DETERMINANTS OF RESPONSIVE EMERGENCY OBSTETRIC REFERRALS AND REFERRAL INTENTIONS AMONG TRADITIONAL BIRTH ATTENDANTS IN LAGELU LGA, OYO STATE, NIGERIA

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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

  1. Demographic Table of Respondents                                                            23
  2. Attitudes of Respondents                                                                       31
  3. Subjective Norms                                                                                        32
  4. Self-Efficacy                                                                                    34
  5. Referral Intentions                                                                                    36
  6. Correlation of Attitude and Referral Intentions                                       37
  7. Correlation of Self-Efficacy and Referral Intentions                           38
  8. Correlation of Attitude and Perceived Behavioral Control                  39

LIST OF FIGURE

Figure                                                                                                        Page

1. Conceptual Model                                                                                                  16

APPENDICES

Appendix                                                                                                                               

1. Questionnaire (English Version)                                                  

2. Questionnaire (Yoruba Version)                                                   

3. Consent form (English Version)                                               

4. Consent form (Yoruba Version)                                       

5. Names of TBAs and their contacts                                              

6. Pictures of the Researcher, Skilled Birth Attendants and TBAs     

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.

DETERMINANTS OF RESPONSIVE EMERGENCY OBSTETRIC REFERRALS AND REFERRAL INTENTIONS AMONG TRADITIONAL BIRTH ATTENDANTS IN LAGELU LGA, OYO STATE, NIGERIA