Perception of Maternal Deaths and Referral Practices of Traditional Birth Attendants in Enugu, Nigeria: A Cross Sectional Study

Abstract

Objective: To determine the factors associated with perception of maternal death and the referral practices of traditional birth attendants in Enugu, Nigeria.

Methods: This was a questionnaire-based cross-sectional study of traditional birth attendants who attended a training workshop in Enugu held between March 15-18th 2014. Statistical analysis involved descriptive and inferential statistics performed with SPSS statistical software version 17.0 for Windows. Tests of association were done with the chi-square test. P values ≤ 0.05 were considered significant.

Results: A total of 105 unskilled birth attendants participated in the workshop out of which 100 consented to participate in the study. Of these, 85 returned their questionnaires and were used for analysis. This gave a response rate of 85%. All the participants were females. Approximately 57.6% (49/85) of respondent’s perceived maternal death as resulting from superstitious reasons (patients’ sins, witchcraft or God’s wish etc.). Perception of maternal death was associated with age (P <0.001), educational level of traditional birth attendants TBAs (P <0.001), duration of practice (P = 0.03) and previous witnessing of maternal death (P=0.02). Approximately 80% (67/85) would not refer high-risk pregnancy or labour to a health facility. The referral practices of traditional birth attendants were associated with their perception of maternal death (P <0.001).

Conclusion: Perception of the cause of maternal death may influence the referral practices of traditional birth attendants. In addition to imparting skills for detecting complicated pregnancies and labour, training programs for traditional birth attendants in this area may need to include aspects that will address superstitious perception of maternal death.