Traditional birth attendants in an endemic area of tetanus neonatorum in Thailand: Pitfalls in the control program

Abstract

A survey of the characteristics of traditional birth attendants in Krabi Province, Thailand, where the incidence rate of tetanus neonatorum was the highest in the country, was conducted in order to obtain background information necessary for planning a training curriculum and to evaluate previous training courses. Five second year medical students were used as research assistants. After the questionnaire was constructed and tested, the students went to visit a sample of 116 traditional birth attendants (TBAs) to interview them about their personal backgrounds, techniques and practices in delivery and beliefs and attitudes towards midwifery. The study revealed that these TBAs were a mixture of Buddhist and Islamic females whose literacy rate was 53 percent. Ninety-one per cent knew about the availability of an injection for antenatal care at the health center, but only about half knew that it was for tetanus prevention. More than half provided antenatal care at their own home but 85 per cent conducted delivery at the client's home. About eighty per cent of the TBAs claimed that sterilization of instruments was performed. However, dressing of the umbilical cord was done inappropriately using various kinds of powders by about 40 per cent. The majority of TBAs had experience with complicated labors but only 30 per cent were referred, perhaps, due to excessive self-confidence and supernatural beliefs. The trained TBAs possessed a higher level of knowledge of immunization and sterile techniques for cord cutting and dressing of the stumps of the umbilical cord than the untrained group. However, knowledge of sterilization of instruments was not significantly different, indicating a need to improve teaching in this area. It was concluded that past training programs had increased the knowledge of the TBAs. However, they were not effective enough to eradicate tetanus neonatorum and to prevent other forms of perinatal morbidity and mortality. Refresher courses emphasizing the dangers of improper dressing of the stump, increasing postnatal visits by professional midwives to detect and avert risks to the newborns and mass immunizations of females of reproductive age are clearly required.