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Intervention Review

Traditional birth attendant training for improving health behaviours and pregnancy outcomes

  1. Lynn M Sibley1,*,
  2. Theresa Ann Sipe2,
  3. Carolyn M Brown3,
  4. Melissa M Diallo4,
  5. Kathryn McNatt5,
  6. Nancy Habarta6

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 18 JUL 2007

Assessed as up-to-date: 29 JUN 2008

DOI: 10.1002/14651858.CD005460.pub2


How to Cite

Sibley LM, Sipe TA, Brown CM, Diallo MM, McNatt K, Habarta N. Traditional birth attendant training for improving health behaviours and pregnancy outcomes. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD005460. DOI: 10.1002/14651858.CD005460.pub2.

Author Information

  1. 1

    Nell Hodgson Woodruff School of Nursing, Lillian Carter Center for International Nursing, Atlanta, Georgia, USA

  2. 2

    Emory University, Rollins School of Public Health, Atlanta, Georgia, USA

  3. 3

    Emory University, Health Sciences Center Library, Atlanta, Georgia, USA

  4. 4

    Atlanta, Georgia, USA

  5. 5

    Lawrenceville, Georgia, USA

  6. 6

    Oak Ridge Institute for Science and Education Research, Atlanta, GA, USA

*Lynn M Sibley, Lillian Carter Center for International Nursing, Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road, Room 428, Atlanta, Georgia, 30322, USA. lsibley@emory.edu.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 18 JUL 2007

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Between the 1970s and 1990s, the World Health Organization promoted traditional birth attendant (TBA) training as one strategy to reduce maternal and neonatal mortality. To date, evidence in support of TBA training remains limited and conflicting.

Objectives

To assess effects of TBA training on health behaviours and pregnancy outcomes.

Search methods

For this update, we searched the Trials Registers of the Cochrane Pregnancy and Childbirth Group and Cochrane Effective Practice and Organisation of Care Group (EPOC) (June 2008).

Selection criteria

Published and unpublished randomized controlled trials (RCT), controlled before/after and interrupted time series studies comparing trained and untrained TBAs or women cared for/living in areas served by TBAs.

Data collection and analysis

Three authors independently assessed study quality and extracted data.

Main results

Four studies, involving over 2000 TBAs and nearly 27,000 women, are included. One cluster-randomized trial found significantly lower rates in the intervention group regarding stillbirths (adjusted OR 0.69, 95% confidence interval (CI) 0.57 to 0.83, P < 0.001), perinatal death rate (adjusted OR 0.70, 95% CI 0.59 to 0.83, P < 0.001) and neonatal death rate (adjusted OR 0.71, 95% CI 0.61 to 0.82, P < 0.001). Maternal death rate was lower but not significant (adjusted OR 0.74, 95% CI 0.45 to 1.22, P = 0.24) while referral rates were significantly higher (adjusted OR 1.50, 95% CI 1.18 to 1.90, P < 0.001). A controlled before/after study among women who were referred to a health service found perinatal deaths decreased in both intervention and control groups with no significant difference between groups (OR 1.02, 95% CI 0.59 to 1.76, P = 0.95). Similarly, the mean number of monthly referrals did not differ between groups (P = 0.321). One RCT found a significant difference in advice about introduction of complementary foods (OR 2.07, 95% CI 1.10 to 3.90, P = 0.02) but no significant difference for immediate feeding of colostrum (OR 1.37, 95% CI 0.62 to 3.03, P = 0.44). Another RCT found no significant differences in frequency of postpartum haemorrhage (OR 0.94, 95% CI 0.76 to 1.17, P = 0.60) among women cared for by trained versus TBAs.

Authors' conclusions

The potential of TBA training to reduce peri-neonatal mortality is promising when combined with improved health services. However, the number of studies meeting the inclusion criteria is insufficient to provide the evidence base needed to establish training effectiveness.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Traditional birth attendant training for improving health behaviours and pregnancy outcomes

In the developing world, many women give birth at home assisted by family members or traditional birth attendants (TBAs). TBAs lack formal training and governments and other organizations have conducted training programs to improve their skills. There is disagreement that these training programs are effective. This review included four studies and examined the effect of TBA training on TBA behaviour and on pregnancy outcomes. We conclude that the potential of TBA training to decrease newborn death is promising, when combined with improved health services. The number of studies, however, is insufficient to provide the necessary evidence for TBA training effectiveness.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

為了改善健康行為與懷孕的預防所提供的傳統接生員訓練

在1970年代到1990年代之間,世界衛生組織(World Health Organization)曾推動傳統接生員(TBA)的訓練,以當作1種用來降低母體與新生兒死亡率的策略。截至今日,支持傳統接生員訓練的證據,仍然是有限而且相互矛盾的。

目標

要評估傳統接生員訓練對於健康行為與懷孕的預防所產生的影響。

搜尋策略

我們搜尋了the Trials Registers of the Cochrane Pregnancy and Childbirth Group以及 Cochrane Effective Practice and Organisation of Care Group(EPOC)(2006年6月);有關於教育、社會,以及健康科學等領域的電子資料庫(從建置日期開始到2006年6月);網際網路;而且還曾與專家聯繫。

選擇標準

已發表與未發表的隨機對照試驗(RCT),之前/之後對照試驗,以及間斷型的時間系列研究,針對受過訓練與未受過訓練的傳統接生員,或是在傳統接生員能夠提供服務的領域中,針對接受生活照料的婦女們,在這些對象之間進行了比較。

資料收集與分析

有3位作者獨立地評估了研究的品質,並擷取出資料。

主要結論

其中共收集了4份研究,包含了2000位以上的傳統接生員與將近27,000名婦女在內。有1份群組隨機的試驗發現,關於胎死腹中(adjusted OR 0.69, 95% confidence interval (CI) 0.57 to 0.83, P < 0.001)、周產兒的死亡率(adjusted OR 0.70, 95% CI 0.59 to 0.83, P < 0.001)以及新生兒的死亡率(adjusted OR 0.71, 95% CI 0.61 to 0.82, P < 0.001),在醫療干預的組別中,明顯較低。母體的死亡率也比較低,但是並不明顯(adjusted OR 0.74, 95% CI 0.45 to 1.22, P = 0.24),可是轉診的比例卻明顯地高出許多(adjusted OR 1.50, 95% CI 1.18 to 1.90, P < 0.001)。有1份在她們之前/之後的對照研究針對被轉診到某種健康服務單位的婦女而言,在醫療干預的組別以及對照組之中,周產兒死亡的數目減少了,但在這些組別之間並沒有明顯的差異(OR 1.02, 95% CI 0.59 to 1.76, P = 0.95)。同樣地,在這些組別之間,每個月的平均轉診數目也沒有什麼不同(P = 0.321)。有1組隨機對照試驗發現,在有關於添加補充性食物的建議之中,出現了某種明顯的差異(OR 2.07, 95% CI 1.10 to 3.90, P = 0.02),但是針對立即以初乳來進行哺育而言,就沒有明顯的差異(OR 1.37, 95% CI 0.62 to 3.03, P = 0.44)。另外1組隨機對照試驗發現,受過訓練的與傳統的接生員比較起來,在經由這些人員照料過的婦女們之中,對於發生產後出血的頻率而言,雙方面並沒有明顯的差異(OR 0.94, 95% CI 0.76 to 1.17, P = 0.60)。

作者結論

在合併改善健康服務的前提下,傳統接生員訓練在降低周產新生兒死亡率方面的潛力,是很值得期待的。然而,能夠符合內容標準的研究之數目,並不足以評估提供建立訓練功效所需的證據基礎。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

針對改善健康行為與懷孕之預防所舉辦的傳統接生員訓練。在開發中國家,許多婦女是在家裡進行生產,並由家中的成員或是傳統接生員(TBAs)予以協助。傳統接生員都缺乏正式的訓練,政府單位與其他組織則都已經進行了訓練的計畫,以幫助提升這些人員的技能。這些訓練計畫是否有效,目前還沒有共識。本篇回顧共收集了4份研究,檢查了傳統接生員訓練對於傳統接生員之行為以及懷孕之預防的影響。我們得到了這樣的結論,在合併改善健康服務的前題下,傳統接生員訓練那麼在減少新生兒死亡人數方面,是值得期待的。然而,若是針對來看,這些研究的數目並不足以作為評估傳統接生員訓練的功效的足夠的證據。