Traditional birth attendants in Malawi

Smit, Jan

doi:10.4102/curationis.v17i2.1385

Cited by 9 publications

(9 citation statements)

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“…With pregnancy and childbirth being natural processes that take place in a specific cultural context, a possible explanation for this delay may be that some of the women might have dismissed certain signs and symptoms as being a normal part of the journey into motherhood [25]. In a study among pregnant women in Senegal, 13% regarded fever, pallor and dizziness as normal signs of pregnancy because these conditions were common among pregnant women in that area [28]. In Tanzania, rural women seemed to avoid going to the hospital due to different interpretations of danger signs [29].…”

Section: Discussionmentioning

confidence: 99%

“…For the other two it was a matter of having no other choice, as observed in other studies [27], [30], [31]. In Malawi there are approximately 5000 TBAs and 2000 of them have been trained by the government of Malawi since 1976 [13], [28]. Although they are not considered a part of the formal healthcare system, they fill a gap of uneven distribution of healthcare personnel, particularly in the rural areas.…”

Section: Discussionmentioning

confidence: 99%

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Piecing Together the Maternal Death Puzzle through Narratives: The Three Delays Model Revisited

2012

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BackgroundIn Malawi maternal mortality continues to be a major public health challenge. Going beyond the numbers to form a more complete view of why women die is critical to improving access to and quality of emergency obstetric care. The objective of the current study was to identify the socio-cultural and facility-based factors that contributed to maternal deaths in the district of Lilongwe, Malawi.MethodsRetrospectively, 32 maternal death cases that occurred between January 1, 2011 and June 30, 2011 were reviewed independently by two gynecologists/obstetricians. Interviews were conducted with healthcare staff, family members, neighbors, and traditional birth attendants. Guided by the grounded theory approach, interview transcripts were analyzed manually and continuously. Emerging, recurring themes were identified and excerpts from the transcripts were categorized according to the Three Delays Model (3Ds).ResultsSixteen deaths were due to direct obstetric complications, sepsis and hemorrhage being most common. Sixteen deaths were due to indirect causes with the main cause being anemia, followed by HIV and heart disease. Lack of recognizing signs, symptoms, and severity of the situation; using traditional Birth Attendant services; low female literacy level; delayed access to transport; hardship of long distance and physical terrain; delayed prompt quality emergency obstetric care; and delayed care while at the hospital due to patient refusal or concealment were observed. According to the 3Ds, the most common delay observed was in receiving treatment upon reaching the facility due to referral delays, missed diagnoses, lack of blood, lack of drugs, or inadequate care, and severe mismanagement.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Piecing Together the Maternal Death Puzzle through Narratives: The Three Delays Model Revisited

2012

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“…Some interventions refer to the provision of skilled home-based childbirth services explicitly in order to accommodate cultural norms [42] , [43] . Several further interventions in which a culture-based rationale was cited for training TBAs were excluded since the TBA was solely responsible for the direct provision of childbirth services [44] – [49] . However, these interventions also aimed to harness the TBAs' cultural role to facilitate linkages with the formal health system and improve referral for obstetric complications.…”

Section: Resultsmentioning

confidence: 99%

Maternity Care Services and Culture: A Systematic Global Mapping of Interventions

et al. 2014

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BackgroundA vast body of global research shows that cultural factors affect the use of skilled maternity care services in diverse contexts. While interventions have sought to address this issue, the literature on these efforts has not been synthesised. This paper presents a systematic mapping of interventions that have been implemented to address cultural factors that affect women's use of skilled maternity care. It identifies and develops a map of the literature; describes the range of interventions, types of literature and study designs; and identifies knowledge gaps.Methods and FindingsSearches conducted systematically in ten electronic databases and two websites for literature published between 01/01/1990 and 28/02/2013 were combined with expert-recommended references. Potentially eligible literature included journal articles and grey literature published in English, French or Spanish. Items were screened against inclusion and exclusion criteria, yielding 96 items in the final map. Data extracted from the full text documents are presented in tables and a narrative synthesis. The results show that a diverse range of interventions has been implemented in 35 countries to address cultural factors that affect the use of skilled maternity care. Items are classified as follows: (1) service delivery models; (2) service provider interventions; (3) health education interventions; (4) participatory approaches; and (5) mental health interventions.ConclusionsThe map provides a rich source of information on interventions attempted in diverse settings that might have relevance elsewhere. A range of literature was identified, from narrative descriptions of interventions to studies using randomised controlled trials to evaluate impact. Only 23 items describe studies that aim to measure intervention impact through the use of experimental or observational-analytic designs. Based on the findings, we identify avenues for further research in order to better document and measure the impact of interventions to address cultural factors that affect use of skilled maternity care.

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“…Dominant symbols of ‘tradition’ as virtue promoted the parallel evolution of indigenous medical customs among the excluded majority, reproducing the colonial duality between these systems and practices (Forster, ; Lwanda, : 80–1, : 32–3; Vaughan, : 304). Azamba and traditional healers were thus important in providing primary healthcare for the majority (Msonthi, ; Smit, ). This was to fit well with the World Health Organization (WHO), which in the 1970s issued a call for traditional midwives to be incorporated into national healthcare plans under the new ‘global’ term ‘traditional birth attendants’.…”

Section: Azamba In History: a Health Policy Footballmentioning

confidence: 99%

Enforcing ‘Progress’: A Story of an MDG 5 Indicator and Maternal Health in Malawi

Danielsen¹

2017

Development and Change

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Considering the importance of metrics in current systems of global health accountability, this article analyses the dynamics behind a maternal health indicator. To achieve the target of Millennium Development Goal 5 (MDG 5) and increase the proportion of births attended by 'skilled health personnel', some districts in Malawi in 2010 introduced information campaigns to promote births in hospitals and a fine to punish mothers who delivered outside of biomedical health institutions. The study is based on ethnographic research in one Malawian village. While many mothers described the ill treatment and bad conditions in maternity wards, most women still started to publicly sanction institutional births. This apparent contradiction can be understood by looking at the positions and motivations of the various actors who participated in the performance of MDG 5 in the village and how their projects became tied to the focus on improving the indicator. Rather than expressing a demand for the existing maternal health services as such, the ethnography suggests that the actors' practices expressed hopes and claims to wider material improvements in a context of inequality. The article highlights dynamics that are concealed if we restrict the analysis to one of biopower, and expands the purview of the study of metrics into the spaces which indicators are intended to represent.

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Traditional birth attendants in Malawi

Cited by 9 publications

References 0 publications

Piecing Together the Maternal Death Puzzle through Narratives: The Three Delays Model Revisited

Piecing Together the Maternal Death Puzzle through Narratives: The Three Delays Model Revisited

Maternity Care Services and Culture: A Systematic Global Mapping of Interventions

Enforcing ‘Progress’: A Story of an MDG 5 Indicator and Maternal Health in Malawi

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