TBAs in rural Northeast Brazil: referral patterns and perinatal mortality

Janowitz, Barbara; Bailey, Patricia; Dominik, Rosalie; Araujo, Lorenna Oliveira Fernandes de

doi:10.1093/heapol/3.1.48

Cited by 9 publications

(6 citation statements)

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“…Little data exists on the effect of TBA training on timing to referral and receipt of referral-level care in case of complications. In rural Fortaleza, Brazil, where a TBA training program was begun in the mid-1970s [58], TBAs conducted 55% of births and were able to recognize labor complications and effectively refer mothers with high obstetric risk (antepartum factors or intrapartum complications) for hospital delivery. There was a significant increase in referrals after training [58]; almost 50% of women at hospitals with complications during delivery had been referred by TBAs, and TBAs referred an average of 12% of pregnant women for hospital delivery, primarily for obstructed labor (40%), primiparity (12%), abnormal presentation (9%), and maternal hemorrhage (7%).…”

Section: Results For Community-based Strategiesmentioning

confidence: 99%

60 million non-facility births: Who can deliver in community settings to reduce intrapartum-related deaths?

Darmstadt

Lee

Cousens

et al. 2009

International Journal of Gynecology & Obstetrics

230

211

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Skilled childbirth care is recommended for all pregnant women, and community strategies need to be linked to prompt, high-quality emergency obstetric care. CHWs may play a promising role in providing pregnancy and childbirth care, mobilizing communities, and improving perinatal outcomes in low-income settings. While the role of the TBA is still controversial, strategies emphasizing partnerships with the health system should be further considered. Innovative community-based strategies combined with health systems strengthening may improve childbirth care for the rural poor, help reduce gross inequities in maternal and newborn survival and stillbirth rates, and provide an effective transition to higher coverage for facility births.

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Section: Results For Community-based Strategiesmentioning

confidence: 99%

60 million non-facility births: Who can deliver in community settings to reduce intrapartum-related deaths?

Darmstadt

Lee

Cousens

et al. 2009

International Journal of Gynecology & Obstetrics

230

211

View full text Add to dashboard Cite

show abstract

“…Most of the 8% who were referred to a hospital were referred by TBAs, and a small proportion of these women were referred further by the Trairi hospital staff to the Teaching Maternity Assis Chateaubriand in Fortaleza where surgery is available. One of the original objectives of the study was to enquire whether TBAs correctly identified wojnen at high obstetric risk and made the appropriate referrals to a hospital for delivery (reported by Janowitz et al, 1988). A greater proportion of infants born at home or whose mothers were referred died than did those born in hospitals.…”

Section: Resultsmentioning

confidence: 99%

“…Surgery is not possible at Trairi, so serious problems require referral to larger hospitals outside the county. The data collection was described by Janowitz et al (1988).…”

Section: Methodsmentioning

confidence: 99%

A Study of infant mortality and causes of death in a rural north-east Brazilian community

et al. 1990

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SummaryIn 1984 a prospective study of 1645 women and 1677 births in a rural community in north-eastern Brazil showed the infant mortality rate to be 65 per 1000 live births. Neonatal, post-neonatal and infant mortality are analysed to determine the most important risk factors for each period. Post-neonatal survival depends largely on factors relating to child care, while neonatal deaths are more likely to be associated with biological factors. The principal cause of death, diarrhoeal disease, was responsible for a third of the deaths.

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“…647 In another study evaluating the impact of TBA training in Ghana, Smith et al 648 found reductions in intrapartum fever, labor Ͼ18 hours, and retained placenta, but the number of perinatal deaths and tetanus cases were too low to evaluate. Clients of trained TBAs were more likely than those of untrained TBAs to be referred for tetanus immunization (58% vs 28%, respectively), and immunization rates in both groups were high (87% vs 77%, respectively).…”

Section: Tba/chw Trainingmentioning

confidence: 99%

Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence

et al. 2005

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ABSTRACT. Background. Infant and under-5 childhood mortality rates in developing countries have declined significantly in the past 2 to 3 decades. However, 2 critical indicators, maternal and newborn mortality, have hardly changed. World leaders at the United Nations Millennium Summit in September 2000 agreed on a critical goal to reduce deaths of children <5 years by two thirds, but this may be unattainable without halving newborn deaths, which now comprise 40% of all under-5 deaths. Greater emphasis on wide-scale implementation of proven, cost-effective measures is required to save women's and newborns' lives. Approximately 99% of neonatal deaths take place in developing countries, mostly in homes and communities. A comprehensive review of the evidence base for impact of interventions on neonatal health and survival in developingcountry communities has not been reported.Objective. This review of community-based antenatal, intrapartum, and postnatal intervention trials in developing countries aimed to identify (1) key behaviors and interventions for which the weight of evidence is sufficient to recommend their inclusion in communitybased neonatal care programs and (2) key gaps in knowledge and priority areas for future research and program learning.Methods. Available published and unpublished data on the impact of community-based strategies and interventions on perinatal and neonatal health status outcomes were reviewed. Evidence was summarized systematically and categorized into 4 levels of evidence based on study size, location, design, and reported impact, particularly on perinatal or neonatal mortality. The evidence was placed in the context of biological plausibility of the intervention; evidence from relevant developed-country studies; health care program experience in implementation; and recommendations from the World Health Organization and other leading agencies.Results. A paucity of community-based data was found from developing-country studies on health status impact for many interventions currently being considered for inclusion in neonatal health programs. However, review of the evidence and consideration of the broader context of knowledge, experience, and recommendations regarding these interventions enabled us to categorize them according to the strength of the evidence base and confidence regarding their inclusion now in programs. This article identifies a package of priority interventions to include in programs and formulates research priorities for advancing the state of the art in neonatal health care.Conclusions. This review emphasizes some new findings while recommending an integrated approach to safe motherhood and newborn health. The results of this study provide a foundation for policies and programs related to maternal and newborn health and emphasizes the importance of health systems research and evaluation of interventions. The review offers compelling support for using research to identify the most effective measures to save newborn lives. It also may facilitate dialogue with policy...

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TBAs in rural Northeast Brazil: referral patterns and perinatal mortality

Cited by 9 publications

References 0 publications

60 million non-facility births: Who can deliver in community settings to reduce intrapartum-related deaths?

60 million non-facility births: Who can deliver in community settings to reduce intrapartum-related deaths?

A Study of infant mortality and causes of death in a rural north-east Brazilian community

Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence

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