Traditional birth attendants, HIV/AIDS and safe delivery in the Eastern Cape, South Africa - evaluation of a training programme

Abstract

Traditional birth attendants (TBAs) are still frequently utilised in rural areas in South Africa, even when mothers have access to formal health care facilities. Studies reveal that utilisation of TBAs can be beneficial in some contexts, with support and supervision from the Western health sector. Aim. To evaluate a training programme for TBAs on HIV/AIDS and safe delivery. The study used a pre-post training evaluation design of 50 TBAs in two primary health care clinic areas in rural South Africa. Most TBAs had some knowledge of risk signs during pregnancy. At follow-up assessment HIV/AIDS knowledge had significantly increased and HIV risk practices when assisting during a delivery had significantly decreased. Most TBAs were involved in HIV/sexually transmitted infection (STI) management such as risk assessment, risk reduction counselling, distribution of condoms, community education and home-based care. After the training significantly more TBAs conducted prenatal check-ups, assessed the baby's position in the uterus and took the mother's and baby's pulse, and fewer TBAs conducted abnormal or complicated deliveries. Training of TBAs can increase their knowledge, improve their attitudes and reduce risk practices. TBAs need skilled and equipped available support to carry out basic preventive measures in the obstetric patient, anticipate and identify obstetric complications, administer nevirapine prophylaxis, and make appropriate and timely referrals backed up with efficient referral mechanisms to reduce maternal morbidity and mortality.