Review of educational interventions to increase traditional birth attendants' neonatal resuscitation self-efficacy

Women Birth. 2019 Feb;32(1):16-27. doi: 10.1016/j.wombi.2018.04.016. Epub 2018 May 21.


Background: Annually, up to 2.7 million neonatal deaths occur worldwide, and 25% of these deaths are caused by birth asphyxia. Infants born in rural areas of low-and-middle-income countries are often delivered by traditional birth attendants and have a greater risk of birth asphyxia-related mortality.

Aim: This review will evaluate the effectiveness of neonatal resuscitation educational interventions in improving traditional birth attendants' knowledge, perceived self-efficacy, and infant mortality outcomes in low-and-middle-income countries.

Methods: An integrative review was conducted to identify studies pertaining to neonatal resuscitation training of traditional birth attendants and midwives for home-based births in low-and-middle-income countries. Ten studies met inclusion criteria.

Findings: Most interventions were based on the American Association of Pediatrics Neonatal Resuscitation Program, World Health Organization Safe Motherhood Guidelines and American College of Nurse-Midwives Life Saving Skills protocols. Three studies exclusively for traditional birth attendants reported decreases in neonatal mortality rates ranging from 22% to 65%. These studies utilized pictorial and oral forms of teaching, consistent in addressing the social cognitive theory. Studies employing skill demonstration, role-play, and pictorial charts showed increased pre- to post-knowledge scores and high self-efficacy scores. In two studies, a team approach, where traditional birth attendants were assisted, was reported to decrease neonatal mortality rate from 49-43/1000 births to 10.5-3.7/1000 births.

Conclusion: Culturally appropriate methods, such as role-play, demonstration, and pictorial charts, can contribute to increased knowledge and self-efficacy related to neonatal resuscitation. A team approach to training traditional birth attendants, assisted by village health workers during home-based childbirths may reduce neonatal mortality rates.

Keywords: Low-and-middle-income countries; Neonatal resuscitation; Self-efficacy; Traditional birth attendants; Training.

Publication types

  • Review

MeSH terms

  • Asphyxia Neonatorum / therapy*
  • Female
  • Humans
  • Infant, Newborn
  • Midwifery / education*
  • Pregnancy
  • Resuscitation / methods*
  • Self Efficacy