The benefits of traditional birth attendants on maternal and fetal outcomes in sub-Saharan Africa: A systematic review and meta-analysis

Abstract

Background The role of traditional birth attendants (TBA) in improving outcomes related to maternal and child health remains controversial. We performed an up-to-date systematic review to pool together available data on the impact of TBA interventions on materno-fetal outcomes. Methods A systematic literature search was conducted on PubMed, Cochrane, Scopus, and 3ie databases (search date: 22nd August 2022) to identify original research articles which studied health outcomes in populations of pregnant women and children following TBA-related interventions. Data on the frequency of the outcome (expressed as proportions) occurring in study populations with and without the intervention were extracted. The data were synthesized and used for meta-analysis, with the creation of sub-groups as appropriate for comparisons. The Cochran-Mantel-Haenszel method was used to generate Odds ratios (OR) with 95% confidence intervals (CI) for data analysis. Results Of the 744 studies found during the initial database search, data was extracted from 45 eligible studies representing observations from 194,699 women and 199,779 children. We found that the involvement and/or training of TBAs in maternal and child healthcare does not significantly contribute to reducing maternal mortality (pooled OR: 0.91, 95% CI: 0.42–1.98) or infant morbidity (pooled OR: 0.85, 95% CI: 0.57–1.27). However, TBA-related interventions proved useful in curbing both neonatal mortality (pooled OR: 0.77, 95% CI: 0.71–0.84) and maternal morbidity (pooled OR: 0.63, 95% CI: 0.43–0.93). Overall, TBA involvement was associated with increased uptake of some health interventions including antenatal consultations, delivery by a skilled birth attendant, early breastfeeding, and immunization (pooled OR: 2.42, 95% CI: 1.75–3.35). Conclusions Based on studies conducted in the past, it appears that proper training and supervision could render TBAs useful in addressing shortages in maternal and child health actors. This finding is particularly relevant for remote communities with few trained healthcare workers and even fewer health facilities. Large community-based prospective studies may be required to investigate the materno-fetal benefits and cost-effectiveness of integrating TBAs within present-day health systems in SSA. Registration: This systematic review was not registered.