The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #56752

Malaika L. Little¹, Kevin A. Rodgers, MD², Sara W. Nelson³, and Karen Richardson-Nassif, PhD². (1) College of Medicine, University of Vermont, 89 Beaumont Ave., Burlington, VT 05405, (802) 660-8840, Malaika.Little@uvm.edu, (2) College of Medicine, Department of Family Practice, University of Vermont, 89 Beaumont Ave, Burlington, VT, VT 05405, (3) School of Medicine, Harvard University, 47 Harrison Street, Brookline, MA 02446

Purpose/Problem: Assess the knowledge/skills and referral practices of trained Traditional Birth Attendant’s (TBA’s) compared to non-trained TBA’s in a rural Honduras, an area with elevated maternal morbidity and mortality, geographic isolation, and few health care providers. Methods: Structured interviews were conducted in Spanish in July 2002 with 12 TBA’s in Subirana, Honduras. Interviews included recognition of and referrals for high-risk pregnancies, and management of obstetrical emergencies, including prolonged labor and postpartum hemorrhage. Six of the TBA’s received training following WHO/Honduran Ministry of Health curriculum in May 2000; the others did not attend this training. Results: Correct management of postpartum hemorrhage, including referral to the health center and promotion of uterine contraction, was reported by all trained TBA’s and one of six untrained midwives. Possible etiologies for prolonged labor were identified by five of six trained and one of six untrained TBA’s. Five of six trained TBA’s referred high risk pregnancies to government health centers in the last year, while untrained midwives made no referrals. All the trained TBA’s, compared to two untrained, knew how to access the regional residential facility that enables access to hospital care for high-risk pregnancies. Conclusion: This study supports a training model for TBA’s that includes individual skill building and integration into the public health system. Two years after instruction, trained TBA’s regularly attended follow-up meetings and demonstrated sustained improvements in knowledge and practice patterns for high-risk pregnancies.

Learning Objectives:

• Identify differences in knowledge, practice patterns, and referral use between trained and untrained midwives in rural Honduras
• Describe the components of the training that was assessed by this study

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.