuscitation equipment and effective referral pathways (Sibley et al 2007;Wilson et al 2011).…”

A Cluster Randomized Controlled Community Based Trial Utilizing a Continuum of care Among Pregnant Women: Outcomes in the Women

“…History has taught us that we do not need expensive technologies to facilitate the reductions of either maternal or newborn deaths (10) . Community based effectiveness trials of maternal and neonatal packages (23,24,25) indicate however that not many have tested strategies to deliver neonatal interventions in existing infrastructures with neonatal mortality as an outcome, in low resource settings (14,15,16,17,18,19) . The role of community health workers in child survival is under debate as to the acceptability, level, function, type of incentives (12,13) .…”

“…The role of community health workers in child survival is under debate as to the acceptability, level, function, type of incentives (12,13) . Traditional birth attendants and other CBAs continue to be the nearest source of care within the community (4,7,9,10,14,15,16,17,18,19) . This article describes cluster randomized community based trial in Zambia, with deliberate interventions in the pregnant mother.…”