Table 6 Individual studies of the effect of traditional birth attendant training in intrapartum care on perinatal-neonatal mortality
Author | Study years | Setting | Study Design | Intervention definition | Concurrent interventions | Intervention Coverage | Total N (A=intervention/endline; B=control/baseline) | Outcomes | Effect on outcome RR/OR (95% CI) |
|---|---|---|---|---|---|---|---|---|---|
O’Rourke[66] | 1991 | Rural Guatemala | Before-after comparison | 3-month hospital-based training program for TBAs - identification of obstetric emergency and referral; encouragement to attend hospital deliveries; strengthening relationships between TBAs and hospital staff | Studied only those patients who were sucessfully referred | A) 465; B) 39 | 1) PMR among referred infants* | RR 0.73 | |
Greenwood et al. [86] | 1983 | Rural Gambia | Before-after comparison | TBA training in intervention villages within a comprehensive primary care program; 10 week training courseantenatal-postnatal care, referral signs; distribute clean birth kit and malaria prophylaxis | Introduction of comprehensive primary health care program, transport improvements | 65% | A) 1159 B) 659 | 1) NMR; 2) PMR | 1) RR 0.66; 2) RR 0.92 |
Janowitz et al. [74] | 1984-85 | Rural NE Brazil | Cross-sectional | TBA training especially in recognition of childbirth complications and referral. Non-randomized comparison of trained TBAs with high case load (>29 births per year) versus unattended home births | Establishment of “mini- maternities” with telephones for TBA births. | 55% | A) 906; B) 118 | 1) NMR | RR 0.60 |
Jokhio et al. [65] | 1998 | Rural Pakistan, Larkana, | Cluster RCT | TBA training in antepartum, intrapartum, postpartum, and neonatal care; distribution of clean delivery kits; referral for emergency obstetrical care. | Lady health workers also trained to support TBA and link community-health center services. | 74% | A) 10114; B) 9443 | 1) PMR; 2) NMR; 3) SBR | 1) aOR 0.71 (0.62-0.83); 2) aOR 0.70 (0.59-0.82); 3) aOR 0.69 (0.57-0.83) |
Excluded from present review --Primary intervention was neonatal resuscitation | |||||||||
Carlo et al[68]. | 2005-2007 | Argentina, DR Congo, Guatamala, India, Pakistan, Zambia | Before-after study | training of community birth attendants (TBAs, nurses) in WHO Essential Newborn Care , including basic resuscitation with bag-mask in 6 countries | Clean delivery, thermal protection, breastfeeding, kangaroo care | 78% of births (post) | A) 22,626; B) 35,017 | 1) PMR; 2) SBR; 3) ENMR | 1) RR 0.85 (0.70-1.02); 2) RR 0.69 (0.54-0.88); 3) RR 0.99 (0.81-1.22) |
Kumar et al[63] | ns | Rural India | Quasi-experimental | TBAs trained in "advanced" resuscitation with suction and bag-mask vs. usual mouth-mouth resuscitation | TBAs delivered 92% of babies at home | A) 964; B) 884 | 1) "asphyxia" mortality; 2) PMR | 1) RR 0.30 (0.11-0.81); 2) RR 0.82 (0.56-1.19) | |
Daga et al[87] | 1988 | Rural India | Before-after | TBA training in basic mouth-to -mouth breathing | Management of low birth weight, hypothermia; transport and referral of high risk babies to hospital | 90% | A) 321; B) 660 | 1) PMR; 2) NMR; 3) SBR | 1) RR 0.59 (0.32-1.09); 2) RR 0.39 (0.21-0.69); 3) RR 0.49 (0.16, 1.50) |
Gill et al[67] | 2006 | Rural Zambia | Cluster RCT | Training of TBAs in a modified neonatal resuscitation program (NRP) w/resuscitator facemask | prevention of hypothermia, antibiotic treatment and facilitated referral for presumptive neonatal sepsis | uncertain | A) 2007 B) 1552 | 1) NMR; 2) “asphyxia” mortality | 1) aRR 0.55 (0.33-0.90); 2) aRR 0.37(0.17-0.81) |
Azad et al [88] | 2004 | Rural Bangladesh | Cluster RCT, factorial design | Intervention arm: Training of TBAs in neonatal resuscitation with bag-valve mask, with subsequent retraining; Control arm: Training of TBAs in mouth-to-mouth resuscitation | Intervention and control: Clean delivery, danger signs, emergency preparedness, facility referral. Women’s participatory groups in half of clusters | ~20% of home deliveries in both study arms | A) 13195; B) 12519 | ENMR | 1) RR 0.95, (0.75 - 1.21) |