[Evaluation of a training program for traditional birth attendants in Quetzaltenango, Guatemala]

In 1992, a training program for traditional birth attendants (TBAs) was initiated in Quetzaltenango, Guatemala, in order to improve the identification and treatment of neonatal disorders and high-risk pregnancies. This program was evaluated by comparing the pattern of hospital referrals by TBAs before and after the training. The study design consisted of a community intervention evaluated by means of several cross-sectional surveys. Comparisons were made between a group of TBAs who had received the training (intervention group) and another group of TBAs from nearby communities who had not received the training (control group). The outcome variables included the TBAs' ability to correctly identify obstetric complications, the point in time at which they sent mothers to the hospital, and perinatal mortality among the children whose mothers were referred to the hospital. Of the 854 women eligible, 845 participated in the study. Following the training program, there was a 200% increase in the number of mothers referred to the hospital by the TBAs. There was also improvement in the ability of the TBAs in the intervention group to refer women with obstetric complications to the hospital, although the effect of the program appeared to have been minimal on both that ability and the reduction of perinatal mortality. Nevertheless, the latter effect should be more precisely determined, since a decrease in perinatal mortality was observed in both the intervention and control groups, with no statistically significant difference.