PATTERN OF PRACTICE AND CHALLENGES EXPERIENCED BY TRADITIONAL BIRTH ATTENDANTS IN IBADAN SOUTH EAST AND OLUYOLE LOCAL GOVERNMENT AREAS, NIGERIA.

Abstract

Trained Traditional Birth Attendants (TBA) play important roles in promoting safe motherhood and reducing infant mortality rate in Nigeria communities. However, the challenges faced by practicing TBAs and their pattern of practice have not been adequately assessed. This study aimed at determining the pattern of practice and challenges faced by TBAs in Ibadan South East and Oluyole Local Government Area (LGA). A cross-sectional survey of all the 172 TBAs who registered and practicing in lbadan South East and Oluyole LGAs was conducted. Six focus Group Discussions (FGDs) (2 for females and 1 for males in each LGA) were conducted among the TBAs. Four gender-sensitive In depth Interviews (IDIs) were conducted for Community Health Extension Workers (CHEWs) who supervise them. In addition, a validated questionnaire was used to collect quantitative data from the TBAs. Content analysis was carried out for the qualitative data while the quantitative data were subjected to descriptive and Chi-square statistical analysis. Participants mean age was 44.7 ± 6.3 years, 92.4% were females and 80.2% had secondary education. More than half (58.8%) were trained by older family members, 24.42% were trained by government while 7.6% were trained by private hospitals. Respondent’ supplementary jobs included petty trading (41.3%) auxillary nursing (12.8%) and religious activities (10.9%). Almost all respondents (91.7%) encouraged pregnant women to attend antenatal clinic and 89.0% referred high risk cases to formal health care facilities. Most respondents (87.9%) did not receive any form of support from the government. Some (30.8%) perceived the relationship between them and formal healthcare workers as not cordial. Many (54.7%) had never used the take-off antenatal and delivery kits given to them after their basic training. The universal precautions practiced by some of the TBAs Include soaking instruments in bleach (46.5%), use of sterile needle equipment for each client (40.2%) and use of gloves during delivery (48.5%). A Large proportion (89.5%) purchased their supplies from patent medicine vendors while few (9.5%) obtained their supplies from primary health care departments in their LGAs. About a third of the respondents practised appropriate record keeping. Gender (male 61.5%, female 31.8%) and levels of education (secondary school 27.5%, primary and informal 5.9%) were both significantly associated with record keeping (p <0.05). Only 23.8% of the respondents educated community members on family planning and the importance of immunization. The challenges perceived by TBAs as revealed by FGDs and IDIs include: little or no supervision, lack of monetary incentives from government, inadequate supplies of delivery materials and lack of funding. The traditional birth attendants were not sufficiently motivated to practice their profession in the two local government areas. There was poor record keeping among them and their inadequate adherence to universe precautions can put their clients at risk of infectious diseases. Regular supportive supervision and in-service training opportunities are needed to promote safe motherhood practices among them.