DETERMINANTS OF RESPONSIVE EMERGENCY OBSTETRIC REFERRALS AND REFERRAL INTENTIONS AMONG TRADITIONAL BIRTH ATTENDANTS IN LAGELU LGA, OYO STATE, NIGERIA
ABSTRACT
Despite all efforts to reduce maternal mortality rate during the Millennium Development Goals (MDGs) initiative, maternal mortality remains unacceptably high. In Nigeria, the maternal mortality rate is 800-1,000 per 100,000 live births, making Nigeria accounts for about 10% of the global estimate for maternal mortality. One of the reasons MDGs initiative failed to achieve the set target was because it focused mainly on clinical measures and other important drivers of maternal health care were ignored. For instance, some of the vital roles of traditional birth attendants (TBAs) were ignored. Although, TBAs practices are not in consistence with best practices but they are safety nets in areas where maternal health care services are short served. They were isolated from the strategies in implementing the MDGs. In Africa, Over 58% of deliveries are delivered outside hospitals in the rural areas which traditional birth attendants have higher patronage and according to WHO, global goal is that over 70% of deliveries should be assisted by skilled birth attendants so as to manage complication cases. Lifetime risk of women to die as a direct result of complication during pregnancy and delivery is estimated to be at 1:16mothers compared to 1 in 8,700 in North America or Europe. Therefore, the main objective of the study was to determine factors that ensure emergency obstetric referrals and referral intentions among traditional birth attendants in Lagelu local government, Oyo State, Nigeria
The study was a cross-section design in which a focus group and validated questionnaire was used to collect information from 52 consenting female traditional birth attendants in lagelu local government. Ethical clearance was obtained from Babcock University Health Research Ethics Committee (BUHREC) to conduct the study. Data collected was analysed using frequency distribution, summaries and descriptive statistics was done.
The result in this study showed that the mean age of the participants was 49 years with majority (75%) attaining primary education only. All the participants (100%) are women. Majority (95%) are also married with 90% of them being Christians. Years of experience of all participants are from 2-25years. High patronage by pregnant women was recorded with each of traditional birth attendants attending to deliveries in a range of 1-25 births annually. Attitude of most of the respondents was unfavorable with mean score of 7.6 on a rating scale of 27points.Subjective norms were above average with 62.52% with mean score of 13.13 on a rating scale of 21 points. Referral intentions were positive for majority(95%) There was a significant relationship between attitude and perceived behavior with p-value less than 0.05. (P < 0.05)
The study concluded that traditional birth attendants have a strong influence on the utilization of emergency obstetric care by pregnant women and a good strategy in reducing the alarming high maternal mortality would be to use the qualities of traditional birth attendants to improve bilateral respect between pregnant women and the hospital staff. The traditional birth attendants should be involved in planning, implementation and monitoring of any intervention training directed to them to enhance their skills in referrals. Partnership between the tbas and the biomedical staffs should also be strengthening.
Keywords: Emergency obstetric referrals, Traditional birth attendants, pregnant women, Maternal mortality, pregnancy complications