Traditional Birth Attendants: Practices & Problems In Konduga Local Government Area Of Borno State; North Eastern Nigeria

Background: Significant number of deliveries in the developing world takes place at home mostly conducted by traditional birth attendants. Some of their practices are harmful and contributes significantly to morbidity and mortality especially if untrained. This study was carried out to document harmful practices, training status and problems of the traditional birth attendants in Konduga Local Government Area of Borno State, North Eastern Nigeria.Methods: Data was collected based on a proforma questionnaire administered to traditional birth attendants by final year medical students supervised by consultant staff from departments of paediatrics and Community Medicine of the University of Maiduguri.Results: There were a total of 48 traditional birth attendants (TBAs) spread across the 5 districts of Konduga Local Government. Forty six (95.8%) were aged ≥ 35years with only 2 (4.2%) below age 35 years. Only 12 (25%) TBAs had some form of training while 36 (75%) did not have any form of training. All the trained TBAs sterilize their delivery kits before any delivery. Cord was severed using a new razor blade by 44 (91.7%) of the TBAs, 3 (6.3%) used bamboo or back of corn stick, while one (2.1%) used a pair of scissors. Various items used in securing the cord includes tie with thread 38 (79.2%), massage and application of warm or cold water before cutting 5 (10.4%), tie with string 3 (6.3%) and soak in dettol 2 (4.2%). Difficulties encountered by the TBAs during conduct of deliveries includes retained placenta 4 (8.3%), breech delivery 4 (8.3%), lack of facilities 2 (4.2%), obstruction 2 (4.2%), antenatal bleeding 1 (2.1%), all of the above 1 (2.1%) and none 34 (70.8%). When asked if they know of a child who have died as a result of stiffness during the cord care period, 23 (47.9%) said yes while 25 (52.1%) said no. Twenty five (52.1%) said it is not too common, 3 (6.3%) said it is common, only 1 (2.1%) said it is very common, while 19 (39.6%) said they have not seen or are not aware of the illness. Eleven (22.9%) of the TBAs saw about 1-2 cases of children dying of stiffness in the last one month, 2 (4.2%) saw 3 and above of such cases, while 35 (72.9%) said they have not seen any of such cases in the last one month.When asked what danger they think can result from not taking proper care of the cord, 18 (37.5%) said sickness /death, 14 (29.2%) said abdominal distention or perforation, 6 (12.5%) said stiffness, 5 (10.4%) said poor cord healing while 5 (10.4%) said they don’t know.Conclusion: In conclusion, there are few facilities and skilled attendants in Konduga Local Government Area to manage normal deliveries and diagnose, manage or refer obstetric and neonatal complications. There is therefore the need for training and retraining of TBAs on safe delivery and good cord care practices. The development of an effective referral system for referral of complicated deliveries and newborn problems needs serious consideration. This will go a long way in lowering the high maternal and neonatal mortality with subsequent lowering of perinatal mortality rates.