Gaps in Quality of Antenatal Care Offered by the Traditional Birth Attendants in Southern in Nigeria

Author(s): Abayomi Joseph Afe, Ganiyu Agboola, Abimbola Oduola, Maduakolam Onyema, Timothy Akinmurele, Florence Olaosebikan, Adeola Olatoun

Introduction: In Nigeria, the annual number of pregnancies is estimated at over 6 million. Of this number, about 58% of pregnant women attended antenatal care at least once while 45% visited antenatal clinics at least 4 times. Also only about 35% of births occurred in health facilities (20% and 15% in public and private sector facilities respectively). About 62% of births occur outside the health facility, majority of which are in the rural areas. Overall, 39% of births are delivered by skilled personnel, 41% by Traditional Birth attendants (TBAs) and relatives while 20% had unassisted delivery ). Traditional Birth attendants are traditional, independent (of the health system), non-formally trained and community-based providers of care during pregnancy, childbirth, and the postnatal period. When trained, TBAs can augment their traditional function of conducting delivery with risk assessment in the prenatal period and referring mothers to health centers if complications are anticipated or in emergency. Trained TBAs can also perform deliveries and cord care hygienically and use appropriate methods to prevent and control post-partum haemorrhage. This study was conducted to show the presence or absence of some essential components ANC care at TBA and use their availability to measure the quality of care available at the TBA centers. Methods: This was a cross sectional questionnaire-based study conducted in 3 southern Nigerian states over a 6 months period. Data were collected from 450 TBAs using interviewer-administered questionnaires. The data analysis was done using statistical package for the social sciences (SPSS) for windows version 20.0 software (SPSS Inc; Chicago, IL, USA). Frequency counts were generated for all variables and statistical test of significance was performed with chi-square test. Significance was fixed at P < 0.05 and highly significance if P < 0.01. Results: There was wide gap in the accessibility of pregnant women attending care at TBA to blood investigations. These gaps ranged from as high as 92% for Hepatitis B test, 87% for blood genotype, 80% for Packed Cell volume(PCV),74% for syphilis infection test(VDRL) to as low as 50% for HIV antibody blood rapid test and 30% for blood group investigation. Tetanus toxoid immunization service was also very low at 38% availability among the TBAs. The commonest service among the TBA was referral services, which was provided by about 94% of the TBAs.Other less common service were group health talks, monitoring of blood pressure, weight measurement , antimalarial prophylaxis and local concoction mixture. Recommendations: There is need to work with TBAs to plug the gaps in the quality of services they provide to their clients.

Traditional Birth Attendants (TBA), Antenatal care (ANC), Prevention of Mother to child transmission of HIV(PMTCT)

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