PMID- 11124242
OWN - NLM
STAT- MEDLINE
DCOM- 20010607
LR  - 20191210
IS  - 0268-1080 (Print)
IS  - 0268-1080 (Linking)
VI  - 15
IP  - 4
DP  - 2000 Dec
TI  - Training traditional birth attendants in clean delivery does not prevent 
      postpartum infection.
PG  - 394-9
AB  - OBJECTIVE: To compare the maternal outcome, in terms of postpartum infection, of 
      deliveries conducted by trained traditional birth attendants (TBAs) with those 
      conducted by untrained birth attendants. METHODS: The study took place in a rural 
      area of Bangladesh where a local NGO (BRAC) had previously undertaken TBA 
      training. Demographic surveillance in the study site allowed the systematic 
      identification of pregnant women. Pregnant women were recruited continuously over 
      a period of 18 months. Data on the delivery circumstances were collected shortly 
      after delivery while data on postpartum morbidity were collected prospectively at 
      2 and 6 weeks. All women with complete records who had delivered at home with a 
      non-formal birth attendant (800) were included in the analysis. The intervention 
      investigated was TBA training in hygienic delivery comprising the 'three cleans' 
      (hand-washing with soap, clean cord care, clean surface). The key outcome measure 
      was maternal postpartum genital tract infection diagnosed by a symptom complex of 
      any two out of three symptoms: foul discharge, fever, lower abdominal pain. 
      RESULTS: Trained TBAs were significantly more likely to practice hygienic 
      delivery than untrained TBAs (45.0 vs. 19.3%, p < 0.0001). However, no 
      significant difference in levels of postpartum infection was found when 
      deliveries by trained TBAs and untrained TBAs were compared. The practice of 
      hygienic delivery itself also had no significant effect on postpartum infection. 
      Logistic regression models confirmed that TBA training and hygienic delivery had 
      no independent effect on postpartum outcome. Other factors, such as pre-existing 
      infection, long labour and insertion of hands into the vagina were found to be 
      highly significant. CONCLUSIONS: Trained TBAs are more likely to practice 
      hygienic delivery than those that are untrained. However, hygienic delivery 
      practices do not prevent postpartum infection in this community. Training TBAs to 
      wash their hands is not an effective strategy to prevent maternal postpartum 
      infection. More rigorous evaluation is needed, not only of TBA training 
      programmes as a whole, but also of the effectiveness of the individual components 
      of the training.
FAU - Goodburn, E A
AU  - Goodburn EA
AD  - Centre for Sexual and Reproductive Health, John Snow Inc., London, UK.
FAU - Chowdhury, M
AU  - Chowdhury M
FAU - Gazi, R
AU  - Gazi R
FAU - Marshall, T
AU  - Marshall T
FAU - Graham, W
AU  - Graham W
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - England
TA  - Health Policy Plan
JT  - Health policy and planning
JID - 8610614
MH  - Bangladesh/epidemiology
MH  - Developing Countries
MH  - Education, Nursing/organization & administration/standards
MH  - Female
MH  - Hand Disinfection
MH  - Home Childbirth/*standards
MH  - Humans
MH  - *Hygiene
MH  - Midwifery/*education
MH  - Outcome Assessment, Health Care
MH  - Pregnancy
MH  - Program Evaluation
MH  - Puerperal Infection/*epidemiology/*prevention & control
MH  - Rural Population
EDAT- 2001/01/01 19:15
MHDA- 2001/06/08 10:01
CRDT- 2001/01/01 19:15
PHST- 2001/01/01 19:15 [pubmed]
PHST- 2001/06/08 10:01 [medline]
PHST- 2001/01/01 19:15 [entrez]
AID - 10.1093/heapol/15.4.394 [doi]
PST - ppublish
SO  - Health Policy Plan. 2000 Dec;15(4):394-9. doi: 10.1093/heapol/15.4.394.