The 130th Annual Meeting of APHA

Abstract #51297

Lynn M. Sibley, CNM, PhD, American College of Nurse-Midwives, Emory University, 1327 Peachtree St. NE #504, Suite 900, Atlanta, GA 30309, (202) 728-9864, antls@learnlink.emory.edu and Theresa Ann Sipe, PhD, College of Health and Human Sciences, Georgia State University, Office of the Dean, Atlanta, GA 30303.

TBAs remain a major workforce in maternity care in developing countries. Yet, after nearly three decades of experience, there is controversy over cost-effectiveness of their training in relation to the global Safe Motherhood Initiative. Donors, governments and non-governmental organizations have spent large sums on TBA training programs, but systematic attention has not been given to their evaluation. There is scant information available to guide policy decisions. This meta-analysis of TBA training effectiveness summarizes the available published and unpublished studies and describes the effect of training on TBAs and on pregnancy outcomes. The goal is to provide information that may be used to inform program policy decisions about TBA training and evaluation research needs.

In this presentation, we focus on TBA training and overall peri-neonatal mortality. Approximately 4 million neonates die each year in developing countries. An equal number are stillborn. These deaths mostly occur among women cared for by unskilled providers such as TBAs and family caregivers. Results of the meta-analysis show that trained TBAs are associated with a small but significant decrease in peri-neonatal mortality, on the order of 4%-8%. In view of the sheer magnitude of peri-neonatal deaths, even a small improvement in outcomes associated with TBA training will be important from a public health perspective.

Learning Objectives: