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  • kristen cheney
    FYI Malawi news... I ll be in DC roughly 11/28-12/2. Anyone in the area wanna get together?? Kristen MALAWI: Role of traditional birth attendants to change
    Message 1 of 2 , Oct 22, 2007
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      FYI Malawi news...
       
      I'll be in DC roughly 11/28-12/2. Anyone in the area wanna get together??
       
      Kristen

      MALAWI: Role of traditional birth attendants to change

      BLANTYRE, 19 October (IRIN) - Malawi is planning to change the role of Traditional Birth Attendants (TBAs) in an attempt to reduce one of the world's highest rates of maternal and infant deaths.

      A 2004 Malawi Demographic and Health Survey said the maternal and infant mortality rate was 984 out of every 100,000 live births, translating to 6,000 maternal deaths each year.

      But such a move, observers say, does not take into account the already overburdened public health system, which would be overwhelmed if TBAs were removed.

      Adamson Muula, a lecturer in community health at the Malawi College of Medicine, in the commercial capital of Blantyre, said less than half the women in Malawi delivered their babies at recommended hospitals, "yet the system is overtaxed."

      "If government plans not to use TBAs anymore, then a safe alternative must be identified. In many cases, not all women, even if they wanted, would end up

      delivering at the hospital. Again, if just 70 percent of all pregnant women were to deliver at the hospital, the hospital system would not cope," he said.

      Birth attendants shoulder the blame

      Sabinna Mlusu, the District Nursing Officer in Blantyre, said the reason for government ending the practice of licensing TBAs was the discovery "that most maternal and infant deaths are caused by delays in arranging transport from homes of TBAs to clinics, and then to referral hospitals. Such delays ended up complicating cases which TBAs could not treat."

      She said the majority of deaths were a consequence of such complications as internal bleeding and high blood pressure, which required emergency medical attention only available at public and private clinics.

      Diana Khonje, neonatal health officer at the Reproductive Health Department in Malawi's Ministry of Health, said government would not completely discard the TBAs, but that they would no longer perform the duties of midwives.

      "They have been given a new roles. One of them will be to arrange transport for expectant women to clinics and teach lactating mothers the importance of breast feeding," Khonje said.

      She dismissed concerns that removing TBAs from the loop would exert an added burden on public health facilities. "There is enough capacity in our hospitals to handle maternity cases. The problem is that most women are ill-informed ... [often] by the same TBAs who were getting paid for the services rendered."

      She said the process for switching the TBAs from handling expectant mothers would be gradual. "We believe in their new roles the TBAs will help government to reach out to the rural poor who are ... [mostly] ill-informed about childbirth and breast feeding."

      Chimota Phiri, the Blantyre District Health Officer, told IRIN that the government was also using traditional leaders to convince people to stop using TBAs. "People tend to listen much more to what their traditional leaders tell them than anyone else. Chiefs must therefore tell people the importance of coming to hospitals with problems affecting their health."

      He said the country's high maternal and infant mortality rate was a consequence of home births. "Such unsafe conditions cause infections to both the mother and the baby, which, in most cases, lead to death."

      But not all traditional leaders accepted that the high rate of maternal and infant deaths could be attributed to TBAs. Chief Kabunduli, from northern Malawi, said government should also shoulder some of the blame. "Experience has shown that most maternal and child deaths occur in houses of TBAs, but it is government that accredits these people."

      Charles Munthali, a health official from the same region, said in one district only 4,000 of the about 10,000 expectant mothers had visited a hospital for antenatal services. "Maternal and newborn deaths are avoidable, but most women prefer to go for deliveries by unskilled TBAs."

      Challenges and strategies

      The United Kingdom Department for International Development (DFID), which has donated about US140 million to Malawi for 2006/07 - including $40 million for budget support, another $40 million for health and HIV/AIDS, and $14 million for education - said there were evident challenges in the health sector, as the maternal mortality rate had risen by more than 50 percent since 1992.

      However, at the same time, the under-five mortality rate had declined to 133 deaths per 1,000 live births in 2004 - a 43 percent reduction in 12 years - and was on target to reach the 2015 Millennium Development Goal in this category.

      The UN Children's Fund (UNICEF) estimates that almost half of all births in developing countries occur without a skilled birth attendant present. Globally, 529,000 women die every year in pregnancy or birth, according to the World Health Organisation (WHO).

      [ENDS]



      --
      "The rainmaker who doesn't know what he's doing will be found out by the lack of clouds."
      -- Luganda Proverb
    • Daniel Dudley
      I forwarded the article to a Peace Corps Volunteer that my school is working with to provide TBA training to about 20 ladies and below is her response. By the
      Message 2 of 2 , Oct 28, 2007
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        I forwarded the article to a Peace Corps Volunteer that my school is working with to provide TBA training to about 20 ladies and below is her response.  By the way, we are doing a fundraiser for her project, and if anyone is interested in helping out in any way it would be appreciated.  She is a PCV that my students met last spring when we went to Malawi, and she has agreed to train 2 or 3 women from the village that we are helping if we can help her raise the funds.  The training costs about $6,000.  If anyone would like to receive her proposal, again please let me know.
         
        "I hope you are well.  The article you forwarded is an example of the differing views of many people within the Malawian Ministry of Health regarding TBAs.  Let me first say what the article does not.  The majority of TBAs in Malawi have never been trained and thus lack the appropriate skills to recognize when to refer women to the health centers as well as the willingness to refer women to clinics and hospitals.  I will also add that Peace Corps endorses and funds TBA trainings throughout the world.
             Prior to writing the proposal for the TBA training, I consulted several physicians, including an OBGYN from CDC in Atlanta who travels extensively in Africa for work.  I was worried about this very issue....perhaps training TBAs may do more harm than good.  Based on reading many journal articles and consulting with many people, including the medical staff at Mchinji District Hospital, I have come to the conclusion that training TBAs is very important. 
            Here is Dr. Jamieson's response to my question of whether she endorses the training of TBAs and integrating them into the nation's health system:
          
         "I personally think that TBAs are an important resource in resource-limited settings like Malawi.  With some basic training they can provide life-saving care in areas in which access to health care is limited.  For example, I have worked with Afghan refugees in camps in remote Pakistani-Afghan border.  There women were delivered primarily by their mother-in-laws and were dying from largely preventable causes, such as postpartum hemorrahage from retained placenta.  For example, if a trained birth attendant knew how to manually remove a placenta some of these women may have lived.  So, yes, I think there is a limited, but important role for TBAs."  If you wish to contact her, her name is Dr. Denise Jamieson, djj0@....
         
            The District Nursing Officer at my Mchinji Hospital and the TBA Coordinator (who the government of Malawi hires to work with the TBAs) all came to me for help regarding TBAs in an effort to train them.  While the hope is to reach a point when all women will be able to deliver in a hospital, it is simply not a feasible reality at this point in time.  Even if the government ministry doesn't train TBAs, the women of Malawi will still go to a traditional birth attendant to deliver.  Women trust their TBAs.  They trust them more than the clinics and hospitals, and it is possible that by working with TBAs (as well as traditional healers, which is already being done) a system can be created to build a bridge between the TBAs and the health system to integrate the two.
            If a TBA can learn to do one thing well (cutting the cord in a hygienic manner to prevent sepsis or being able to recognize when to refer a woman to the hospital), that is a step forward from where we are.  Attributing the reason for maternal deaths to TBAs is a mistake.  They are providing the care and aid that the government is incapable of providing.  It may be true that delay in reaching a hospital results in death, but is also true that a woman may wait a day or two before the ambulance that has been called arrives to take her to the district hospital.  She may already be dead at this point. 
            The TBA issue is a complicated one, but I believe we must be realistic relative to what Malawian women do when it comes to delivering their babies.  I think there are probably more medical practitioners within Malawi who believe that training and integrating TBAs into the health system is beneficial than those who don't.  The reproductive health unit is Lilongwe are the ones who have agreed to provide the delivery kits to the TBAs which are about 100 USD per TBA for a year, so I think this demonstrates the differing view points.
            What I do think is very important is that the ministry and district hospital stay in contact with TBAs after the trainings.  The TBAs need to feel important and will be much more willing to work with the medical establishment if they are respected and shown that the government does care about them.  They are taught in the trainings how to submit reports using pictographs, and these are then submitted to the district health office.  This will give us more statistical information and help in formulating new and improved health outreach programs."
             




        To: ujeni@yahoogroups.com
        From: kcheney12@...
        Date: Mon, 22 Oct 2007 17:35:22 -0400
        Subject: [ujeni] Malawi News

        FYI Malawi news...
         
        I'll be in DC roughly 11/28-12/2. Anyone in the area wanna get together??
         
        Kristen
        MALAWI: Role of traditional birth attendants to change
        BLANTYRE, 19 October (IRIN) - Malawi is planning to change the role of Traditional Birth Attendants (TBAs) in an attempt to reduce one of the world's highest rates of maternal and infant deaths.
        A 2004 Malawi Demographic and Health Survey said the maternal and infant mortality rate was 984 out of every 100,000 live births, translating to 6,000 maternal deaths each year.
        But such a move, observers say, does not take into account the already overburdened public health system, which would be overwhelmed if TBAs were removed.
        Adamson Muula, a lecturer in community health at the Malawi College of Medicine, in the commercial capital of Blantyre, said less than half the women in Malawi delivered their babies at recommended hospitals, "yet the system is overtaxed."
        "If government plans not to use TBAs anymore, then a safe alternative must be identified. In many cases, not all women, even if they wanted, would end up
        delivering at the hospital. Again, if just 70 percent of all pregnant women were to deliver at the hospital, the hospital system would not cope," he said.
        Birth attendants shoulder the blame
        Sabinna Mlusu, the District Nursing Officer in Blantyre, said the reason for government ending the practice of licensing TBAs was the discovery "that most maternal and infant deaths are caused by delays in arranging transport from homes of TBAs to clinics, and then to referral hospitals. Such delays ended up complicating cases which TBAs could not treat."
        She said the majority of deaths were a consequence of such complications as internal bleeding and high blood pressure, which required emergency medical attention only available at public and private clinics.
        Diana Khonje, neonatal health officer at the Reproductive Health Department in Malawi's Ministry of Health, said government would not completely discard the TBAs, but that they would no longer perform the duties of midwives.
        "They have been given a new roles. One of them will be to arrange transport for expectant women to clinics and teach lactating mothers the importance of breast feeding," Khonje said.
        She dismissed concerns that removing TBAs from the loop would exert an added burden on public health facilities. "There is enough capacity in our hospitals to handle maternity cases. The problem is that most women are ill-informed ... [often] by the same TBAs who were getting paid for the services rendered."
        She said the process for switching the TBAs from handling expectant mothers would be gradual. "We believe in their new roles the TBAs will help government to reach out to the rural poor who are ... [mostly] ill-informed about childbirth and breast feeding."
        Chimota Phiri, the Blantyre District Health Officer, told IRIN that the government was also using traditional leaders to convince people to stop using TBAs. "People tend to listen much more to what their traditional leaders tell them than anyone else. Chiefs must therefore tell people the importance of coming to hospitals with problems affecting their health."
        He said the country's high maternal and infant mortality rate was a consequence of home births. "Such unsafe conditions cause infections to both the mother and the baby, which, in most cases, lead to death."
        But not all traditional leaders accepted that the high rate of maternal and infant deaths could be attributed to TBAs. Chief Kabunduli, from northern Malawi, said government should also shoulder some of the blame. "Experience has shown that most maternal and child deaths occur in houses of TBAs, but it is government that accredits these people."
        Charles Munthali, a health official from the same region, said in one district only 4,000 of the about 10,000 expectant mothers had visited a hospital for antenatal services. "Maternal and newborn deaths are avoidable, but most women prefer to go for deliveries by unskilled TBAs."
        Challenges and strategies
        The United Kingdom Department for International Development (DFID), which has donated about US140 million to Malawi for 2006/07 - including $40 million for budget support, another $40 million for health and HIV/AIDS, and $14 million for education - said there were evident challenges in the health sector, as the maternal mortality rate had risen by more than 50 percent since 1992.
        However, at the same time, the under-five mortality rate had declined to 133 deaths per 1,000 live births in 2004 - a 43 percent reduction in 12 years - and was on target to reach the 2015 Millennium Development Goal in this category.
        The UN Children's Fund (UNICEF) estimates that almost half of all births in developing countries occur without a skilled birth attendant present. Globally, 529,000 women die every year in pregnancy or birth, according to the World Health Organisation (WHO).
        [ENDS]


        --
        "The rainmaker who doesn't know what he's doing will be found out by the lack of clouds."
        -- Luganda Proverb


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