ABSTRACT
Despite all efforts to reduce maternal mortality rate during the Millennium Development Goals (MDGs) initiative, maternal mortality remains unacceptably high. In Nigeria, the maternal mortality rate is 800-1,000 per 100,000 live births, making Nigeria accounts for about 10% of the global estimate for maternal mortality. One of the reasons MDGs initiative failed to achieve the set target was because it focused mainly on clinical measures and other important drivers of maternal health care were ignored. For instance, some of the vital roles of traditional birth attendants (TBAs) were ignored.Although, TBAs practices are not in consistence with best practices but they are safety nets in areas where maternal health care services are short served. They were isolated from the strategies in implementing the MDGs.In Africa, Over 58% of deliveries are delivered outside hospitals in the rural areas which traditional birth attendants have higher patronage and according to WHO, global goal is that over 70% of deliveries should be assisted by skilled birth attendants so as to manage complication cases. Lifetime risk of women to die as a direct result of complication during pregnancy and delivery is estimated to be at 1:16mothers compared to 1 in 8,700 in North America or Europe.Therefore, the main objective of the study was to determine factors that ensure emergency obstetric referrals and referral intentions among traditional birth attendants in Lagelu local government, Oyo State, Nigeria
The study was a cross-section design in which a focus group and validated questionnaire was used to collect information from 52 consenting female traditional birth attendants in lagelu local government. Ethical clearance was obtained from Babcock University Health Research Ethics Committee (BUHREC) to conduct the study. Data collected was analysed using frequency distribution, summaries and descriptive statistics was done.
The result in this study showed that the mean age of the participants was 49 years with majority (75%) attaining primary education only. All the participants (100%) are women. Majority (95%) are also married with 90% of them being Christians. Years of experience of all participantsare from 2-25years. High patronage by pregnant women was recorded with each of traditional birth attendants attending to deliveries in a range of 1-25 births annually. Attitude of most of the respondents was unfavorable with mean score of 7.6 on a rating scale of 27points.Subjective norms were above average with 62.52% with mean score of 13.13 on a rating scale of 21 points. Referral intentions were positive for majority(95%) There was a significant relationship between attitude and perceived behavior with p-value less than 0.05. (P < 0.05)
The study concluded that traditional birth attendants have a strong influence on the utilization of emergency obstetric care by pregnant women and a good strategy in reducing the alarming high maternal mortality would be to use the qualities of traditional birth attendants to improve bilateral respect between pregnant women and the hospital staff. The traditional birth attendants should be involved in planning, implementation and monitoring of any intervention training directed to them to enhance their skills in referrals. Partnership between the tbas and the biomedical staffs should also be strengthening.
Keywords: Emergency obstetric referrals, Traditional birth attendants, pregnant women,
Maternal mortality, pregnancy complications
WordCount:466
TABLE OF CONTENTS
Content Page
Title Page i
Certification ii
Dedication iii
Acknowledgements iv
Abstract v
Table of Contents vi
List of Tables ix
List of Figures x
Appendices xi
CHAPTER ONE: INTRODUCTION
1.1 Background to the Study 1
1.2 Statement of the Problem 4
1.3 Objective of the Study 5
1.4 Research Questions 5
1.5 Hypotheses 6
1.6 Justification for the Study 6
CHAPTER TWO: REVIEW OF LITERATURE
- Introduction 7
2.1 Causes of Maternal Mortalities 8
2.1.1 Global Epidemiological Trends in Pregnancy Outcomes 10
2.1.2 MDGs Initiative to address the Gaps 11
2.1.3 Maternal Mortality in Nigeria 12
2.2 Conceptual Model 14
2.2.1 Theory of Planned Behavior (TPB) 16
Content Page
CHAPTER THREE: METHODOLOGY
- Introduction
3.1 Research Design 17
3.2 Population 17
3.2.1 Study Area 17
3.2.2 Inclusion Criteria 18
3.2.3 Exclusion Criteria 18
3.3 Sample size and sample Technique 18
3.4 Instrument 19
3.5 Reliability of Instrument 19
3.6Method of Data Collection 19
3.7Dissemination of Result 19
3.8 Ethical Consideration                                                                        20
3.9 Method of Data Analysis 20
CHAPTER FOUR: DATA ANALYSIS, RESULTS AND DISCUSSION OF FINDINGS
- Introduction 21
4.1 Data Analysis 22
4.2 Demographic Characteristics of Respondents                            22
4.2.1 Attitude of Respondents                                                                        31
4.2.2 Subjective Norms of Respondents                                                      32
4.2.3 Perceived Behavioral Controls                                                       34
4.2.4 Referral Intentions of the Respondents                                                 36
4.2.5Hypothesis 1 37
4.2.6 Hypothesis II and III 39
Content Page
CHAPTER FIVE: SUMMARY, CONCLUSION AND RECOMMENDATIONS
5.1 Summary 40
5.2 Conclusion                                                                                           41
5.3 Recommendations 42
5.3.1 Implication for Health Promotion                                                       42
5.3.2 Limitation of Study                                                                              42
REFERENCES
APPENDICES
LIST OF TABLES
Table                                                                                                                   Page
- Demographic Table of Respondents                                                           23
- Attitudes of Respondents                                                                      31
- Subjective Norms                                                                                       32
- Self-Efficacy                                                                                   34
- Referral Intentions                                                                                   36
- Correlation of Attitude and Referral Intentions                                      37
- Correlation of Self-Efficacy and Referral Intentions                          38
- Correlation of Attitude and Perceived Behavioral Control                 39
LIST OF FIGURE
Figure                                                                                                      Page
1.
Conceptual Model 16
APPENDICES
Appendix
1. Questionnaire (English Version)Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â
2. Questionnaire (Yoruba Version)Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â
3. Consent form (English Version)Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â
4. Consent form (Yoruba Version)Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â
5. Names of TBAs and their contacts                                             Â
6. Pictures of the Researcher, Skilled Birth Attendants and TBAs    Â
CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
Pregnancy complication is unpredictable even when it occurs and a major cause of maternal mortality in developing countries where majority of the pregnant women are assisted by Traditional birth attendants during deliveries. (TBAs)(Julia Hussein, 2012) Three quarters of maternal death occurring in developing countries are caused by direct obstetric cases such as postpartum hemorrhage, postpartum sepsis, Eclampsia, obstructed labor and complications of unsafe abortion.(WHO, 2004) A global goal is to ensure that before 2015, 80% of deliveries should be assisted by skilled birth attendants but over 50% of deliveries are assisted by TBAs in developing countries.(Statistics, 2015) Although, the positive impacts of TBAs can’t be neglected but their attitudes, belief and perceived behavior towards obstetric care is needed to be determined since they can’t handle complications in pregnant women and this contribute mostly to maternal mortality. Pregnancy complications cause 75% of maternal death in developing countries which are categorized as direct causes while indirect causes have 25%.(Imogie, 2013)TBAs can’t predict nor handle complications in pregnant women but they can facilitate a smooth referral to skilled birth attendants where emergency obstetric care can be performed. TBAs have been identified to be the backbone of maternal health care for pregnant women in Africa.(Foundation, 2010) A global goal in improving maternal health is that 80% of deliveries should be assisted by skilled birth attendants. However, over 50% pregnant women patronize TBAs in a developing country which thus, increases over the years.
According to United Nations, A traditional birth attendant (TBA) is a pregnancy and child care provider. They assist pregnant women during deliveries and acquired skills by delivering babies herself or through apprenticeship to other TBAs. They attend to majority of deliveries in the rural areas of middle and low-income countries. They are highly respected in Africa communities. They provide essential social support to women during childbirth with little or no financial reward. Their clients trust them more than the skilled birth attendants and share secrets with them because community women perceive them as part of the community and this fosters a very good relationship between the TBAs and the community members.The TBAs have been the natural helpers at the rural areas where the official health care services are not accessible or short served. They bridge the gaps in supporting women with deliveries. Some received formal education but choose not to register with official health system. One of the criteria for being accepted as a TBA in some communities is having experience as a mother.As seen in Mexico, TBAs attend to approximately 45% of deliveries.(Olufunke M. Ebuehi, 2012) The health system of Ghana also allows TBAs to attend to routine deliveries while complications cases are referred to skilled birth attendants due to the partnership that exist between the official health care and TBAs and this has a significant impacts in reducing maternal mortality in Ghana.
