1.1 Introduction
Traditional Birth Attendance (TBA) is the key actors in reducing maternal and infants mortality as well as morbidity of the mothers. Again, the meagre financial resource located to health sector in developing countries cannot meet the growing demand on reproductive health services both in rural and urban areas. The most disadvantaged women are those living in rural areas. It is not surprising therefore, that to date there are still some child bearing women do not attend antenatal clinic and many women are still delivering at home (Grieco & Turner, 2005). For instance the proportion of deliveries attended by skilled health personnel in developing countries was 65% in 2009 and in some countries was lower than the stated (WHO, 2012).
As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Research hypothesis and questions, Limitations of the Study and Definition of technical terms.
1.2 Background of Study
Many developing countries have attempted training TBAs as a response to safe motherhood program with different approaches (MacArthur, 2009). In this section the process and the expected impact of few studies will be briefly described. Experts on reproductive health argue that for TBAs to help reduce infant and maternal mortality in countries south of the Sahara and other developing countries, there is need to equip skilled personnel with supplies to support carrying out basic preventive measures in obstetric care, anticipate and identify obstetric complications, administer nevirapine prophylaxis, and make appropriate and timely referrals backed up with efficient referral mechanisms (Msaky et al., 2004).
The rest of the deliveries were attended by unskilled persons like mother-in-law, mother, aunt or sister in law and TBAs (TDHS, 2010). The underlying reasons for most deliveries occurring at home with assistance and TBAs were poverty, distance to health facilities, lack of information, inadequate services and medical supplies, lack of competent personnel in reproductive health at the health facilities and above all the cultural practices related to birthing (Cosminisky, 1983; Grieco & Turner, 2005; WHO, 2012). All these factors are likely to contribute to women preferences to go to TBAs for child delivery than to formal health facilities.
Training TBAs has been reported from other developing countries outside Africa. For example in Bangladesh TBAs was trained by local nongovernmental organizations on hygiene delivery, comprising three cleans (Peltzer & Henda, 2006). Most of these women and infants are from developed countries (Grieco & Turner, 2005; Mbidzenyuy, 2012). In sub- Saharan Africa countries for instance, maternal mortality varies widely, but is ranging from 800 to 2500 per 100,000 live births. Infant mortality ranges from 100 to 150 per 1000 (Grieco & Turner, 2005; WHO, 2012). These women and infants do not need to suffer and die; most lives could be saved using relatively easy and cheap methods (Grieco & Turner, 2005; WHO, 2012) partly by training TBAs who take on board the social cultural practices related to child birth and caring the infants and are always omnipresent in villages (Grieco & Turner, 2005; Mbidzenyuy, 2012).
Interventions to reduce adverse outcomes in births attended by an TBAs and other unskilled birth attendants may include, provision of oral uterotonics (Sutherland et al, 2010; Prata et al., 2011) and/or clean delivery kits (Winani et al., 2007) to mothers or postnatal home visits (Bang et al., 2005) to identify problems. Various efforts by governments in developing countries are being taken to reduce maternal deaths, stillbirths and neonatal deaths related to intrapartum events in unattended births (WHO, 2012). These include use of anti-natal clinic, immunization and insistence to deliver in health facilities (MoH, 2003; Dzadecyson, 2007; Jamison et al., 2006, WHO, 2012). If TBAs could be taken on board after training could avert some of these health problems especially maternal and new-born mortality. The number of TBAs in developing countries is not known. Conservative estimates suggest that there will be between 180 million non-skilled birth attendants in sub-Saharan Africa by 2015 (Crowe et al., 2012).
Therefore, in Takum Local Government Area of Taraba State where the research was carried out, the activities that was conducted is to know the Impact of Traditional Birth Attendance Intervention on Mother and Child Health.
1.3 Statement of Problems
Investigation revealed that the use of unskilled personnel including Traditional Birth Attendance (TBA) is likely to be among the reasons for the high maternal and infant mortality rate in sub Saharan Africa. Despite the expansion of interventions, including construction of more health facilities close to the community, increased use of antenatal clinic, and increased coverage of immunization (MoH, 2003) the problem has persisted. There are several factors that need to be addressed to build an effective intervention framework of reducing maternal and infant mortality rate. TBAs can help to break socio-cultural barriers on intervention on reproductive health programmes.
1.4 Aim and Objectives of Study
The aim of the study is to examine the Impact of Traditional Birth Attendance Intervention on Mother and Child Health in Takum Local Government Area, Taraba State. In achieving this aim, the following specific objectives were laid out as follows:
- To examine the impact of training of Traditional Birth Attendants (TBAs) on the Newborn care in resource poor setting in the study area;
- To determine the policy implications pertaining to traditional birth attendants in order to improve the health of women and children in Nigeria;
- To determine whether TBAs trained are superior to untrained TBAs in knowledge and practice regarding maternal and newborn care;
- To investigate the effect of traditional birth attendants on maternal health in the study area; and
- To ascertain the knowledge and perception of TBAs’ practices by women of child-bearing age in Takum Local Government Area, Taraba State.
1.5 Research Questions
The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:
- Are trained TBAs superior to untrained TBAs in knowledge and practice regarding maternal and newborn care?
- What is the impact of training of Traditional Birth Attendants (TBAs) on the Newborn care in resource poor setting in the study area?
- What is the policy implications pertaining to traditional birth attendants in order to improve the health of women and children in Nigeria?
- What is the effect of traditional birth attendants on maternal health in the study area?
- What are the knowledge and perception of TBAs’ practices by women of child-bearing age in Takum Local Government Area, Taraba State?
1.6 Research Hypothesis
In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.
Hypothesis One
- H0: There is no significant knowledge and perception of TBAs’ practices by women of child-bearing age in the study area
- H1: There is significant knowledge and perception of TBAs’ practices by women of child-bearing age in the study area
Hypothesis Two
- H0: There is no significant effect of traditional birth attendants on maternal health in Takum Local Government Area, Taraba State
- H1: There is significant effect of traditional birth attendants on maternal health in Takum Local Government Area, Taraba State
1.7 Significance of Study
The study will play an important role by providing information that will assist TBAs on child delivery in the study area. This study will be of immense benefit to other researchers who intend to know more on this study and can also be used by non-researchers to build more on their research work. This study contributes to knowledge and could serve as a guide for other study.
1.8 Scope of Study
The scope of the research is focused on the Impact of Traditional Birth Attendance Intervention on Mother and Child Health in Takum Local Government Area, Taraba State.
1.9 Limitations of the Study
During the course of this study, many things militated against its completion, some of which are:
- Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
- Research material: availability of research material is a major setback to the scope of the study.
- Frequent power failure: This made the researcher append more money on fuel to ensure sustainable power.
- Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
1.10 Definition of Terms
Attitude: The way one behaves towards somebody or something that shows how you think or feel.
Knowledge: To have information about something because you have experience or because you have learned it or be told.
Mortality: The number of death in a particular situation or period of time.
Perception: To notice something in a particular way or hold a view about something.
