REVIEW

TRADITIONAL BIRTH ATTENDANTS IN

MALAWI
JJM Smit

The M alawian T B A is alm ost invariably a

OPSOMMING fem ale, aged betw een 35 and 60 years. She
begins her m idwifery w ork only after she has
Tradisiohele Vroedvroue en tradisionele helers is ’n bate belangrike skakel in die had children o f her own, and usually learns
ketlingyan gesondheidspersoneel wat prim ere gesondheidsorg in M alawi verskaf from som e close relative w ho is an established
TBA. She performs from 1 to 25 deliveries
Ten spyte van die oprigting van hospitale en gesondheidsentrums is dit tot hierdie
m onthly, ch arg in g betw een 20 cents and
tradisionele vroedvroue en tradisionele helers waartoe die mense hulself ten tye R 3.00 per delivery. A few do not charge.
van siekte en geboorte wend, Ongeveer 60 p ersen t van alle bevallings in Malawi Two-thi rds o f TBA s carry out deliveries in the
vind in die dorpies pldas. D it is dus belangrik dat die nodige aandag aan die patient’s own home, som etim es being called
verskillende aktiwiteite van hierdie tradisionelepraktisyns gegee wordom die doel at the onset of labour, but som etimes only later
van - "gesondheid vir almal in die ja a r 2000", soos in M alawi toegepas, bereik w h en d if f ic u ltie s a rise . T he rem ain in g
word. D ie opleiding van tradisionele vroedvroue vorni deel van die Moeder- en one-third have their own maternity units and
Kindersorgdiensteindteland. tend to do more deliveries, to charge more, and
to deal with normal cases rather than problem
D ie Departem ent van Gesondheid is verantwoordelik vir die opleiding en beheer cases.
van tradisionele vroedvroue. In 1976 het die Departement van Gesondheid ’n
register begin om die tradisionele vroedvroue wat alreeds opgelei is, aan te tekeru The TB A usually sees her patients antenatally
Vroegin l9 7 8 is 'n opleidingskursus vir geselekteerde tradisionele vroedxroue in and prescribes potions made from powdered
d ie K a m u zu H o s p ita a l in L ilo n g w e , a a n g e b ie d . V a n a f 1 9 8 2 h e t d ie bark, roots or twigs. She often administers
sim ilar m edicine during labour. Nearly all
o p le id in g s p r o g r a m van t r a d i s io n e l e v r o e d v r o u e to t ’n n a s io n a le
T B A s w a n t c lo s e r a sso c ia tio n w ith the
opleidingsprogram ontv\’ikkel. ’n Totaal van 841 tradisionele vroed\roue is tot 1987
recognised health services and w elcome the
opgelei en die program w ord steeds voortgesit. id e a o f re c e iv in g tra in in g . T h o se w ith
maternity units in their own homes are more
ABSTRACT
uniform ly positive about this than the others.
Traditional Birth Attendants (TBAs) and traditional healers form an important link T h e m a te rn ity u n its o f th ese T B A s are
in the chain o f health personnel providing prim ary health care in Malawi. In spite typically a mud and thatch house partitioned
o f the establishment o f hospitals and health centres, it is to these traditional healers to divide the labour ward from the post-natal
or w aiting area. Some, however, have several
and TBAs that the majority o f p eople turn in times o f sickness and child-birth.
b u ild in g s, for w aitin g patients, antenatal
Approximately 60 p e r cent o f all deliveries in M alawi occur in the villages. It is
clinics, prem ature baby nurseries, and some
therefore important that due regard be p a id to the activities o f these traditional have corrugated i ron roofs. The TBAs seem to
practitioners in order to ensure the achievement o f the goal ~ ''Health for all by the select them selves for their work, and without
year 2000". The training o f TBAs is seen as p a rt o f the Maternal and Child Health an aptitude for and an i nterest i n thei r work are
Services in the country. unlikely to embark on it. The few apprentice
TBA s in the survey conducted by the Ministry
The Ministry o f Health is responsible fo r the training and control o f Traditional o f Heal th, often "looked the brightest and most
Birth A ttendants and in 1976 opened a register in order to list all those trained In intelligent of the younger wom en available in
early 1978 a training course for selected TBAs was conducted a t the Kamuzu the village" (Bullough, 1978:83).
Central Hospital, Lilongwe and from 1982 the training programme evolved into a
national training program m e fo r TBAs. By February 1987, a total o f 841 The investigation into TBA s by the Ministry
Traditional birth A ttendants had been trained and the programme is still continuing. o f H e a lth (M O H ) r e v e a le d th a t th e ir
m anagem ent o f labour is based on different
principles from those o f W estern medicine.
They have, however, adopted som e Western
INTRODUCTION 1973 the S ecretary for Health in M alawi practices on their own initiative. For example,
a u th o r iz e d an in v e s tig a tio n in to h o m e TBA s deliver their patients in the supine
Approxim ately 60 per cent o f all deliveries in d e liv e rie s in th e Z o m b a and M ach in g a p o sitio n w h e re a s m o st h o m e d eliv e rie s
Malawi occur in the villages, where the patient districts, and in 1976 in the Lilongwe district. conducted by relatives are believed to be
receives prim ary care either from a close (Bullough 1978). managed with the m other in a semi-upright,
relative o r another village w om an acts as sitting or squatting position.
village midwife. These women are called T1 IE T Y PIC A L M ALAW IAN
Traditional Birth Attendants (TBAs). Before TR A D ITIO NA L BIRTH ATTEN DA N T The TB A is prepared to care for premature
1978, when training courses were c o n d u aed babies, deal w ith abortions and treat women
for such workers, the care that they provided, B a s e d o n th e a b o v e in v e s ti g a ti o n s , fo r in f e rtility an d o th e r g y n aeco lo g ical
although undoubtedly loving, w as on the characteristicsoftheM alaw ianT B A emerged. diseases. They do not concern them selves wi th
w hole unskilled, misdirected and harm ful. In children’s diseases. A small number, are also

Cui^tionis, Vol. 17, No. 2, 1994 25

traditional healers and then they treat ail forms
o f disease and include children am ongst their
patients (Bullough, 1978; 83)
T R .\IN IN G OF TR A D ITIO NA L
HI RTII ATTENDANTS
A fter the investigation by the M OH this body
approached the N urses and M idwives Council
o f Malawi (N M CM ) to ask the Council to
establish a training course for a grade of
midwives w ho w ere w illing to w ork in the
rural areas. The Council suggested that the
training should last betw een six w eeks and
three months (M NCM , 1976).
It w as then decided that the MOH should be
responsible for the training and control of
TBA s and in 1976 the M inistry opened a
register in order to list all trained TBs. It was
s u g g e s te d th a t th e s e w o m e n b e le f t
independent o f the normal medical services,
and kept free from oppressive paperwork and
reports. This w ould preserve their dignity and
at the same time ensure that costs did not
escalate (Bullough, 1978: 83).
In early 1978 a training course for 15 TBAs
w as conducted at Kam uzu Central Hospital,
Lilongwe; they were selected from amongst
those w ho carried out deliveries in their own
maternity unit, and w ho perform ed five or
more deliveries per month. They came for two
w eeks training in groups of three and four, and
afterw ards had three follow -up visits.
The syllabus included instruction in hygiene,
the normal events o f pregnancy and labour, the
recognition o f w om en at risk o f obstetric
abnormalities, the m anagem ent o f labour, the
puerperium and the new-born child. Some
child care and developm ent w as taught. Great
em phasis w as placed on the fact that normal
labour is short and that referral to hospital is
essential when delay occurs.
The basic concept stressed w as that their job
w as to manage normal labour in a safe way,
but that abnorm alities o f labour w ere the
concern of hospital staff. It w as emphasised
that they could im prove their results and
reputation by learning to select and recognise
p a tie n ts w ho m ight e x p e rie n c e p ro b lem
labours, and then refer them to hospital.
On completion of the residential course they
were issued with United Nations International
C h ild re n ’s E m e rg e n c y F u n d (U N IC E F )
midwifer)’ bags. This bag is made of stainless
steel and contains the following items needed
duri ng a delivery: a plastic apron, a plastic sheet,
a pair of scissors, a kidney dish, two round
stainless steel bow ls, a pair o f cheatles, a
scrubbing brush, a pair of scissors, soap in a dish,
cottonwool, gauze, swabs for wiping the eyes o f
the baby and protargol eye drops to instill into
the eyes of the baby after bi rth. Other useful items
of equipment such as hurricane lamps, blankets
and soap were also given (Bullough, 1978, 84).
An interview with TBA Mrs Marika Naphira,
showed the author the contents o f her midwi fery
bag, in O aober 1987.
26
EVALUATION OF TH E IN ITIAL
TRAINING PROGRAM M E
The efficacy o f this first training program m e
w as assessed during a fourth and final home
v is it w hen a q u e stio n n a ire , u sed b efo re
training had begun, w as repeated. Records o f
deliveries performed were exam ined and the
equipm ent issued to them inspected. The
training team o f the MOH w as pleased with
the resu lts and related th at th e p ersonal
r e la tio n s h ip s w ith th e T B A s h a d b e e n
excellent, and that a considerable degree o f
mutual trust had developed. Referred patients
arrived in considerable numbers, including
antenatal patients with labour com plications,
and puerperal infections(B ullough, 1978,84).
M uch building activity w as stim ulated by the
fi rst course arranged by the M OH duri ng 1978,
m an y o f th e p a rtic ip a n ts h a v in g s in c e
extended or improved their prem ises. Before
the course, all but one w ere delivering their
patients on the ground, but since then, many
have had labour beds constructed although no
mention w as made o f this being necessary or
desirable. The benefits of this first training
course w ere compared with the costs. There
w ere many hidden costs such as use o f staff
time, but approxim ated costs w ere:-
Transport (for six visits to each
Traditional Birth Attendant) K1 275.00
Equipment K 700.00
Food K 105.00
TOTAL K2 080.00
However, these 15 TBAs are responsible for
about 2 000 deliveries per year, and no further
cost, except for occasional follow-up visits,
need be expected. Their combined w ork-load
is equivalent to that of four or five small
two-m idwife matem ity units.
NATIONAL TRAINING
PROGRAM M E
B ullough (1978) hoped that these results
w ould be considered positively enough to
w a rra n t th e in tro d u c tio n o f a N a tio n al
P ro g ra m m e for tra in in g th e T B A . H e
suggested that such a program m e would be
b e st arra n g e d in th e fo rm o f an in itial
saturation program m e trying to cover the
country and then later as a sm aller programme
m aintaining supervision, w hich w ould be
essential, and running sm aller n u m b erso f new
courses. It w as pointed out that TB A s only
conducted a minority o f village deliveries
during 1978, but it w as postulated that a
national training programme w ould increase
their influence, make them m ore successful
and increase the amount o f w ork they do. In
this way the effects o f their training could
spread to affect all home deliveries (B ullough,
1978, 84-85).
The vision regarding a National T raining
Programme for Traditional Birth Attendants
becam e a reality through the hard w ork and
enthusiasm o f Dr C. Bullough and the medical
an d n u rsin g s ta ff o f th e M O H w ith the
c o - o p e r a t i o n o f th e P r i v a te H o s p ita l
A ssociation o f M alawi (PH A M ) personnel.
The training program m e started in 1978 in the
district o f Lilongwe and three more districts
w ere added in 1980, nam ely M zimba, Dowa
and Mwanza; training w as extended to cover
the w hole country in 1982. T he training
program m e w as impl emented i n support of the
m ain objective o f the M aternal and Child
H e a lth P ro g r a m m e e n u n c ia te d in th e
M inim um Plan, M iniplan, w hich is:
"... to increase protection o f the high
risk group, that is children, under the
age o f five years and m others in the
child-bearing age, against causes of high
morbidity and mortality" (M inistry of
Health 1987; 2)
INCREASING NUM BERS OF
TR A IN ED TR A D ITIO NA L BIRTH
A TTEN DA N TS
By February 1987, a total o f 841 TBAs had
b e e n tra in e d and the p ro g ram m e is still
continuing. Table 1 show s that the number has
been increasingconstantly since 1982, with an
average annual increase o f 148. This is a
considerable achievem ent in view of staff
shortages and difficulties w ith identification
o f untrained TBAs. D istricts are encouraged
to train ten w om en per y ear if adequate
identification can be achieved. TBAs are not
selected in proportion to population density
and there is no national target as the num ber
o f untrained A ttendants is unknown. (See
T able 1)
M ETHO DS A N D C O URSE C O N TENT
T he training courses are held in the M inistry
o f Health and PHAM hospitals. The course
extends over four w eeks using the following
educational methods:
• Lectures
• O bservation
• Discussions
• Role play
• Dem onstrations
• Practice
• Evaluation exercises.
• Field trips to see pit latrines and p ro teaed
well projects.
• Familiarization tours to health centre(s),
ch ild ren’s wards, care o f the new-born
units, "under five"-clinics and nutrition
clinics.
• Social and extra-curricula activities over
the weekends covering the following:
- Health-care and prevention o f infections;
Curationis, VoL 17, No. 2, 1994
 the participants with knowledge, skills and
Table 1: Trained Traditional Birth Attendants, 1978 -1986
a t t i t u d e s f o r p l a n n i n g , o r g a n i s in g ,
im plem enting and evaluating a TBA training
DISTRICT 1978 1980 1982 1983 1984 1985 1986 TOTALS program m e. Special attention w as paid to local
Chitipa Nil Nil Nil 40 8 6 10 34 custom s and needs.

Karonga Nil Nil 7 10 Nil 9 10 36 T he content o f the training was:

Rumphi Nil Nil 8 9 10 7 Nil 34
1. Concept o f culture and relation to health
Mzimba 6 Nil 5 Nil Nil 9 20 in a comm unity.
Nkhata Bay Nil Nil 7 6 9 12 8 42
2. Profile o f the TBA.
Kasungu Nil Nil 10 8 11 9 18 56
3. Review o f the TB A syllabus.
Ntchisi Nil Nil 8 7 7 10 9 41
Dowa Nil 8 10 6 7 9 Nil 40 4. Teaching m ethodology for a TBA
programme.
Mchinji Nil Nil 10 7 6 Nil 8 31
Salima Nil Nil 10 10 10 10 10 50 5. Selection criteria and administrative
aspects o f the programme.
Nkhotakota Nil Nil Nil 10 10 Nil 8 28
Lilongwe 15 Nil 10 Nil Nil 10 Nil 35 6. A ssessm ent and supervision of the TBA,
including assessm ent of knowledge and
Dedza Nil Nil 9 10 Nil 10 Nil 29 use o f delivery records and quarterly
returns (M inistry o f Health 1987; 51).
Ntcheu Nil Nil 9 8 Nil 8 10 35
Mangochi Nil Nil 9 10 6 8 10 43 In April 1985, a National TBA T workshop
w as held in Lilongwe. The objectives of the
Machinga Nil Nil 9 10 9 Nil 9 37
w orkshop were:
Zomba Nil Nil 10 8 Nil 7 Nil 25
1. T o review critically the T B A ’s training
Mwanza Nil 5 Nil Nil Nil 10 14 29 activities and identify areas needing
Chlradzulu Nil Nil 9 8 Nil Nil Nil 17 improvement.

Blantyre Nil Nil 9 8 8 Nil 20 45 2. To exam ine the T B A ’s activities and find
Thyolo Nil Nil 9 9 9 Nil 9 36 out how other activities as
recom m ended by the 1984, Maternal
Chikwawa Nil Nil . 10 6 6 7 7 36 and Child Health Review Mission, could
Mulanje Nil 0 8 7 7 Nil Nil 22 be incorporated into their training and
services(M inistry o f Health 1987,5).
Nsanje Nil Nil 10 10 10 10 Nil 40
O ne o f the main recom mendations w as to
TOTAL 15 19 181 185 130 142 169 841 i n c o r p o r a t e r e f r e s h e r c o u r s e s in th e
program m e to include new areas o f child
(M inistry of H e alth 1 9 8 7 ,4 ). spacing, m alaria and diarrhoea management
in c lu d in g u se o f c h lo ro q u in e and oral
rehydration solutions. This activity started in
- C hild-care and nutrition; I'R A D ITIO NA L BIRTl I July 1985. By February 1987, 123 trained
A 'lT E N D A N T TRAINERS T B A s had u ndergone a w e e k ’s refresher
- P e rs o n a l h y g ie n e , e n v ir o n m e n ta l c o u rse . T h is ac tiv ity is still co n tin u in g
hygiene and sanitation; In tandem with the TBA s training programme, (M inistry o f Health 1987, 5-6).
supervision w as equally im portant for the
- M anagem ent of antenatal clinicpatients, functioning o f the programme. As it was not A s special attention is paid during the training
that is, identification and referral o f possible for the personnel o f the Head Office course to local custom s and needs of the area,
at-risk m others to the nearest health o f the MOH tosuperviseall the trained women the TBA Ts use all sorts o f material to show
centre; in their area, the M inistry decided to train how these TB A s can function in their own
specific personnel to educate TBA; they are surroundings. T eaching hygiene, for example,
- Use, managem ent and care o f UNICEF called Traditional Birth Attendant Trainers is em phasised in many ways. O ne example is
Traditional Birth Attendant kit; (TBATs). the way in which women are shown how to
w ash their hands. The trainer uses water, soap,
- M a n a g e m e n t o f la b o u r , d e liv e ry , The first trainees’ workshop w as conducted in a maize cob, and a tin with a small hole in it,
post-partum or perinatal care o f the May 1981, fol lowed by tw o further workshops w hich is used as a running tap. This could also
new-born; in June and July 1982. T w o nurses were be taught with the aid o f pictures. The cutting
trained from each district, that is, a Registered o f the b ab y ’s cord is demonstrated by using a
- Recognition o f obstetric com plications C o m m u n ity H ealth N urse o r R eg istered rope or a soft cotton belt, which is tied in two
th a t m ay a ris e d u rin g la b o u r a n d N urse/M idw ife or an Enrolled Nurse/Midwife places, m aking knots. A razor blade is then
delivery; or Enrolled Comm unity Health Nurse. One o f used for cutting in between the two knots. For
the two w as the Maternal and Child Health equipm ent to cut the cord, the women are
- The role of the health team, the TBA and C o-ordinator. No specific selection criteria taught to prepare the bigger m atchbox in
her re latio n sh ip w ith o th er prim ary w ere applied (M inistry o f Health 1987:51). w hich they pack self-prepared boiled cord
health care workers; ligatures, a new razor blade and a piece of
(M inistry o f Health, 1987 2-3). The objective o f these w orkshops was to equip soap; they feel com fortable with this type of

Curationis, Vol. 17, No. 2, 1994 27

kit, and it can be mai ntained and cl eaned easi Iy
(Chirambo, 1985:29).
PERSONAL VISIT TO A
I'RADITIONAL BIRTH ATTENDANT
During a visit in 1984 to a local TBA, Mrs
N ajere K um w em be, (also registered as a
traditional healer at N anjira) the researcher
found that she w as com bining traditional
m edicine very successfully with her modern
scientific knowledge o f obstetrics. She has
built up a wide reputation since she started to
practise there in 1968 because she has the
ability to ‘see inside the uterus’ and spot any
abnorm alities im mediately. The patient is then
referred to the hospital at Lilongwe, A fter the
abdominal palpation on an antenatal patient,
she rubs medicine on the abdom en o f the
patient as well as on a hand mirror. The mirror
is then held in front o f the abdom en and
‘reflects’ the contents i nside. Accordi ng to her,
it w orks like an X-ray photo. The medicine is
made of roots o f a certain tree w hich her
husband obtains from the Dedza-district, and
these roots are then boiled in a tin. Qualified
nurses num ber am ong M rs K um w em be’s
patients. Her practice is inspected regularly by
the MOH and she attends updating courses in
midwifery when it is expected o f her.
M rs Kumwembe also functions as a traditional
healer and treats ‘mentally confused patients
that scream and sh o u t’. She g iv es them
medicine consisting o f dried roots which are
first ground into pow der, then sieved and
mixed with water. The patient receives two
teaspoonfuls of this m ixture twice a day. The
medicine calm s the patient dow n but if the
patient does not im prove she refers the patient
to the psychiatric hospital in Zomba (V isit to
Mrs N. Kumwembe, 14 July 1984^ This
corresponds with a statem ent by Dr Stevenson
that the local treatm en t o f neuroses and
hysteria may be as effective in many cases as
the treatment w hich conventional medicine
can offer (Stevenson, 1964:10).
NATIONAL EVALUATION OF
TRADITIONAL BIRTl I
ATTENDANT PROGRAMME
Since the T B A ’s training programme started
in 1 9 7 8 , n o c o m p r e h e n s i v e n a tio n a l
e v alu a tio n h as been u n d e rta k e n . D u rin g
A ugust 1980, the U nited N ation’s Family
Planning Assistance (U N D PA ) programme,
visited Malawi and gave their support to the
programme and the evaluation o f Maternal
and Child Health services. The evaluation of
the Traditional Birth A ttendants’ program m e
w as then undertaken jointly during 1985 and
1986 by the G overnm ent o f Malawi with
W HO and UNFPA.
It w a s r e c o m m e n d e d th a t th e T B A ’s
programme becom es an integral part o f the
family health program m e at national, regional
and district level. T his w as im plem ented and
the training o f Traditional Birth A ttendants is
seen as part o f the M aternal and Child Health
Services (M inistry o f Health, 1986, 7-13).
28
One o f the mai n findi ngs o f the worki ng group
was that there was a need to increase the level
o f aw areness am ong the com m unity o f the
activities and role o f the TBA s, and their
participation in primary health care o f Village
H e a lth C o m m itte e s in o rd e r to e x te n d
coverage o f maternal and child health. It was
recom mended that this orientation should be
done by the trainer on com pletion o f the
T B A ’s tra in in g se ssio n s, at c o m m u n ity
leadership m eetings in their hom e areas after
consultation w ith the TBA T. C om m unity
support for the TBAs needed strengthening,
particularly with regard to referral o f high risk
m others (M inistry of H ealth 1987, iii).
SELECTION OF TR.\DITIONAL
BIRTH ATTENDANTS
A nother recom mendation o f the review team
w as that in view o f the fact that about 50 per
c e n t o f T B A s p e rfo rm e d le s s th an th e
minim um requirem ent o f 24 deliveries per
annum w hich w as required for selection up to
1987, and 25 per cent performed less than 10
d eliv eries on average per annum , a new
approach to their selection o f needed to be
im plem ented, based on the follow ing five
points:
1. Population the TBA is likely to be serving.
2. Proximity to other health facilities.
3. V isit to villages, discussion with village
leaders and review of the workload o f
the TBA by the trainer before selection
is made.
4. Identification of untrained TBA s should
be an on-going process throughout the
year through discussion with village
leaders and untrained A ttendants when
encountered during outreach clinics, or
by Health Surveillance Assistants.
5. Health Centre staff should be involved in
the selection o f TBAs (Mi nistry of
Health 1987, v).
These recom mended criteria are taken into
c o n s id e ra tio n w h e re v e r p o s s ib le w h e n
selecting w om en for training.
SUMMARY
Traditional healing is an established part o f a
culture. It is practised in various degrees in all
cu ltu res including the A frican culture. It
should also be noted that traditional m edicine
still rem ains the only source o f care for many
people in developing countries, and for them
p rim ary health care is sy n o n y m o u s w ith
traditional medicine. In M alawi, as in other
A frican countries, traditional h ealers and
T B A s p la y an im p o rta n t ro le in th e ir
c o m m u n itie s, e sp e c ia lly w ith reg a rd to
common ailm ents and mental disorders. In
spite of the establishm ent o f hospitals and
health centres, it is to these traditional healers
that the majority of people tum in tim es o f
sic k n e ss and c h ild -b irth . It is th e re fo re
im perative that all due regard should be paid
to the various activities o f these traditional
p r a c t i t i o n e r s in o r d e r to e n s u r e th e
achievem ent o f the goal - "Health for All by
the Y ear 2000", as is done in M alawi. The
Traditional Birth A ttendants and traditional
healers form an im portant link in the chain of
health personnel providing primary health
care in M alawi.
REFERENCES
BU LLO U G H C H W (1978). Tradional Birth
A tten d a n ts in M alaw i, in H ealth for A ll.
M alawi M inistry o f Health; Lilongwe.
C HIRA M BO, M.T. 1985 A study o f why the
Traditional Birth A ttendants are incorporated
in to th e P rim a ry H ea lth C are p la n o f a
developing country like M alaw i. Unpublished
dissertation subm itted for B SC degree in
N ursing Studies: U niversity o f Ulster.
M INISTRY OF HEALTH, {1918). H ealth fo r
all. R eport o f the National Sem inar on PHC,
Llongw e, 30 O ctober - 3 November. M alawi
M inistry of Health: Llongwe.
M IN IS T R Y O F H EA LTH , (1986). The
N a tio n a l H ealth Plan o f M alawi, 1 9 8 6 -1 9 9 5 .
M alawi M inistry o f Health: Llongwe.
M INISTRY OF HEALTH,(1987). R eport on
E valuation o f Traditional Birth A ttendants
Program m e, February. Malawi M inistry of
H ealth: Llongwe.
N u rse s a n d M idw ives C ou n cil o f M alaw i
(1976). M inutes o f the Council, 16 N ovem ber
1976. Malawi: Llongwe.
STEV ENSO N, D.J.D. (1964). The H ealth
Services o f M alaw i, Unpublished thesis for the
D egree o f D octor in M edicine. U niversity o f
Glasgow.
Visits and interviews with Traditioim l Birth
Attendaius: undertaken by author.
Mrs. M arika Naphira, K um itaw a V illage, 21
O ctober 1987.
M rs. N. K umwembe, N anjira Village, 14 July
1984.
Joyce Smit
D,CUR(U.P.E.)
Senior Lecturer
Department of Nursing
University of Stellenbosch
Curationis, VoL 17, No. 2, 1994