Prevalence, Trends, and Drivers of the Utilization of Unskilled Birth Attendants during Democratic Governance in Nigeria from 1999 to 2018

Abstract

Comprehensive epidemiological data on prevalence, trends, and determinants of the use of unskilled birth attendants (traditional birth attendants (TBAs) and other unskilled birth attendants) are essential to policy decision-makers and health practitioners, to guide efforts and resource allocation. This study investigated the prevalence, trends, and drivers of the utilization of unskilled birth attendants during democratic governance in Nigeria from 1999 to 2018. The study used the Nigeria Demographic and Health Surveys data for the years 1999 (n = 3552), 2003 (n = 6029), 2008 (n = 28,647), 2013 (n = 31,482), and 2018 (34,193). Multivariate multinomial logistic regression was used to investigate the association between socioeconomic, demographic, health-service, and community-level factors with the utilization of TBAs and other unskilled birth attendants in Nigeria. Between 1999 and 2018, the study showed that the prevalence of TBA-assisted delivery remained unchanged (20.7%; 95% CI: 18.0–23.7% in 1999 and 20.5%; 95% CI: 18.9–22.1% in 2018). The prevalence of other-unskilled-birth-attendant use declined significantly from 45.5% (95% CI: 41.1–49.7%) in 2003 to 36.2% (95% CI: 34.5–38.0%) in 2018. Higher parental education, maternal employment, belonging to rich households, higher maternal age (35–49 years), frequent antenatal care (ANC) (≥4) visits, the proximity of health facilities, and female autonomy in households were associated with lower odds of unskilled birth attendants’ utilization. Rural residence, geopolitical region, lower maternal age (15–24 years), and higher birth interval (≥2 years) were associated with higher odds of unskilled-birth-attendant-assisted deliveries. Reducing births assisted by unskilled birth attendants in Nigeria would require prioritized and scaled-up maternal health efforts that target all women, especially those from low socioeconomic backgrounds, those who do not attend antenatal care, and/or those who reside in rural areas.

“If you are on duty, you may be afraid to come out to attend to a person”: fear of crime and security challenges in maternal acute care in Nigeria from a realist perspective

“…Health workers' attitude in guarding their own safety may result in negative consequences such as complications during labor, including maternal or child death, depending on the stage at which a woman attends the facility. In the longer term, this may make women not to even access the facility at all and seek alternative care from other sources, such as traditional birth attendants [41], some of whom may not be skilled [42,43].…”

Nigeria, a high burden state of obstetric fistula: a contextual analysis of key drivers

“…Trained traditional birth attendants (TBAs): TBAs are community-based providers of care during pregnancy, childbirth and postnatal period without formal medical training and are traditionally independent of the health system [ 59 , 60 ]. A review on delivery by unskilled birth attendant in Nigeria revealed that the prevalence of TBA-assisted delivery remained unchanged between 1999 and 2018 [ 60 ]. Usually, the TBAs are more accessible and available within the community.…”

“…TBAs were documented to be mainly responsible for unbooked emergencies resulting in high death rate of 2900 per 100,000 births in Zaria due to their inability to treat principal causes of maternal deaths [ 66 ]. The adverse outcomes of maternal mortality, morbidity and disability that result from delivery by TBAs occur because they are unskilled in managing pregnancy and labour complications and lack skills for risk stratification [ 60 ]. Notwithstanding, the TBAs can still contribute to the reduction of maternal morbidity and mortality by facilitating facility and skilled attended births in the community but this can only be feasible if they are appropriately integrated with the local health system.…”

“If you are on duty, you may be afraid to come out to attend to a person”: Fear of crime and security challenges in maternal acute care in Nigeria from a realist perspective.

“…Health workers' attitude in guarding their own safety may result in negative consequences such as complications during labor, including maternal or child death, depending on the stage at which a woman attends the facility. In the longer term, this may make women not to even access the facility at all and seek alternative care from other sources, such as traditional birth attendants [42], some of whom may not be skilled [43,44].…”