ASSESSMENT OF THE ROLE OF TRADITIONAL BIRTH ATTENDANTS

TOWARDS REDUCING MATERNAL MORBIDITY AND MORTALITY

RATE IN

JIBIA LOCAL GOVERNMENT AREA

A RESEARCH PROJECT

BY

AUWAL HABIBU

KASIMU KOFAR BAI, SCHOOL OF NURSING KATSINA

IN PARTIAL FULFILMENT FOR THE REQUIREMENT OF NURSING AND

MIDWIFERY COUNCIL OF NIGERIA FOR THE AWARD OF

“REGISTERED NURSE" CERTIFICATE

i
 NOVEMBER, 2021

DECLARATION

This is to declare that this research project title “ Assessment on the role of traditional

Birth Attendants Towards Reducing maternal mortality and morbidity in Jibia Local

Government Area” as a result of my work except where acknowledge as being drived

from other resources.

Examination number: ________________________________

Signature: ____________________________________

(Auwal Habibu)

_________________

Kasimu kofar Bai School of Nursing Katsina. Date

ii
 CERTIFICATION

This is to certify that the research project titled “Assessment on the role of traditional
Birth Attendants Towards Reducing maternal mortality and morbidity in Jibia Local
Government Area” by Auwal Habibu with examination
number:__________________________ has been examined and approved for the
award of registered nurse certificate.

Signature:_________________________ _____________________

Malama Bintu Mustapha Date

(Project supervisor)

Signature:________________________ _____________________

Mal. Muhammad Nuraddeen Umar Date

(Head of School)

Signature:_______________________
_____________________

Name:__________________________ Date

iii
 (Chief examiner)

ABSTRACT

The research study was carried out to find out the role of TBA towards reducing
maternal morbidity and mortality rate in Jibia local government. Descriptive design
was employed using structured interview as a tools and the sample size of 50 was
used, and data collected were analyzed using frequency tables. The main aim of this
study is to assess the role of traditional birth attendants towards reducing maternal
morbidity and mortality. Result shows that 50% of the respondent agreed with washing
of hand with soap and water before contact with the pregnant women will improve the
maternal health, it is therefore recommended that TBAs should wash their hands
before contact with pregnant women. 90% of the respondents disagreed that good
nutrition have negative impact in pregnancy, considering findings obtained in the
study some recommendations where made which include government should improve
the services of TBAs on how to sterilize their instruments before conducing deliveries,
detect any sign of complicated delivery and also educate them on how to cut the cord
to prevent infection and mother-to-child transmission of HIV. This will also assist in
preventing crossing over of blood which may lead to erythroblastosis fetalis if
incompatibly occurs in subsequent delivery.

Key words: Assessment, TBA, reducing morbidity, mortality.

iv
 DEDICATION

This research project is dedicated to my parents who have done everything possible to

see my success I equally dedicate this work to those mothers who either gaveoff as a

result of delivery or suffered the consequences of improper conduction of delivery.

v
 ACKNOWLEDGEMENT
I thank Almighty Allah for sparing my life and making it possible for me to reach the

final stage of my programme, as well as writing this project. I can't thank him enough

for his infinite mercy.

I'll like to express my propound gratitude and appreciation to my project supervisor in

person of Malama Bintu Mustapha for her patience in supervision, assistance and

devoting her time to make sure things are are done in a right manner, in fact without

her helpful hand this project won't be a success. Thank you ma for everything you've

done, you're a mum and blessing indeed.

Special thanks to the school Director Mal. Muhammad Nuraddeen Umar for the words
of courage and commitment towards success of this journey. Likewise deputy
directors, HODs and as well other members management of the school, the academic
and non-academic staff for their contribution right from day one.
The words of my pen aren't enough to thank my parents for their unconditional love
and their unflinching sacrifice day-after-day. May Allah reward you unlimitedly. Also
a big shout-out to my aunt like no other, Dr. Fatima Isma'il whose kindness and
support remain unmatched, indeed in her I always see humanity. May Allah fullfil

vi
your heart desires. Also to my friend and classmate sister Ahmed Faith Oyiza, whose
class notes saved my ass during various exams, thank you darling sister for always
being there for me, God bless you dear. To my childhood friends Aisha Sani
Muhammad, Muhammad Salihu and Ibrahim Abbas, I sincerely thank you for your
kind support in words and in kind, your display of support has been unmatched and
will never go in vein. Thanks to everyone who contributed in anyway they can towards
success of this undertaking. May Allah reward to y'all in abundance.

TABLE OF CONTENTS
Contents Page
Title page - - - - - - - - - - i
Certification - - - - - - - - - - ii
Abstract - - - - - - - - - - iii
Dedication - - - - - - - - - - iv
Acknowledgement- - - - - - - - - v
Table of contents- - - - - - - - - vi
List of tables - - - - - - - - - - viii
CHAPTER ONE
1.0 Introduction- - - - - - - - - 1
1.1 Background of the study- - - - - - - 1
1.2 Statement of the problem - - - - - - - 2
1.3 Objective of the study - - - - - - - - 2
1.4 Research questions - - - - - - - - 3
1.5 Significance of the study - - - - - - - 3
1.6 Scope of the study- -- - - - - - - 4
1.7 Operational terms definitions - - - - - - - 4

vii
 CHAPTER TWO
2.0 Literature review - - - - - - - - 6
2.1 Conceptual review - - - - - - - - 6
2.2 Theoretical Review - - - - - - - - 16
2.3 Empirical review - - - - - - - - 20

CHAPTER THREE
3.1 Research Design - - - - - - - - - 22
3.2 Research setting - - - - - - - - - 22
3.3 Target population - - - - - - - - 23
3.4 Sampling size - - - - - - - - - 23
3.5 Sampling technique - - - - - - - 23
3.7 Validity of the instruments - - - - - - - 24
3.8 Reliability of the instrument - - - - - - - 24
3.9 Method of data collection - - - - - - - 24
3.10 Method of data analysis - - - - - - - 24
3.11 Ethical consideration - - - - - - - - 24
CHAPTER FOUR
4.0 Result - - - - - - - - - - 25
4.1 Data presentation - - - - - - - - 25
4.2 Answering research questions - - - - - - 32
CHAPTER FIVE
5.0 Discussion of findings - - - - - - - - 33
5.1 Key findings - - - - - - - - 33
5.2 Implication of the Findings with Literature Support - - - 34

5.3 Alignment of findings with previous findings of studies cited - - - 34

5.4 Implications of Findings to Nursing- - - - - - 35

viii
5.5 Limitation of the Study- - - - - - - - 35

5.6 Summary of the Study - - -- - -- - - - 36

5.7 Conclusion - - - - - - - - - -36

5.8 Recommendation - - - - - - - - -37
5.9 Suggestion for further studies - - - - - - - -37
References- - - - - - - - - - -38

LIST OF TABLE

S/N TABLES DESCRIPTION PAGE

1 Table 1.0 Frequency distribution and percentage showing age 27
range respondents
1 Table I . Frequency distribution and percentage showing sex 28
of the respondents.

2 Table II Frequency distribution and percentage of the 28

respondents showing marital status

3 Table III Frequency distribution and percentage shown the 29

religion of the respondents.

Frequency distribution showing the role of TBAs 29

towards improving maternal health.

Frequency distribution showing the healthy practice 30

carried out by TBAs toward improving maternal
health during delivery

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Frequency distribution showing the level of 31
knowledge of TBAs towards improving maternal
health.

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 CHAPTER ONE

1.0 Introduction

1.1 Background of the Study

Despite advance in modern health care traditional birth attendant (TBA) have continued to

be heavily utilized in rural communities in Nigeria. Major disparities in maternal health in

Nigeria remain present despite the goal of the united nations millennium development

goals to reduce maternal mortality by 2015. Nigeria 7 comprised of 774 local governments

and 374 ethnic groups, setting the stage for variability in customs and traditions regarding

childbirth and postnatal practices. Nigeria was identified as one of the countries that needed

to achieved MDGs due to high maternal mortality rates occurring in the country. The 2013

Nigerian national demographic and health survey (NDHS) reported that maternal mortality

ratio was 576 deaths per 100,000 live births due to exposure to hemorrhages, infections,

unsafe abortions, obstetric emergencies, HIV/AIDs and practices that contribute to high

mortality. Before modern medicine, mothers and mothers-in-law often assisted their

daughters with delivery and would depend on traditional birth attendant (TBAs), if issues

or complications where to arise. Traditional birth Attendants (TBAs) in Nigeria have the

potential to contribute significantly to maternal health outcomes because of their high

utilization within the country.

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TBAs are defined as care providers who are traditionally independent of the health system,

and are community based providers of care during pregnancy, childbirth and the postnatal

period. TBAs do not receive formal medical training when compared to other health

professionals such as obstetricians and gynaecologists. However TBAs are much more

affordable and accessible than skilled birth attendants (SBAs) in most part of the country

including Jibia local government which contributes to the high demand for TBAs at the

area, and they lead to reduction in maternal morbidity and mortality in Jibia local

government Area.

1.2 Statement of the Problem

There is high reduction of maternal morbidity and mortality in Jibia local government area,

due to the effort of traditional birth attendant. The motivation of the researcher is to find

out the role of traditional birth attendant toward reducing maternal morbidity and mortality

in Bakori LGA.

1.3 Objectives of the Study

1. To find out the role of traditional birth attendants in Bakori local government.

2. To find out the training given to the traditional birth attendants as part of the health

care team.

3. To find out those practice by traditional birth attendants that are harmful or

beneficial.

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1.4 Research Questions

1. What are the role of traditional birth attendants towards reducing maternal

morbidity and mortality?

2. What are the training given to the traditional birth attendants as part of the health

care team?

3. What are those practices by traditional birth attendants that are harmful or

beneficial?

1.5 Significance of the Study

- The study will contribute to the global awareness on the role of traditional birth

attendants toward reducing maternal morbidity and mortality.

- The research work is hoped to serve as a guide for other colleagues who want to

write on the same topic which is to guide for future planning on the same issues.

1.6 Scope of the Study

The study focused on the role of traditional birth attendants in Jibia local government area

toward reducing maternal morbidity and mortality rate.

1.7 Operational Definition of Terms

- Birth: When a baby is born

- Breast feeding: is the act of nourishing the baby with milk.

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- Community: All the people who live in a particular areas, country etc.

- Morbidity: Refers to having a disease or a symptoms of disease or to the amount of

disease within a population, or medical problem caused by treatment.

- Mortality: Is the state of being mortal or susceptible to death.

- Obstetric: The branch of medical science concerned with care of women during

pregnancy, childbirth and after.

- Pregnancy: Is a condition from the concept to expulsation of the fetus delivery.

- TBA: Traditional Birth Attendants

- WHO: World Health Organization.

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 CHAPTER TWO

2.0 LITERATURE REVIEW

2.1 Conceptual Review

The world health organization (WHO) defined traditional birth attendant (TBA) as “a

person who assists the mother during child birth and initially acquired her skills by

delivering babies herself or through an apprenticeship to other TBAs and skilled birth

attendant as an accredited health professionals(WHO, 2018).

Traditional birth attendants are often older women, respected in their communities they

consider themselves as private health care practitioners who respond to request for

services. the focus of their work is to conduct deliveries at home, they provide health

education to women on nutrition during pregnancy and lactation, they arrange means of

transport and accompany women in labour to health (CMNYirenda, 2016).

The TBA training has been an important component of policy intervention to improve

maternal and child health in developing countries. In many developing countries where

there is often a shortage of trained biomedical personnel, maternity care is usually provided

by the TBAs (O’ Rourke 2015, WHO, 2014). They are accessible and culturally acceptable

and one known to influence women’s decisions about using biochemical health services

(WHO, 2014). In the 1990s and 1980s training TBAs in modern medical method was seen

as a pregressive step towards reducing high mortality rate (Replogle, 2017). As a

5
consequence TBAs were trained to recognize the warning signs of a complicated

pregnancy, treat basic problems, and refer risky causes to a skilled medical practitioner

(Replogle, 2017). TBA training become wide spread after the WHO recognized the

importance of TBAs in primary health care in the international conference held at Alma’ata

in 1978. This chapter details the history of TBA training policies and the concern about the

changing policy paradigms. The chapter also critically reviews the design and content of

TBA training programmes, as per the guidelines of the WHO, UNICEF and UNFPA join

statement and in relation to evidence of programme implementation in developing

countries and in the context of biochemical and tradition knowledge.

2.1.1 History of Traditional Birth Attendants

Prior to the advent of modern obstetric services, traditional birth attendants have existed

since human existence and have rendered services to pregnant women and women in

labour for a long time (Cephass, 2018).

They were initiated through dreams and revelations and continuously through

apprenticeship from family members who where TBAs. They practice using both spiritual

and physical methods and their work was founded on spiritual directions use of spiritual

arte facts, herbs, and physical examination. Their belief that immediate cutting of the cord

and improper disposal of the placenta has negative consequences on child during

adulthood (Lidya, 2018) shows how deeply rooted and traditionally old it has existed in

rural settings. They do not/may not have formal education and training and there are no
6
specific professional requisites such as certification or license in communities one of the

criteria for being accepted as TBAs by client is experience as a mother and many more

such as elderly women having delivered 2-4 children and above, hence they serve as a

bridge between the community and formal health system (Sarmieto, 2016).

In Africa, key midwife, community midwife/traditional midwife has historically been the

major care givers for women during childbirth (Aboriga, et al 2015). These care providers

(TBAs) have along history especially in developing countries such as Ghana, where TBA

has been a part time work for women during childbirth (Aborigo et al., 2015). These care

providers (TBAs) have along history especially in developing countries such as Ghana,

where TBA has been a part time work for unskilled persons who mediate pregnancy and

birth with some spiritual practices as many rely on herbal medicine which are culturally

inherited to assist women during, before and after labour (Nicholas, 2014). Women in these

countries prefer delivery at home because it is easier and cheaper.

However, with time, advancement in training and role of TBAs began to change in Yirol

west county, south Sudan, where they were directed to start referring all women in labour

to health facilities for childbirth instead of assisting them in villages (Wilundac, 2017).

Nevertheless TBAs have continued to be heavily utilized in rural community in Nigeria in

order to reduce maternal morbidity and mortality. (Internal journal of maternal and child

health, 2017).

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2.1.2 History of Traditional Birth Attendants Training

Efforts to train TBAs in developing countries have been in practice since the 1920s in the

Sudan and in the 1950s in Thailand and Philippes (Bayoumi, 2014, Brey 2016, WHO

2016).

In 1970s and 1980s the training of TBA became more widely accepted as an integral

component of maternal and child health interventions (CEDPA 2014, Kwasth 2016).

Recognizing the importance of TBAs in providing reproductive health care, the Alma'ata

conference in 1978 initiated the training of TBAs and their involvement in primary health

care through 1970s and 1980s, who actively promoted the training of TBAs, which was

manifested in the increase in the number of countries having some form of TBAs training

from 24 to 52 countries between 1972 and 1982 (Kruske and Barclay 2017, Leedam 2017).

The success of the TBA training programme was focused on one indicator which was a

reduction in maternal mortality rates (Kruske and Barclay 2017). However, the

measurement of maternal mortality is problematic, large scale studies are required to

calculate maternal mortality rates accurately and they cannot be compared between time

periods due to changes in definition (UNFPA 2013, WHO 2016, see also Hill et al., 2017).

In the 1990s, it became evident that maternal mortality rate globally had not reduced as

expected and, according to estimates, had actually increased slightly, (UNFPA, 2014,

WHO 2016; 2014; 2015). In 1999 a WHO report stated that:

8
“There is no evidence that TBA training alone leads to reductions in maternal mortality,

although there continues to be a recognition that TBAs can provide culturally appropriate

nurturing in the community settings, offer a first-link with the formal health care system,

and provide some simple services such as the distribution of nutrition supplements”

(WHO, 2016).

In 2005 world health report published by WHO mentions that there are no elements to

demonstrate that TBAs training is cost-effective, instead the most effective measure is to

provide professional skilled care, inducing the possibility of reaching a well-equipped

hospital (WHO, 2015). Some public health studies have also proposed that TBA training

has little impact on maternal health and suggested diversion of funds to more effective

interventions such as support for referral and essential obstetric services at first level

referral facilities (Goodburn et al.,2013, Hyppolito, 2017). Other researchers have extreme

view points and opine that TBAs serve no purpose and therefore their service need to be

eliminated, as Berer Suggests:

“Where the resources for and access to a more skilled level of care slowly but surely

consigned to history-which is where they belong” (Berer, 2013).

Since the 1990s, WHO and other major health policy makers moved funding away from

training TBAs towards encouraging and proving skilled attendants during delivery,

(Kruske and Barclay 2017, Replagle 2017). A join WHO/UNFPA/MCH statement in 2014

9
declared that TBA training be considered only as an interim measure until all women and

children have access to acceptable, professional, modern health services.

UNFPA no longer promotes the training of TBAs to recognize or treat complications

related to pregnancy (UNFPA, 2018).

2.1.3 Rational and Objectives of TBAs Training programme

In 1992, WHO, UNICEF and UNFPA, jointly issued a statement on TBAs to reflected

common goals to contribute to the global effort aimed at improving reproductive health

(WHO, 2016). The present TBAs training programme is meant to follow the goals and

objectives defined in this statement. The goal include:

a. Reduction of maternal mortality rate by half,

b. Access by all couples to information and services to prevent pregnancies that are

too early, too closed, too kite or too many; and

c. Access by all pregnant women to prenatal care, trained attendants during childbirth,

and referral facilities for high risk pregnancies and obstetric emergencies (WHO,

2015).

The join statement clearly affirms that the future goal of the training programme is to train

TBAs in simple focused and limited function that “will help in the transition to providing

professional care for all (WHO, 2016). Over a period of time the programme envisages that

the utilization of TBAs will diminish as the goal of safe motherhood is approached (WHO,

10
2016). Thus, the aim of the programme is to attain the goal of safe motherhood based upon

the assumption that the goal of safe motherhood based upon the assumption that the

contribution of TBAs in maternal and child health care will eventually diminish. This is

despite evidence that TBAs continue to be accessed by people even in places where

medical facilities are easily available and accessible (Bajpai, 2016, Devanesan 2013, Lips

2014, Kausar et al., 2008, Mathews et al., 2015: 2014, Smith 2014).

“For a long time to come, even when women have access to modern health care and the

services of a professional midwife or physician, they will also seek the care of the

traditional healers and birth attendants for advice and complementary care until the modern

health care system can meet all the needs of its clients” (WHO, 2015).

The objectives of the TBAs programme written in the joint statement by

WHO/UNICEF/UNFPA are followed as a guideline by developing countries are to:

a) Enhance the links between modern health care services and the community;

b) Increase the number of births attended by trained birth attendants; and

c) Improve skills understanding and stature of TBAs (WHO, 2015, UNFPA, 2016).

2.1.4 Health Practices of TBAs and sepsis among mothers and Babies

A key example of one of the problems facing TBAs is the birthing practice that cause

sepsis. A recent large study in India conducted by the sample registration system (SRS)

assessing the causes of maternal mortality rate shows sepsis as the second main cause

11
accounting for 11 percent of the maternal deaths (SRS, 2016). The smaller studies have

shown that sepsis is one of the causes of mortality and morbidity among mothers and

neonates in India (Chhabra and Sironi, 2014, Khan et al., Costello et al., UNICEF, 2017).

The modes of transmission of puerperal sepsis are categorized into nosocomial, exogenous,

and endogenous factors. Nosocomial infections are acquired from health institutions or

from the patient’s own flora. Exogenous infections come from external contamination,

especially when deliveries take place under unhygienic conditions. Endogenous organisms

consist of mixed Flora colonizing the women’s own genital tract (Hussein and Fortney,

2014).

There are claims that deliveries assisted by relatives and TBAs take place in unhygienic

conditions and often lead to infection. Sample registration system is the largest demograph

sample survey in India and is being used to provides direct estimates of maternal mortality

through a nationally representative samples. The study of maternal mortality rate in india:

1997-2003-Trends, causes and Risk factors has investigated 4,484 maternal deaths among

over 1.3 million births (SRS, 2016). TBAs have been accused of creating or even

compounding problems of infections at home deliveries (Adamson 2016, Barns, 2018,

Boerma, 2017, Feyi – Waboso, 2018). However, the claims are not based on scientific

studies analyzing the cause effect relationship between unhygienic traditional practices and

mortality or morbidity among mothers and babies. To improve hygiene in home deliveries,

since the 1970s WHO has advocated for beneficial biochemical practices such as safe and

12
clean delivery through the “three cleans” programme (hand washing with soap, clean cord

care, and clean surface) and promoted the distribution kits to TBAs (WHO, 2015). The

delivery kit distributed to TBAs contains materials that are designed to help make

deliveries cleaner and safer (Lettenmaier et al., 2018).

However, an intervention study in Bangladesh established that following the three clean

methods alone does not control sepsis among mothers (Goodburn et al., 2013). Another

study in Ghana found that TBA training was actually protective against postpartum fever

(Smith et al., 2014). Apart from this, there is little data and evidence to buy out the effect of

TBA practices on the occurrence of sepsis among mothers or babies.

The following section reviews the evidence of clean delivery practice adopted by TBAs

including hand washing, clean cord management and use of the delivery kit to obtain a

general sense of their potential helpfulness to TBAs.

Hand washing

Hand washing is known to be the most important component of infection control and can

be achieved by standard hand washing with soap and water (Hussein and Fortney 2014).

Hand hygiene is not a new concept; the success story of reducing sepsis by hand washing

was established in 1946, when Ignaz Semmelweis observed that maternal mortality was

mainly caused by physicians due to their unclean hands (Benko and Schejbalova, 2016).

This was the first evidence indicating that cleansing heavily contaminated hands,

13
especially among physicians handling several patients, may reduce healthcare-associated

transmission of contagious diseases.

In the context of TBAs however, they deal with only one delivery at a time and therefore

this kind of cross-contamination is unlikely to happen.

TBAs have been criticized for not undertaking measures of cleanliness while providing

care for mothers and newborns such as washing their hand (Fatmi et al., 2015). The

practice is perceived as a possible means of reducing the risk of infection (Saeed et al.,

2017). However, a study in nine state in india showed that TBAs generally washed their

hands and feet before entering the house of labour (Bajpai, 2016). In contract, a study in

litter Pradesh and another in bangladesh found that TBAs generally washed their hands

only after finishing the task of delivery, due to local beliefs that the act of giving birth was

polluting (Jeffrey et al., 2014, Rozario 2018). Indeed, studies in india have noted that

babies were generally received with unwashed and ungloved hands by TBAs (Syamala,

2014), in some cases alcohol was used to wash hands in Gujarat and Maharashtra (Bajpai,

2016).

TBAs are taught, as part of their training to clean their hands with soap and water and use

gloves during delivery and one of the expected beneficial effects is that the improved

hygiene is practice of TBAs will reduce postpartum infections among mothers and babies

(Goodburn et al., 2013). An intervention study in Tanzania, examining the cause-effect

relationship between hand washing, use of gloves and maternal infections found that
14
washing hands by birth attendants before the delivery and the use of new gloves were not

important factors affecting rates of infection in mothers (Winani et al., 2015). Apart from

this later study there is little other evidence about the relationship between washing hands

and infection among mothers and babies, suggesting that there is debate about the efficacy

of hand washing and that local practices may differ for reasons of belief rather than

associations with cleanliness in relation to infection.

2.1.5 The role of Traditional Birth Attendants in Maternal Complications

Complications during childbirth is one of the main causes of death and disability among

women of reproductive age in developing countries. Some of the main maternal

complications during delivery include excessive post-partum bleeding, retained placenta

and abnormal presentation. Haemorrhage due to severe bleeding is a major cause of

maternal death worldwide (Khan et al., 2016, Costello et al., 2016). Studies have found that

post-partum haemorrhage can kill within an average of two to six hours and before

effective community awareness of treatment and first aid could prevent many of the

maternal deaths (Kvale et al., 2015). Therefore TBAs and other family members present

during delivery can prevent these deaths by identifying the complication and taking

appropriate action. Studies have shown on increase in knowledge of risk factors and signs

of danger in pregnancy and childbirth with TBAs training (John, et al., 2013, Rodgers et

al.,2014, UNFPA 2016).

15
2.1.6 Practice Adopted by Traditional Birth Attendants for Infants Care

According to recent estimates, about four million newborn babies in developing countries

die within four weeks after birth (WHO, 2015). South Asia accounts for more than one

third (36%) of these deaths (Hyder et al., 2013). A recent study observes that globally, the

main direct causes of neonatal death are estimated to be preterm birth (28%), severe

infections (26%), and asphyxia (23%) (Lawn et al., 2015). A recent report by save the

children foundation observed that most of the maternal and newborn deaths could be

prevented by tetanus immunization for pregnant women a skilled attendant at birth, prompt

treatment of newborn infections and education about the importance of proper hygiene

warmth and breast feeding for infants (Save the Children, 2016).

a) Warmth for newborn Babies: the WHO observes in a report that in developing

countries there is little understanding of the thermal needs of newborn babies or of

the extent and significance of neonatal hyperthermia (WHO, 2016). Newborn

babies are often considered to be polluted in traditional communities and therefore

almost all newborn babies are bathed within the first hour of birth which may lead

to hypothermia especially among low birth weight babies (Sreeramereddy et al.,

2016)

b) Use of hygiene protective during delivery

Sepsis caused by infection is one of the leading causes of maternal and infant deaths

in the world. Apart from maternal personal hygiene, sepsis can also be caused by

16
 vaginal examination with unclean hands (Asghar Rana, 2018). Studies have shown

that trained TBAs conduct vaginal examination more than untrain TBAs (John et

al., 2018). The TBA practices that cause sepsis among infants include using

unclean, unwashed hand to deliver babies and using local unhygiene maternal to

cut, tie and apply to the cord. Hand hygiene is known to be the most important

component of infection control, and can be achieved by standard hand washing with

soap and water (Hussein and Fortney, 2014). A study examining TBA training

outcomes demonstrated a fall in the incidence of low birth weight and neonatal

tetanus that occurred with an increase in referral for tetanus toxoid infections by

TBAs who had been trained (Lartson et al., 2017).

2.2 Theoretical Review

Around the world, there is significant unmet need for health care with a better

understanding of why people use or do not use these services, health care organizations

can seek to improve the quality of human life by bridging the detected gaps to enhance

utilization.

Anderson’s model of health services utilization.

Anderson’s model of health services utilization was reviewed and used for this study.

Anderson (2018) developed a model of health care utilization which looks at three

categories of determinants;

17
1. Predisposing characteristics: these categories represent the procliverty to utilize

health services based on demograhphics position within the social structure and

belief of health services benefit. An individual who believes health services are

useful for treatment, will likely utilize those services.

2. Enabling characteristics: These include resources found within the family and the

community. Family resources comprise economic status and the location of

residence community resources incorporate access to health care facilities and the

availability of person for assistance.

3. Need based characteristics: these include the perception of need for health services,

whether individual, social or clinically evaluated perception of need (Wounsky,

2018).

In the 1970’s Anderson’s model was later expanded and refines to indicate the

health care system. The health care system includes health policy, resources and

organization as well as the changes in these over time. Resources comprise the

volume and distribution of both labour and capital including education of health

care personnel and available equipment. Organization refers to how a health care

system manages its resources which ultimately influences access to and structure of

health services. according to this level of revised model, how an organization

distribute its resources and whether or not the organization has adequate labour

volume will determine if an individual uses their health services. in addition, the

18
 updated model includes recognition that consumer satisfaction reflects health care

user.

The model also includes the notion that there are several health services available

and both the types of services available (a hospital, dentist, laboratory or pharmacy)

and the purpose of the health care service (i.e primary or secondary) will determine

the type of service utilized. This according to the revised model, whether or not a

specific health care service is utilized and the frequency a service is utilized will

have different determinants based on characteristics of the population and the health

services (Anderson, 2018 and Newman 2015 in Rehban 2016).

During the 1980’s AND 1990’s Anderson’s model was again revised to form three

components with a linear relationship;

1. Primary determinants

2. Health behaviours

3. Health outcomes

Primary determinants: Are noted as the direct cause of health behavior. These determinants

include characteristics of the population (Demographics), Health care system (resources

and organization), external environment (political physical and economic influence on

utilization).

19
Health behavior

The model explains that health behaviours are the direct cause of health outcomes health

behaviours includes; personal health characteristics, use of health services.

Health outcome include: Perceived health status, evaluated health status, and consumer

satisfaction (Anderson, 2018).

Consumer satisfaction: include convenience of using the services, quality of the services

provided, availability of the needed services, price or cost of the service, provider

characteristics attitude, skills, proficiency etc. this will lead to the use of both preventive

and emergency services.

This theory was related to the research study on the lack of transportation and financial

problem, that is why women prepared to deliver at home with the help of TBAs.

2.3 Empirical Review

Adelajo (2013) Studied home delivery and newborn care practices among women in a sub

urban area of western Nigeria. He carried out a cross sectional survey in the immunization

clinic of Shagamu local government. A total of 300 TBA’s were planned while 33.3%

were unplanned. Only 13.4% of deliveries had a skilled birth attendant present and (15.7%)

gave birth alone.

20
Yanagisawa (2015) on study of determinants of birth attendants choice of women in rural

areas of Cambodia preformed a population based survey on skilled attendant choice. By

women in rural Cambodia to idenitify determinants of birth attendants choice, with

contract with birth attendant as an exposure factor. Subjects were women aged 15-49 years

who had delivered babies during three month prior to the survey of 980 included in the

analysis, 19.8% had skilled attendants present at the birth. The determinants of facility

delivery choice were different from skilled attendant’s choice in home birth and contact

with birth attendants worked differently on the choices. For facility delivery choice,

contract with skilled attendants through antenatal care was a significant determinant for

home births, the choice of skilled and unskilled attendants at the preceding delivery was a

significant determinant for community based programs, women who once chose unskilled

attendants were five to seven times less likely to choose skilled attendants in the following

delivery than primiparas.

Itina in (2017) conducted a study on a group of 52 TBAs in Offot in the south eastern

nigeria to help develop effective programmes for TBAs in the safe delivery and early

referral of women with complications to hospitals, findings showed that the majority of the

TBAs were ill informal training, when they talk on the TBAs role. Ignorance about

maternal complications during childbirth and the appropriate treatment was evidence for

most of the groups. A small number of the group relied solely on divine revelation for

guidance in the management of childbearing women. In this study, TBAs reported that they

21
managed problems in pregnancy primarily with fasting, prayers, herbal medicine, or

enema. They were generally uninformed about the causes of/and management of

antepartum and postpartum haemorrhages a major cause of maternal mortality.

22
 CHAPTER THREE

3.0 Methodology

3.1 Research Design

The research is descriptive in nature, it focuses on the assessment of role of traditional birth

attendants to ward reducing maternal morbidity and mortality in Jibia local government

area.

3.2 Research Setting

The research was conducted at Jibia local government area for the purpose of study, a brief

information of the research area is provided. Jibia is among the local government of

Katsina state.

The predominant population of Jibia people are Hausa, Fulani followed by some Bare-bari

then minority Igbo and Yoruba tribes.

EDUCATION: Jibia local government composed of primary school, secondary which

include Governments and privates.

OCCUPATION: The people of Jibia town are mostly engaged in trading, smuggling of

foodstuffs and other items from neighboring Niger republic due to their proximity. Somes

are farmers while somes are civil servants, then women who are mostly full time house

wives.

23
GENERAL DEVELOPMENT: Since after the creation of Jibia local government area,

some new generation development began to occur in PHCs, private clinics and dispensary

in rural areas and of course with introduction of general hospital in the heart of the townas

well as marketing system.

3.3 Target Population

The target populations of the study were traditional birth attendant in Jibia local

government area.

3.4 Sampling (Size and Formula)

According to M. Dragida when the target population in research is relatively low, the

researcher uses the entire population further study. its in view of this that the research will

use the total population of the study i.e 50.

3.5 Sampling Technique

Stratified random sampling techniques was used and simple random sample was used to

select fifty (50) respondent.

3.6 Instrument for Data Collection

24
Questionnaire and interview guide was used in order to obtain information from the

research subject.

3.7 Validity of the Instrument

In order to measure instrument for accuracy, the questionnaire was validated by expert

who happened to be the supervisor of this research project.

3.8 Reliability of the Instrument

The reliability of the instrument will be tested and a pretest will be carried out to see how

reliable it will be. The questionnaire will be administered to respondents in the study area

twice and the two result will be collected to obtain the co-efficient of the reliability

consistency of the result.

3.9 Method of Data Collection

The data used in the study was collected through interview and questionnaire which was

self administered. The questionnaire where letter retrieved after filling in by the

respondents.

3.10 Method of Data Analysis

The data obtained from the respondents where analyzed and presented using frequency

distribution tables and percentage.

25
3.11 Ethical Consideration

In this process of conducting research, an informed consent of the area of the study was

obtained from the respondents, the religion and culture of the respondents were respected.

It is a self-introduction which was made clear that the study is for academic purpose and

the information will be kept confidential.

26
 CHAPTER FOUR

DATA PRESENTATION AND ANALYSIS

Below are the statistical analysis of data obtained from section A,B,C and D of the

questionnaire.

Table 1.0: Frequency distribution and percentage showing age range respondents.

Responses Frequency Percentage

15-30 years 3 6%

35-40 years 7 14%

46-50 years 15 30%

60- above 25 50%

Total 50 100%

The above table shows that most of the respondents are between the range of years above

with the 25 respondents (50%) while 15 of the respondents are between 26-30 years (30%)

while 7 respondents are between 21-25 years (14%) and 3 respondents are between 15-20

years (60%) respectively.

27
Table 1.1: Frequency distribution and percentage showing sex of the respondents.

Responses Frequency Percentage

Male 0 0%

Female 50 100%

Total 50 100%

The above table shows that all of the respondent were female with 100%.

Table 1.2: Frequency distribution and percentage of the respondents showing marital status

Responses Frequency Percentage

Married 36 72%

Single 0 0%

Divorced 0 0%

Widow 14 28%

Total 50 100%

28
The table above shows 36 respondents were married accounting for 72% while 14 were

widow accounting for 28%.

Table 1.3: Frequency distribution and percentage shown the religion of the respondents.

Responses Frequency Percentage

Islam 46 92%

Christianity 4 8%

Total 50 100%

The table shows that 46 respondent were muslims accounting for 92% while 4 respondents

were Christian accounting for 8%.

Table 1.4: Frequency distribution showing the role of TBAs towards improving maternal

health.

S/N ITEMS SA A D SD Mean

1 Provision of maternal and health care services 14 29 6 1 3.02

2 Assisting the delivery of the baby 12 18 15 5 2.74

3 Recognized danger sign and early labour 25 22 0 3 3.38

4 Referring the above women to the hospital when 15 25 7 3 3.04

29
 need arises

5 Distance to health facilities and transportation 11 28 8 3 2.94

problem

The above table shows that the respondents agreed with item 1,2,34 and with the following

mean value 3.02, 2.74, 3.38, 2.04 and 2.94, the table shows that all the listed roles of TBAs

towards improving maternal health care in line with the study from the responses gotten

from respondents.

Table 1.5: Frequency distribution showing the healthy practice carried out by TBAs toward

improving maternal health during delivery.

S/N ITEMS SA A D SD Mean

1 Improvement of maternal hygiene 24 22 1 3 3.37

2 Washing hands with soap and watch before any 18 10 14 8 2.3

contact with pregnant women.

3 They use sterile gloves in conducting vaginal 14 29 1 6 3.02

examination.

4 Using of sterile blade to cute the baby cord 15 25 7 3 3.38

5 Encouraging pregnant women to take 9 8 4 29 2.4

immunization especially against tetanus.

30
The table above shows that the respondent agreed with item 1,3 and 4 with the following

mean value 3.7, 3.2, and 3.38 while some respondents disagreed with item 2 and 5 with

following mean value 2.3 and 2.4 respectively.

2.0: Frequency distribution showing the level of knowledge of TBAs towards improving

maternal health.

The period of labour divided Frequency Percentage

into 3 stages.

Yes 50 100%

No - -

Total 50 100%

The table above shows that the respondents with the percentage of 100% and nill

respondents choose no with 0%.

Table 2.1: Frequency distribution showing the level of knowledge of TBAs toward

improving maternal health.

There are negative effects Frequency Percentage

associated when women

gave birth in supine position

Yes - -

31
No 50 100%

Total 50 100%

The table above shows that the respondent choosed no with the percentage of 100%, nill

respondents choose yes with 0%.

Table 2.2

The most reliable sign of 3rd stage of labour is Frequency Percentage

lengthening of the umbilical cord as the placenta

separate.

Yes 40 80%

No 10 20%

Total 50 100%

The above table shows that most of the respondent choosed yes with 40 (80%) while others

choose no with 10 (20%) respectively.

Table 2.4: Frequency distribution showing the level of knowledge of TBAs toward

improving maternal health.

32
Second stage of labour continue after the cervix is Frequency Percentage

dilated to 10cm until the delivery of the baby.

Yes 44 88%

No 6 12%

Total 50 100%

The above table shows that most of the respondent choosed yes with 44 (88%) while others

choosed no with 6 (12%) respectively.

Table 2.5 Frequency distribution showing the level of knowledge of TBAs toward

improving maternal health.

Good nutrition have negative impact in pregnancy Frequency Percentage

Yes 5 10%

No 45 90%

Total 50 100%

The above table shows that most of the respondent choosed no with 45 (90%) while others

choosed no with 5 (10%) respectively.

4.2 Answering Research Question

33
Research question 1: What are the roles of TBAs towards improving maternal health?

Answer: According to the information obtained all the respondents agree that provision of

maternal and health care service as shown in table 4.1 with the mean of 3.2, likewise all the

respondents agreed with the provision of maternal health care services during delivery with

the mean of 2.74. also all the respondents agreed with assisting the delivery of the baby

with the mean of 3.04, moreover, most of the respondents agreed with referring the above

women to the hospital with the mean of 3.04.

Research question 2: What are the healthy practices carried out by the TBAs towards

improving maternal health during delivery?

Answer: Reference to information obtained from table 1.5 most of the respondents agreed

with improvement of maternal hygiene with mean of 3.37, so also some of the respondents

disagreed with washing of hand with soap and water before any contact with the pregnant

women will improve the maternal health with the mean of 2.3, then most of the

respondents agreed with the use of sterile gloves in conducting vaginal examination with

the mean of 3.02, and also most of the respondents agreed with the use of sterile blade to

cut baby’s cord with the mean of 3.38, moreover, most of the respondents disagreed with

the encouraging women to take immunization especially against tetanus with mean of 2.4.

Research question 3: What are the level of knowledge of TBAs towards improving

maternal health.

34
Answer: Reference to the information obtained from the respondents in table 2, 100% of

the respondents disagreed that there are negative effects associated with women gaving

birth in supine position. In addition, in table 2.2, 88% of the respondents agreed that the

most reliable sign at 3rd stage of labour is the lengthening of the umbilical cord as the

placenta separates then also 80% of the respondents agreed that second stage of labour

continues after the cervix is dilated to 10cm until the delivery of the baby as shown in table

2.3 moreover, 90% of the respondents disagreed that good nutrition have negative

impacting pregnancy.

35
 CHAPTER FIVE

5.0 Discussion of Findings

5.1 Identify Key Findings

The study succeeded in identifying the role of traditional birth attendants towards reducing

maternal morbidity and mortality in Jibia local government. The research finding was

discussed based on the structured interview and related literature.

In view of the nature of the study it can be seen that majority of the respondents falls

between the age of 31 years above with 50% in table 1. Table 1.1 shows that majority of

the respondents were female with 100%. Table 1.2 shows that most of the respondents

were 92% muslims and 8% Christians. Table 1.3 shows that most of the respondents were

married with 72% and 28% widowed.

One of the research question is what are the roles of traditional birth attendants towards

improving maternal health? The research response following the interview are found in

table 1.4 in which most of the respondents agreed that provision of maternal and health

care services, assisting women during delivery, recognizing signs of danger and early

36
labour and also referring the pregnant women to the hospital when need arises are the

major role of traditional birth attendant towards improving maternal health.

Looking at the second research question of the study which said; What are the reality

practices carried out by the traditional birth attendants towards improving maternal health

during delivery? From table 1.5 it can be inferred that most of the respondents agreed that

improvement of maternal hygiene, washing hands with soap and water before any contact

with the pregnant women, and the use of sterile blade to cut the baby’s cord are the major

healthy practices carried out by TBAs during delivery.

Also, going by the research question three that says; What are the level of knowledge of

traditional birth attendants towards improving maternal health as shown in table 2, 100% of

the respondents agreed that there are negative effects associated with women giving birth

in supine position. From table 2.2, 88% of the respondents agreed that the most reliable

sign of 3rd stage of labour is the lengthening of the umbilical cord as the placenta separates,

in table 2.3, 80% of the respondents agreed that second stage of labour continue after the

cervix is dilated to 10cm until the delivery of the baby. From table 2.5 90% of the

respondents disagreed that good nutrition have negative effect in pregnancy.

5.2 Alignment of Findings with Previous Studies

According to the data analyzed 72% of married women, 28% widowed of the respondent

shows that traditional birth attendants contributed in reduction of maternal morbidity and

mortality. Which is inline with the findings of Amutali Onukagha (2016), that says

traditional birth attendant contributed in improving maternal and child health outcomes.
37
Also with regard to the level of knowledge of TBAs toward improving maternal health as

shown 100% of the respondent shows that they have adequate knowledge regarding stages

of labour in which management is instated at every stage. This is inline with the findings of

Monica (2014) that says traditional birth attendants are not only train for normal delivery,

but are also train to manage each stage of labour, they are well monitored with good

working equipment and how to used those equipment when the need arise.

Also with regard to practice carried out by traditional birth attendant toward improving
maternal health during delivery, most of the respondents agreed that TBA’s practice hand
washing with soap and water before any contact with pregnant women, and the use of
sterile blade to cut the baby’s cord. This is inline with the findings made by Amutah
Onukagha, (2016). An emphasis was made in order to ensure effective utilization of
infection prevention measures in conducting delivery in order to improve the health of
women and children and are been provided with delivery kit.
5.3 Implication of Finding With Literature Support
The finding relation to the research questions showed that assessment of at risk women in
labour is the major role of traditional birth attendant toward improving maternal health
which correlates with many opinions of (Replogle, 2017) which says that individual TBAs
were trained to recognize the warning sign of a complicated pregnancy, treat basic
problems and refer risky cases to a skilled medical practitioner. The finding relating to this
research showed that use of sterile blade to cut the baby’s cord, washing of hands with soap
and water before any contact with pregnant women (hand hygiene) shows the healthy
practices carried out by the traditional birth attendants towards improving maternal health
during delivery which correlate with 1970 WHO’s guide for beneficial biochemical
practice such as safe and clean delivery through the three cleans program i.e hand washing
with soap, clean cord care and clean surface.

38
5.4 Implication to Nursing
The implication of the study includes the interviews about hygiene and providing liquid
soaps (hand sanitizer) like oil, which many TBAs use for delivery are potential
intervention. While the role of traditional birth attendants in managing maternal
complications remain uncertain, practices such as oral administration of misoprostol and
planners ahead for maternal complications may improve outcomes and may be feasible for
TBAs education, behavior change, and services delivery interventions can address and
improve causes of neonatal death.
5.5 Limitation of the Study

The research was limited to Jibia local government area due to limited human resources,

time and financial resources, while conducting the study and ethical considerations were

also considered.

5.6 Summary

The research conducted was assessment of traditional birth attendants towards reducing

maternal mortality and morbidity in Jibia Local Government. Interview and questionnaires

were used as instruments for data collection. From the study conducted on at risk women in

labour, the findings are: provision of maternal health services during pregnancy and

assistin women during delivery are the major roles of traditional birth attendants towards

improving maternal health. Also using sterile blade in cutting the baby’s cord and washing

of hands with soap and water before any contact with pregnant women are the major

healthy practices carried out by traditional birth attendants towards improving maternal

health during delivery and this helps in reducing maternal morbidity and mortality. It's also

cncluded that most of the TBAs knows that the separation of placenta with umbilical cord
39
is 3rd stage of labour and also known that retained placental tissue and infections after

delivery may contribute to uterine atony.

5.7 Conclusion

Traditional birth attendants played important role in reduction of maternal mortality in Jibia

LG, but the concern is that most are not well trained on the pregnant women delivery in the

hands of midwives due to their scientific knowledge. Therefore, information may be used

to develop, structured surveys about traditional birth attendants practices in the community.

Future programs and research should explore integrating TBAs training and practices with

that of existing community health workers while acknowledging their important cultural

role.

5.8 Recommendation

In view of the research findings, the following are here by made with the hope that if

implemented will go a long way in reducing complication, infection, morbidity and

mortality rate maternals and neonates and improve the services of traditional birth

attendants. Since the services of TBAs is more accepted by the community at the grass

roots level the federal and state governments as well as NGOs should encourage and

mobilize them by providing all what they need in conducting delivery in the community

and training the accordingly.

- Accepting and acknowledging the traditional births attendants at various

communities.

40
 - Training TBAs on how to sterilize their instruments before conducting deliveries,
detect any sign of complicated delivery and also educate them on how to cut the
cord to prevent infection.
- Government should consider training of TBAs since they are closer to the
community than the midwives.
- Community based midwives should be included in training TBAs since they are
also community based practitioners in order to improve care delivery.
5.9 Suggestions for Further Studies
In case of future studies, the following areas should be looked into:
- Factors influencing the use of TBAs among pregnant women.
- Impact of TBAs on the health of pregnant women.
References

Adamson P. (2016). Community a failure of imagination (UNICEF).

Bajpai, S. (2015) chapter 8: Making labour and childbirth easier, in:S.mira (ed) Healing

heritage: local beliefs and practices concerning the health of woman children: A

multistate study in India Chefna publication).

Bajpai, S. (2016) Chapter 4: Advice and Restrictions during pregnancy, in S. Mira (ed) hler

healing heritage: local beliefs and practice concerning the health of women and

children: A multi-state study in india. (Bombay, Chetna).

Bajouni, A. (2014). The training and actively of village midwives in trophical doctor, 6, pp.

118-125.

Berer, M. (2013). Traditional birth attendants in developing countries reproductive health

matters, 22, pp. 36-39

41
Chhabra, S. and Sirahi, R (2014). Auterting maternal and newborn care.’ Pakistan estern

Mediterranean health journal, 11 (112). Opp. 226-234.

Goddburn, E.A., Chowdhury, M. Gazi, R. Marshal, T. (2013) training traditional birth

attendants in clean delivery. health policy and planning, 15 (4), Pp. 394-399.

Hussein, J and Fortney, J.A (2014). Puepheral sepsis and maternal mortality: What role

can new technologies play? International journal of gynaecology and obstetric, 85

(suppl.l). pp 552-561.

Hyder, A.A., Wali, S.A., McGuckin, J. (2013). The Burden of disease form neonatal

mortality: A Review of south Asia and sub-saharan Africa. British journal of

obstetrics and gynaecology, 110 (10), 894-901.

John A., Carvalho, I. and Kalinga, MJ (2013). Evaluating traditional midwife training

programs: Lessions learned from Tanzania, international journal of gynaecology

and obstetrics, 13, pp 277-278.

Jerrey, P; Jerry, R. and Lyon A. (2014). Labour pains and labour women and childbearing

in india and London, 2ed books limited.

Khan, K.S, Wojdyla, D., Say, Li, Gulmezoghu, A.M & Yan look, P.F (2016) who analysis

of causes of maternal maternal death: A systematic review; lancet, 367 (9516), Pp

1066-1074.

Lettenmairer, C. Liskin L., Chumeh, C.A and Harris, J.A (2018). Training for better

maternal health care, population reports, (sept.).

42
WHO (2015). Evaluation of midwifery care: A case study of rural Guatenia (chapel Hill,

North Carolina, measure evaluation. Cardina population centre, university of North

Carolina.

43
 APPENDIX I

Kasimu Kofar Bai,

School of Nursing Katsina,
P.M.B 2017.
Katsina state.
Date:.
Dear Respondent,

I am a final year student from the above mentioned institution conducting a research on

Assessment on the role of traditional birth attendants towards reducing maternal mortality

and morbidity rate in Bakori metropolis. Please respond to the question by answering the

question based on your view.

It consist of section A and B.

Instruction

Respondent name is not required, all information obtained will be kept confidentially and

research purpose only Section (A) is on personal Data while section (B,C and D) is based

on this research topic.

SECTION “A”

1) Age range

a. 25 – 30 ( ) b. 35 – 40 ( )

1
 c. 46 – 50 ( ) d. 60 – above ( )

2) Sex

a) Male ( ) b) Female ( )

3) Level of education

a. Basic education ( )

b. Student ( )

c. Post basic ( )

4) Professional status

a. Skilled birth attendant ( )

b. Nurses ( )

c. Doctor ( )

5) How many years have you been in the active services

a. 1-5 years ( )

b. 6 – 10 years ( )

c. 11 – 15 years ( )

d. 20-25 years ( )

e. 30 and above ( )

2
SECTION “B”

From this statement below answer the questions appropriately option indicate the role

TBAs

KEY:

SA: Strongly Agreed

A: Agreed

D: Disagreed

SD: Strongly Disagreed

S/N ITEMS SA A D SD

1 Provision of maternal and health care services

2 Assisting the delivery of the baby

3 Recognized danger signs and early labour

4 Referring the above women to the hospital when need

arises.

5 Distance to health facilities and transportation problem

3
SECTION C

From this statement choose and answer the appropriate option indicate the activities of

TBAs that are carried out toward improving maternal health during delivery.

S/N ITEMS SA A D SD

1 Improvement of maternal hygiene

2 Washing hands with soap and water before any contact

with pregnant women.

3 They use sterile gloves in conducting vaginal

examination.

4 Using of sterile blade to cut the baby cord.

5 Encouraging pregnant women to take immunization

especially against tetanus.

6 Position pregnant women during labour

4
SECTION D

Answer the correct option with regard to the care of women during birth.

S/ STATEMENT YES NO NOT SURE

N SD

1 The period of labour divided into 3 state

2 There are negative effects associated when a women

gave birth in supine position.

3 The most reliable sign of 3rd stage of labour is the

lengthening of the umbilical cord as the placental

separates

4 Second stage of labour continues after the cervix is

dilated to 10cm until the delivery of the baby

5 Good nutrition have negative impact in pregnancy