The impact of training and supervision on traditional birth attendants

A survey of 40 trained and 40 untrained traditional birth attendants (TBAs) was done over a 3-week period in two counties in Uganda to evaluate the impact of training and supervision on TBAs. Forty womens' groups and 20 mothers were also interviewed. The result showed that the most utilized birth attendants were mothers-in-law, trained and untrained TBAs, and the pregnant woman herself. Childbirth was regarded as a normal, private event and the birth attendants were normally called when labour was well advanced or in case of complications. Trained TBAs were attending three times the number of deliveries as untrained TBAs. There was no difference in the knowledge and practices of trained and untrained TBAs, and in the performance of supervised versus unsupervised trained TBAs. All TBAs demonstrated poor knowledge and practices in the management of complications of pregnancy and labour. Reasons suggested for the poor performance included an over ambitious, inappropriate initial training, and lack of useful supervision. Overall the study concluded that there was a case for continuing with the training and supervision of TBAs provided changes were made to the selection, training and supervision processes.