Traditional Birth Attendant

CHAPTER ONE

INTRODUCTION

1.0         Background of the Study

Annually, almost four million children that are delivered die in the first week of their life, all over the world ().  It is also believed that 529,000 mothers lost their lives in connection with pregnancy-related reasons (WHO, 2005). On the other hand, the World Health Organisation (WHO), estimated that about 536, 000 women lost their lives yearly due to pregnancy-related causes and almost 10 million women suffer life threatening conditions and diseases that is linked to pregnancy or when giving birth to a child (WHO, 2007; Ndep, 2014). In third world countries with Nigeria as a typical example, several women are still delivering at the Traditional Birth Attendants’ centre and without the help of trained medical practitioners (Mrisho, Schellenberg, Mushi, Obrist, Mshinda, Tanner & Scellenberg, 2007).  A survey report shows that implementation of skilled birth healthcare services could result in the reduction of about 20-30% of newborn deaths (Darmstadt, Bhutta, Cousens, Adam, Walker & De Bermis, 2005).

Several studies have confirmed that in sub-Saharan African countries including Nigeria, between 60-90% of deliveries are attended to by Traditional Birth Attendants, with countries like Chad, Niger and Nigeria having a very large numbers of women who are taken care of and delivered by TBAs ().  

WHO defines a Traditional Birth Attendant (TBA) as someone that helps the pregnant mother during childbirth and who initially acquired her skills delivering babies by herself or by working with other birth attendants (). In the northern parts of Nigeria, TBAs are usually of the female sex only, while in some other parts of the country, they may be both males and females gender (Adesina, 2015). The number of TBAs in developing countries is not known. Conservative estimates illustrate that there is a likelihood that the number of non-skilled birth attendants will be between 180 million in sub-Saharan Africa by the end of this year, 2015 (). The introduction of modern medical practices tends to relegate TBA practices to the background or totally eliminate it; nevertheless, Traditional Birth Attendant is an age long profession in most parts of the world especially developing countries like Nigeria. Most pregnant women register with the health facilities and attend antenatal care, but when it comes to the time of delivery they return to be delivered by TBAs because they believe they will be given proper care and in cases of any spiritual attack the TBAs can save them and their children from such attacks  ().  Some of the factors that promote women’s continuous patronage of the TBAs include: the woman’s level of education, employment, family income, treatment and service cost, male involvement, distance to access health facilities; attitude of health care workers, perceive danger of utilizing modern health care facilities in terms of health care workers competence to deliver services and confidence on the availability and potency of drugs and other essential commodities, religious belief and marital status (Obasi, 2013).

There are two categories of TBAs: the retired trained midwives who have worked in the formal healthcare system or have received formal training as health workers and the TBAs who acquire their skill through personal experience inherited from their mother or grandmother or might acquire the skills by learning from other elderly and experienced TBAs either formally trained or untrained. The millennium development goals 4, 5 and 6 that were health related had made some remarkable achievements but the target set could not be fully met by the 2015 deadline. Therefore, it has been replaced with the Sustainable development Goals (SDG) that was adopted on September 25th, 2015 by over 150 World leaders from   193 countries during the United Nations Sustainable Development Goals (SDGs) in New York, USA. The Goal three of the SDGs focuses on ensuring healthy lives and promoting the well-being for people of every age categories by the year 2030. The SDGs have six key targets which are health related including: Reproductive, maternal, newborn, child and adolescents health; tackling infectious diseases such as Hepatitis, Malaria, HIV, tuberculosis, and neglected tropical diseases; non-communicable Sicknesses especially diseases pertaining to the heart, diabetes and cancer; mental health and substance abuse; injuries and violence as well as the universal health coverage (WHO, 2015). 

The place of TBAs cannot be ignored in the health of mothers and children in this era of HIV/AIDS since they tend to fill the gaps in maternal and child health care in rural and semi-urban Nigeria. Having this in mind, assessing Traditional Birth Attendants knowledge of his/her HIV status, the clients’ HIV status, knowledge about mother to child transmission of HIV, health education as well as preventive practices including using razors and sharp objects before, during and after delivery process that exposes the Traditional Birth Attendants, women and their children to HIV infection.

The first recognized case of Acquired Immune Deficiency Syndrome (AIDS) was reported in 1981 among homosexuals or gay men in the United States of America (AVERT, 2014). The discovery of AIDS was shortly followed in 1983 by the discovery of HIV which is responsible for AIDS.  According to UNAIDS and WHO (2005) reports, it is estimated that over 25 million people have been killed by AIDS since its inception, which makes it one of the most destructive epidemics ever recorded in the history of the world (). The virus that is responsible for AIDS is known as the Human immunodeficiency Virus (HIV); the virus is an organism that is too small and cannot be seen with unaided eye which belongs to the Retrovirus family.

All over the world, HIV/AIDS has been confirmed to be the frontline cause of maternal death especially among women of childbearing age. HIV is one of the most outstanding health challenges ravaging the world today. Research has shown that almost every HIV infections that occur in children are as a result of an HIV positive woman giving birth. Therefore, it can be said that the world wide spread of HIV (epidemiology) is a reflection of how many women are actually infected with the virus. The Federal Ministry of Health report of 2009 indicated that there were 370, 000 new HIV infections in newborn children in 2009 with black skin African nations which Nigeria is a part contributing almost 90% of the HIV/AIDS epidemics (FMoH, 2010). A NACA report of 2014 with regards to 2013 projection estimates deduced that about 3,229,757 people are living with HIV. The report also showed that an estimated 220,394 additional HIV infections did happened in 2013 while citizens totaling 210,031 lost their lives due to cases relating to AIDS and most of them are women (NACA, 2014). There is imbalance in the burden of HIV  infection that has been placed on women and children, who in many context has continued to experience high cases of new HIV infections and other HIV-related illnesses and in most cases may lost their lives (FMoH, 2010). Also, a report from the World Health Organisation (WHO) stated that in 2013 there were around 35 million people globally that were living positively with HIV, out of which 3.2 million of them were young children that are below 15 years of age{WHO, 2005 #51;WHO, 2015 #79}. The major factor that contributes to the high prevalence of HIV among children is maternal to child transmission as shown by the 2012 sentinel survey which uses mainly data obtained from the formal health facilities in countries to estimate the total number of HIV infections that exist in the country.