A traditional birth attendant (TBA) training program, conducted in Quetzaltenango, Guatemala, was evaluated by comparing TBA referral patterns before and after training to determine if trained TBAs were better able to manage high risk situations. Evaluations were based on questionnaires administered to 845 referred mothers and a review of their medical records. Two community groups, one where the TBA training program was offered (intervention) and the other in surrounding communities (non-intervention) where the program was not offered, formed the basis for comparisons. Specific outcome variables included the ability of TBAs to correctly identify complications, the timing of referrals, and perinatal mortality of infants born to mothers referred to the hospital by TBAs. In general, the TBA training program resulted in improvement in the ability of TBAs to refer women with complications in a timely manner but had little impact on the ability of TBAs to identify specific obstetrical complications or on reducing perinatal morality. Over the study period, there was a marked increase in the overall number of TBA referrals in both intervention and non-intervention communities with the greatest change in percent increase of unnecessary referrals. The increase was not likely due to the training program since it occurred in both communities. Changes in the ability of TBAs to correctly identify obstetric complication after the training program were similar in both intervention and non-intervention communities and, therefore, could not be attributed solely to the TBA training program. TBAs in intervention communities referred their patients to the hospital in a more timely manner following the training program than TBAs in non-intervention communities. A multivariate analysis of timely versus late referrals identified a borderline statistically significant improvements in timeliness for intervention versus nonintervention communities for all women as well as for women with specific complications of malpresentation, prolonged labor, and preterm labor. Univariate analyses of perinatal mortality rates showed significant improvement for only those infants of women attended by intervention community TBAs, but there was no significant difference between communities, nor were there significant improvements found in the multivariate analysis. Comparisons of perinatal mortality for specific complications of malpresentation, prolonged labor and preterm labor were also not significant. Improvements in identification of obstetric complication and the reduction of perinatal mortality were noted in both intervention and non-intervention communities. These changes may have resulted from a hospital training program and may have obscured the impact of the TBA training program. In general, there was improvement in all intermediate and final outcome measures following the TBA training program; however, differences between the two communities were not statistically significant at $\alpha$ = 0.05.
| Identifer | oai:union.ndltd.org:UMASS/oai:scholarworks.umass.edu:dissertations-9024 |
| Date | 01 January 1994 |
| Creators | O'Rourke, Kathleen Mary |
| Publisher | ScholarWorks@UMass Amherst |
| Source Sets | University of Massachusetts, Amherst |
| Language | English |
| Detected Language | English |
| Type | text |
| Source | Doctoral Dissertations Available from Proquest |
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