This article presents the findings of a survey of a group of 52 traditional birth attendants (TBAs) in a clan in south-eastern Nigeria. The purpose of the study was to develop a database from which to design an effective programme for TBAs in the safe delivery and early referral of women with complications to hospital. The study showed that the majority of TBAs were illiterate and had no previous experience or training, even informal training, when they took on the TBA role. Ignorance about maternal complications during childbirth and the appropriate treatment was evident for most of the group. A small number of the group relied solely on divine revelation for guidance in the management of child-bearing women. The results of the survey clearly showed that educational programmes for TBAs and better integration into the health care system are essential for lowering maternal mortality and morbidity rates in areas where most mothers are not open to nor have access to professional care in childbirth.
PIP: To develop a database for the design of a traditional birth attendant (TBA) training program, a survey was conducted of the 52 Offot Clan TBAs in 21 villages in southeastern Nigeria's rain forest belt (Akwa Ibom State). The ultimate goal of the training program is to identify and correct risky practices that impede safe motherhood. The average age of TBAs was 45.3 years (range, 28-70 years); 46.2% were married and 46.2% were widowed. 67.3% were illiterate. All claimed they were supernaturally endowed to practice their profession. After starting practice, 10 of the 19 TBAs with some previous training (generally by close relatives) and 7 of the 34 untrained TBAs participated in continuing education, primarily a Ministry of Health workshop. 51 of the 52 TBAs accepted that there is a need for training before commencing practice and 50 supported regular monitoring to ensure acceptable practice standards. TBAs reported that they managed problems in pregnancy primarily with fasting, prayers, herbal medicines, or enema. They were generally uninformed about the causes and management of antepartum and postpartum hemorrhage--a major cause of maternal mortality. An educational program has been designed to upgrade TBA knowledge and practices and a need has been identified to register, retrain, and monitor all practicing TBAs. Obstetricians and trained midwives in the area are being encouraged to offer support and leadership to TBAs rather than continue to shut them out of the health care system.