Demographic characteristics of women that use traditional birth attendants in Bongo District, Ghana

European Journal of Midwifery, Volume 4, No. January, Year 2020

Interpretation

INTRODUCTION Over the last decade, the government of Ghana has implemented several interventions aimed at increasing access to skilled birth-care services from trained professionals. Despite these efforts, there is a wide gap between antenatal care attendance and skilled delivery attendance, particularly in rural areas. Evidence shows that many women in rural and deprived communities in Ghana rely on traditional birth attendant (TBA) delivery services. This has created a gap where antenatal attendance is high while skilled delivery is relatively low. The purpose of this study is to identify and analyse the sociodemographic characteristics of women who use the services of TBAs in Bongo District, Ghana. METHODS Using a descriptive study design, a survey was conducted involving 330 mothers randomly selected from 1685 mothers who delivered at home by 2014 in Bongo District. The questionnaire for mothers who delivered at home by a TBA comprised 28 questions. RESULTS The results show that women who used TBA were older, without formal education, married, predominantly farmers, married to spouses who were farmers without formal education. Most of the sampled women were co-currently covered by the national health insurance. CONCLUSIONS This study describes the demographic characteristics of women who use a TBA. Therefore, ongoing efforts aimed at increasing access to and use of professional antenatal services should incorporate sociodemographic factors in the rural context. Bongo District was selected for the study because it recorded the lowest performance of skilled delivery services from 2008 to 2010 in the Upper East Region. This situation led to reported cases of four maternal deaths in 2008, five in 2009 and three in 201020. The district lies between longitudes 0.45’W and latitudes 10°50’N to 11°9’N, with an area of 459.5 km2. It is located within the onchocerciasis-free zone of Ghana. Bongo District is bounded to the North and East by Burkina Faso, to the West by Kassena-Nankana Municipality and Kassena-Nankana West District and to the South by Bolgatanga Municipality. The population of the district is about 84545, with 40084 males and 44461 females21. The district is predominantly rural, with over 80% of the inhabitants living in areas classified as rural. It is fairly homogeneous with the Boosi and Gurusi ethnic groups forming about 80% of the population21. The modern healthcare system of the Bongo District is consists of one hospital in Bongo, the District capital, four health centres, thirteen completed Community-based Health Planning and Services (CHPS), sixty-two outreach stations, ten feeding/nutrition centres and one rehabilitation centre. The District Health Management Team (DHMT) headed by District Director of Health Services (DDHS) superintends the District Health Administration. The DHMT is supported by sub-district health management team (SDHMT) in all the six sub-districts with twenty-three midwives. Increase awareness creation on health promotion and protection was undertaken by community health nurses, community health officers, midwives and the Public Health Unit of the hospital, at the various health facilities, outreach points, schools and community durbars. Topics include environmental and personal hygiene, hand washing, good nutrition, seeking early treatment, know your HIV status, childcare, early initiation of antenatal care to women, free registration of pregnant women with NHIS, free maternity services for women, and many others. The study adopted a cross-sectional descriptive design. Descriptive research design helps assist the researcher in exploring and explaining a situation in its natural environment. Additionally, it permits the researcher to describe the characteristics of persons, situations and the occurrence of phenomena22. According to Glass and Stanley23 descriptive design is used when the researcher intends to accurately show the status of one or more variables, or to specify a phenomenon of human experience. The design has been adopted in this study in order to answer the questions: ‘what exists?’ or ‘how do the phenomena appear?’. The design is flexible and allows the researcher to choose quantitative or qualitative methods to answer the questions24. The descriptive study design was relevant to the study as the main objective was to identify factors influencing the use of TBAs. The study populations included women who gave birth, within one year before the survey, in the study area. Out of a total of 1685 mothers who delivered at home by 2014, a sample of 330 was derived using the Yamane24 formula (n=N/[1+N×e2], where n = sample size, and e is the acceptable sampling error in a population N) at 95% confidence level (CI) and 5% margin of error. A simple random sampling technique (lottery method with replacement)25 was employed to select 330 mothers who delivered at home by TBA in Bongo District for the study sample. The sample frame was obtained from the names and addresses of mothers available in child welfare clinics’ registers. Data were gathered from participants with the use of both closed and open-ended interview questions. Questionnaires for mothers who delivered at home by a traditional birth attendant (TBA) were administered. The questionnaire for mothers who delivered at home by TBA comprised 28 questions on demographic characteristics of the respondents. This set of questions was mainly close-ended. The questionnaire was pre-tested on 25 mothers attending a child welfare clinic in Bongo District hospital. Each mother was interviewed after the purpose of the study was explained. The purpose of pre-testing the instrument was to obtain clarity and to find out its appropriateness to the main study. There were no difficulties encountered with the questionnaire. However, the pre-test helped to modify some questions. Data quality control was guaranteed throughout the process of data collection, coding, entry and analysis. Training exercises were conducted for all data collectors, and their work in the field supervised strictly for adherence. Supervision of data collectors included observation of how they were administering questions. Codes were assigned to questions in the questionnaires for easy detection and correction of errors. The completed questionnaires were checked for completeness by data collectors daily. Consequently, problems encountered were discussed among the survey team and addressed immediately. Ethics constitute values that determine the degree to which research procedures adhere to professional, legal and social requirements about the study26. In order to satisfy the ethical requirement of the study, a research proposal was submitted by the researchers to the School of Allied Health Sciences, University for Development Studies for appraisal and approval. Following the approval by the University, further approvals were sought from the Regional Health Directorate of Upper East Region and Bongo District Health Directorate to use the district as the setting for the study. At the community level, verbal informed consent was sought from participants to conduct interviews. Each respondent was made aware that participation in the study was optional – a respondent had the right to decide whether to participate in the study or not, and to withdraw from the study at any time if she so wished. Respondents were assured that information they provided would remain confidential and their identity kept anonymous. Consequently, respondents were asked to desist from writing their names on the questionnaire. Finally, each questionnaire was accompanied by a cover letter that explained the aims of the study as well as the rights and obligations of the research participant as well as the researcher. The research assistants used the local dialect to facilitate understanding and to seek participation, for those participants who could not read and write English. The completed questionnaires were checked for completeness and consistency of responses. The Statistical Package for Social Sciences (SPSS) computer software package (Version 16.0) was the tool used to analyse the data, organised mainly into frequency tables. Reasons that accounted for the use of and challenges associated with using a TBA were computed and presented in tables in a ranked order. Chi-squared test by cross-tabulation was also employed to measure how utilisation of TBA services relate to sociodemographic variables and other service characteristics. The study considered p-values <0.05 as significant.

AI Digest

Study Justification:

– The study aims to address the gap between antenatal care attendance and skilled delivery attendance in rural areas of Ghana.
– It focuses on understanding the sociodemographic characteristics of women who use traditional birth attendant (TBA) delivery services in Bongo District.
– By identifying these characteristics, the study can inform efforts to increase access to and use of professional antenatal services in rural areas.

Study Highlights:

– The study found that women who used TBAs were older, without formal education, married, predominantly farmers, and married to spouses who were farmers without formal education.
– Most of the sampled women were also covered by the national health insurance.
– These findings highlight the specific demographic characteristics of women who rely on TBAs for delivery services in Bongo District.

Study Recommendations:

– Ongoing efforts to increase access to and use of professional antenatal services should incorporate sociodemographic factors in the rural context.
– Policies and interventions should be tailored to address the needs and preferences of women who use TBAs, such as providing education and awareness programs targeted towards older, less educated, and farming communities.
– Collaboration between the government, healthcare providers, and community leaders is crucial to ensure the success of these interventions.

Key Role Players:

– Government agencies responsible for healthcare policy and implementation.
– District Health Management Team (DHMT) and sub-district health management teams.
– Healthcare providers, including midwives and community health nurses.
– Community leaders and traditional birth attendants.
– Researchers and academics involved in studying and analyzing the data.

Cost Items for Planning Recommendations:

– Education and awareness programs targeting rural communities.
– Training programs for healthcare providers on addressing the specific needs of women who use TBAs.
– Resources for data collection and analysis.
– Communication and coordination efforts between key role players.
– Monitoring and evaluation of the interventions.
– Potential infrastructure improvements to enhance access to professional antenatal services in rural areas.

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is relatively strong, but there are some areas for improvement. The study design is described as descriptive, which limits the ability to establish causation or make strong conclusions. Additionally, the sample size of 330 mothers may not be representative of the entire population. To improve the evidence, the study could consider using a more rigorous research design, such as a randomized controlled trial, and increase the sample size to improve generalizability. Furthermore, including a control group of women who did not use traditional birth attendants would provide a basis for comparison and strengthen the findings. Overall, the evidence could be strengthened by incorporating more robust research methods and increasing the sample size.

Abstract

Bongo District was selected for the study because it recorded the lowest performance of skilled delivery services from 2008 to 2010 in the Upper East Region. This situation led to reported cases of four maternal deaths in 2008, five in 2009 and three in 201020. The district lies between longitudes 0.45’W and latitudes 10°50’N to 11°9’N, with an area of 459.5 km2. It is located within the onchocerciasis-free zone of Ghana. Bongo District is bounded to the North and East by Burkina Faso, to the West by Kassena-Nankana Municipality and Kassena-Nankana West District and to the South by Bolgatanga Municipality. The population of the district is about 84545, with 40084 males and 44461 females21. The district is predominantly rural, with over 80% of the inhabitants living in areas classified as rural. It is fairly homogeneous with the Boosi and Gurusi ethnic groups forming about 80% of the population21. The modern healthcare system of the Bongo District is consists of one hospital in Bongo, the District capital, four health centres, thirteen completed Community-based Health Planning and Services (CHPS), sixty-two outreach stations, ten feeding/nutrition centres and one rehabilitation centre. The District Health Management Team (DHMT) headed by District Director of Health Services (DDHS) superintends the District Health Administration. The DHMT is supported by sub-district health management team (SDHMT) in all the six sub-districts with twenty-three midwives. Increase awareness creation on health promotion and protection was undertaken by community health nurses, community health officers, midwives and the Public Health Unit of the hospital, at the various health facilities, outreach points, schools and community durbars. Topics include environmental and personal hygiene, hand washing, good nutrition, seeking early treatment, know your HIV status, childcare, early initiation of antenatal care to women, free registration of pregnant women with NHIS, free maternity services for women, and many others. The study adopted a cross-sectional descriptive design. Descriptive research design helps assist the researcher in exploring and explaining a situation in its natural environment. Additionally, it permits the researcher to describe the characteristics of persons, situations and the occurrence of phenomena22. According to Glass and Stanley23 descriptive design is used when the researcher intends to accurately show the status of one or more variables, or to specify a phenomenon of human experience. The design has been adopted in this study in order to answer the questions: ‘what exists?’ or ‘how do the phenomena appear?’. The design is flexible and allows the researcher to choose quantitative or qualitative methods to answer the questions24. The descriptive study design was relevant to the study as the main objective was to identify factors influencing the use of TBAs. The study populations included women who gave birth, within one year before the survey, in the study area. Out of a total of 1685 mothers who delivered at home by 2014, a sample of 330 was derived using the Yamane24 formula (n=N/[1+N×e2], where n = sample size, and e is the acceptable sampling error in a population N) at 95% confidence level (CI) and 5% margin of error. A simple random sampling technique (lottery method with replacement)25 was employed to select 330 mothers who delivered at home by TBA in Bongo District for the study sample. The sample frame was obtained from the names and addresses of mothers available in child welfare clinics’ registers. Data were gathered from participants with the use of both closed and open-ended interview questions. Questionnaires for mothers who delivered at home by a traditional birth attendant (TBA) were administered. The questionnaire for mothers who delivered at home by TBA comprised 28 questions on demographic characteristics of the respondents. This set of questions was mainly close-ended. The questionnaire was pre-tested on 25 mothers attending a child welfare clinic in Bongo District hospital. Each mother was interviewed after the purpose of the study was explained. The purpose of pre-testing the instrument was to obtain clarity and to find out its appropriateness to the main study. There were no difficulties encountered with the questionnaire. However, the pre-test helped to modify some questions. Data quality control was guaranteed throughout the process of data collection, coding, entry and analysis. Training exercises were conducted for all data collectors, and their work in the field supervised strictly for adherence. Supervision of data collectors included observation of how they were administering questions. Codes were assigned to questions in the questionnaires for easy detection and correction of errors. The completed questionnaires were checked for completeness by data collectors daily. Consequently, problems encountered were discussed among the survey team and addressed immediately. Ethics constitute values that determine the degree to which research procedures adhere to professional, legal and social requirements about the study26. In order to satisfy the ethical requirement of the study, a research proposal was submitted by the researchers to the School of Allied Health Sciences, University for Development Studies for appraisal and approval. Following the approval by the University, further approvals were sought from the Regional Health Directorate of Upper East Region and Bongo District Health Directorate to use the district as the setting for the study. At the community level, verbal informed consent was sought from participants to conduct interviews. Each respondent was made aware that participation in the study was optional – a respondent had the right to decide whether to participate in the study or not, and to withdraw from the study at any time if she so wished. Respondents were assured that information they provided would remain confidential and their identity kept anonymous. Consequently, respondents were asked to desist from writing their names on the questionnaire. Finally, each questionnaire was accompanied by a cover letter that explained the aims of the study as well as the rights and obligations of the research participant as well as the researcher. The research assistants used the local dialect to facilitate understanding and to seek participation, for those participants who could not read and write English. The completed questionnaires were checked for completeness and consistency of responses. The Statistical Package for Social Sciences (SPSS) computer software package (Version 16.0) was the tool used to analyse the data, organised mainly into frequency tables. Reasons that accounted for the use of and challenges associated with using a TBA were computed and presented in tables in a ranked order. Chi-squared test by cross-tabulation was also employed to measure how utilisation of TBA services relate to sociodemographic variables and other service characteristics. The study considered p-values <0.05 as significant.

Materials

https://efashare.b-cdn.net/materials/ec061eeba8b52f3f3dc1390fde34f4a60fc26520e8436019eeefdb976f5cb605/EJM-4-1-s1.pdf

Innovations

Based on the information provided, here are some potential innovations that could be used to improve access to maternal health in the Bongo District, Ghana:

1. Mobile clinics: Implementing mobile clinics that travel to rural areas, where access to healthcare facilities is limited, can provide essential maternal health services to women who rely on traditional birth attendants. These clinics can offer antenatal care, skilled delivery services, and postnatal care.

2. Telemedicine: Introducing telemedicine services can connect women in remote areas with healthcare professionals who can provide guidance and support during pregnancy and childbirth. This can help address the lack of skilled birth attendants in rural communities.

3. Community health workers: Training and deploying community health workers who can provide basic maternal health services, education, and referrals in rural areas can help bridge the gap between antenatal care attendance and skilled delivery attendance. These workers can also collaborate with traditional birth attendants to ensure safe and hygienic practices.

4. Health education campaigns: Conducting targeted health education campaigns that focus on the importance of skilled birth attendance and the potential risks associated with relying solely on traditional birth attendants can help raise awareness and encourage women to seek professional care during pregnancy and childbirth.

5. Financial incentives: Providing financial incentives, such as subsidies or cash transfers, to women who choose to deliver in healthcare facilities with skilled birth attendants can help reduce the financial barriers that may prevent them from accessing these services.

6. Strengthening healthcare infrastructure: Investing in the improvement and expansion of healthcare facilities in rural areas can increase the availability and accessibility of skilled birth attendants. This includes ensuring the availability of necessary equipment, supplies, and trained healthcare professionals.

7. Collaboration with traditional birth attendants: Engaging traditional birth attendants in the healthcare system by providing them with training, resources, and support can help improve the quality and safety of their services. This collaboration can also facilitate referrals to healthcare facilities when necessary.

It’s important to note that the specific implementation of these innovations would require further research, planning, and coordination with relevant stakeholders in the Bongo District.

AI Innovations Description

Based on the information provided, the recommendation to improve access to maternal health in Bongo District, Ghana is to develop and implement targeted interventions that address the sociodemographic characteristics of women who use traditional birth attendants (TBAs).

1. Increase awareness and education: Develop and implement community-based health promotion campaigns that specifically target women who use TBAs. These campaigns should focus on the importance of skilled birth attendance, the risks associated with TBA deliveries, and the availability of professional antenatal services. Utilize various communication channels such as community durbars, schools, and outreach points to reach the target population.

2. Improve accessibility of professional antenatal services: Enhance the availability and accessibility of professional antenatal services in rural areas. This can be achieved by increasing the number of health centers, community-based health planning and services (CHPS), and outreach stations in the Bongo District. Ensure that these facilities are adequately staffed with trained midwives and healthcare professionals.

3. Address financial barriers: Explore options to reduce financial barriers to accessing professional antenatal services. This can include providing free registration of pregnant women with the National Health Insurance Scheme (NHIS) and offering free maternity services for women. Collaborate with relevant stakeholders to advocate for increased funding and resources for maternal health services.

4. Tailor interventions to the specific needs of the population: Take into consideration the sociodemographic characteristics of women who use TBAs when designing interventions. For example, consider the age, educational background, occupation, and marital status of these women. Develop culturally sensitive and context-specific interventions that resonate with the target population.

5. Strengthen collaboration and coordination: Foster collaboration and coordination among key stakeholders, including the government, healthcare providers, community leaders, and non-governmental organizations. This will ensure a comprehensive and integrated approach to improving access to maternal health services in the Bongo District.

By implementing these recommendations, it is expected that access to skilled birth-care services will be improved, leading to a reduction in maternal mortality and morbidity rates in the Bongo District, Ghana.

AI Innovations Methodology

To improve access to maternal health in the Bongo District, Ghana, here are some potential recommendations:

1. Strengthening the healthcare infrastructure: Invest in building and upgrading healthcare facilities, including hospitals, health centers, and Community-based Health Planning and Services (CHPS) centers. This will ensure that women have access to skilled birth-care services closer to their homes.

2. Training and deploying more skilled healthcare professionals: Increase the number of midwives, nurses, and doctors in the Bongo District. This can be done through training programs and incentives to attract healthcare professionals to work in rural areas.

3. Community education and awareness: Conduct health promotion campaigns to educate women and their families about the importance of skilled delivery attendance and the risks associated with relying on traditional birth attendants. This can be done through community durbars, schools, and outreach programs.

4. Strengthening the National Health Insurance Scheme (NHIS): Ensure that pregnant women are aware of their entitlement to free registration and maternity services under the NHIS. This will remove financial barriers to accessing skilled delivery services.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Baseline data collection: Gather data on the current utilization of skilled delivery services, demographic characteristics of women, and other relevant factors in the Bongo District.

2. Define indicators: Identify key indicators to measure the impact of the recommendations, such as the percentage increase in skilled delivery attendance, changes in demographic characteristics of women accessing maternal health services, and changes in maternal mortality rates.

3. Develop a simulation model: Use statistical software or modeling techniques to create a simulation model that incorporates the baseline data and the potential impact of the recommendations. This model should consider factors such as population size, healthcare infrastructure, healthcare workforce, and community awareness.

4. Run simulations: Run multiple simulations with different scenarios, varying the implementation of the recommendations. This will help determine the potential impact of each recommendation individually and in combination.

5. Analyze results: Analyze the simulation results to assess the potential impact of the recommendations on improving access to maternal health. Compare the different scenarios to identify the most effective combination of recommendations.

6. Validate the model: Validate the simulation model by comparing the predicted outcomes with real-world data. This will help ensure the accuracy and reliability of the model.

7. Communicate findings: Present the findings of the simulation study to relevant stakeholders, including policymakers, healthcare providers, and community leaders. This will help inform decision-making and prioritize interventions to improve access to maternal health in the Bongo District.

Author

Dima Health

Statistics:

Citations: 1

Identifiers:

DOI: 10.18332/ejm/114884

Research Areas:

Community Interventions, Disability, Food Security, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Quality of Care, Social Determinants, Workforce

Study Countries:

Burkina Faso, Ghana, Multi-Countries

Study Design:

Cross Sectional Study, Grounded Theory

Study Approach:

Mixed-methods, Qualitative, Quantitative

Participants Gender:

Female