Nvivo 9.0
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Factors that motivate women to give birth at home and their reasons to seek the assistance of TBAs have not been explored in depth. Currently, most published studies investigating reasons for home delivery in Zambia and other developing countries have focused on the structural barriers to facility delivery services such as lack of geographical access to emergency obstetric care and financial limitations.
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There is a lack of evidence on the main reasons for home delivery and use of TBAs. Nevertheless, many women in rural Zambia, still give birth at home and TBAs are essential providers of obstetric care. This change in policy has resulted in TBAs not being recognised as part of the providers of essential obstetric care in Zambia. Rather, all women are recommended to use facility-based delivery services provided by trained and skilled healthcare staff. Ĭonsequently, there has been a policy change in many developing countries − including Zambia to stop the funding and training of TBA programmes. Moreover, the TBAs have no access to referral services to the hospital in case of complications during and after labour.
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For example Gill and colleagues showed that training TBAs to manage common perinatal conditions significantly reduced neonatal mortality in Lufwanya, Zambia.Īlthough training TBAs may provide them with basic midwifery skills, most TBAs have no access to the requisite clean delivery tools such as supply of drugs and equipment for obstetric care this may increase the risk for infections during childbirth. Reviews and studies conducted in Zambia and other developing countries have reported the effectiveness of TBAs in improving maternal and newborn health outcomes. The World Health Organisation (WHO) has defined TBAs as persons who assist the mother during childbirth and learns her skills through apprenticeship that involves both observation and imitation, and is often highly regarded by the community that chooses her to assist women in childbirth. Moreover, more than half (53 %) of the women in Zambia, do not receive skilled birth attendance, The survey further shows that these numbers are even higher in rural areas where more than seventy percent of the women give birth at home, outside the health facility, and are often assisted by TBAs. The latest demographic and health survey (DHS) showed that the country’s MMR is 591 maternal deaths per 100 000 live births. Zambia is one of the sub-Saharan African countries with a high maternal mortality ratio (MMR).