Effect of training on the resuscitation practices of traditional birth attendants

Training programs in more modern methods of birth asphyxia resuscitation were started for traditional birth attendants (TBAs) in 54 villages (population 62,427) of Raipur Rani Block near Chandigarh, India during 1989-1991. A continuing training program by the primary health center staff at 4 focal villages, for one day each month, had been in progress for several years. About 80-100 TBAs attended these sessions. Resuscitation methods included gravity drainage of secretions, physical stimulation by flicking at the soles of the feet, cleaning the mouth by a finger wrapped in gauze, mouth-to-mouth breathing, cardiac massage, and prevention of heat loss by wrapping the baby in multiple layers of cloth. In 1988, 31 TBAs also received advanced training in the use of the mucus extractor and bag-and-mask ventilation. Two trained field workers visited the villages once a fortnight to contact child workers, TBAs and health workers, and checking the local register of vital events to record births. Family members and/or the TBA who assisted at the delivery were interviewed, and a detailed birth history was recorded for stillborn and asphyxiated babies. TBAs assisted with the delivery of 1884 babies (93.7%). Of these, 31 asphyxiated babies and 30 recently stillborn babies were eligible for the resuscitation survey, but information could not be collected for 2 of the stillborn infants. Both traditional and modern resuscitation methods were used in 30 cases (51%), modern methods only in 13 (22%), traditional methods in 2 (3%), and no resuscitation effort was made in 14 cases (24%). Among 21 cases delivered by the trained TBAs, mucus traps and bag-and-mask were used in 33.3% and 42.6%, respectively. Instillation of onion juice and warming of placenta were practiced in a significantly higher proportion of cases by traditionally trained TBAs than by those who had received advanced training. Adoption of modern resuscitation methods by the TBAs demonstrates that they are likely to change their practices.     

Practices and beliefs of traditional birth attendants: lessons for obstetrics in the north?

The majority of mothers in countries in Africa, Asia and Latin America are supported by Traditional Birth Attendants (TBAs) during pregnancy and childbirth. TBAs do more than just deliver babies. As part of the local community they are acquainted with the women and their families with whom they share the cultural ideas about how the birth has to be prepared for and performed. They know the local medicines and rituals which are used before, during and after delivery. The work of the TBAs is adapted and strictly bound to the social and cultural matrix to which they belong, their practices and beliefs being in accordance with the needs of the local community. Therefore they may not be able to assist women at childbirth outside their own socio-cultural environment. Comparison of the practices and beliefs of TBAs in Africa, Asia and Latin America revealed a large variation among the different cultures of the three continents. Surprisingly, in spite of the cultural differences there were clearly some common practices and beliefs which may occur in all three continents. It is assumed that these common practices are due to the expression people give to the basic events of life such as pregnancy, labour and lactation. A short review of common practices is presented as they may be of value in obstetrical practice in the northern countries.     

Training birth attendants in the Sahel

A small-scale training programme for birth attendants in a remote area of Burkina Faso was evaluated two years after it had been started. The evaluation methods included interviews with trained birth attendants and the analysis of health service statistics and survey data. The findings showed that the programme had been moderately successful in imparting knowledge and overcoming cultural inhibitions about assisted deliveries. However, the effectiveness of the programme was severely curtailed by structural deficits in the health system, especially lack of skilled staff, supervision and transport. In deprived areas such as the Sahel, it is probably the health centre, the hospital and the referral system that should be the first priority for improvement, rather than grass-roots practices.     

Characteristics of traditional birth attendants and their beliefs and practices in the Offot Clan, Nigeria

The fragile X syndrome, one of the most common forms of inherited mental retardation, is caused by an expansion of a polymorphic CGG repeat upstream of the coding region in the FMR1 gene. The expansion blocks expression of the FMR1 gene due to methylation of the FMR1 promoter. Functional studies on the FMR1 protein have shown that the protein can bind RNA and might be involved in transport of RNAs from the nucleus to the cytoplasm. A role of FMR1 protein on translation of certain mRNAs has been suggested. An animal model for fragile X syndrome exists and these mice show some behavioural difficulties mimicking the human fragile X syndrome phenotype. This review presents what is known about the protein and what is learned from the animal model for fragile X syndrome.     

What in the world is being done about TBAs? An overview of international and national attitudes to traditional birth attendants

Many of the half million women per year who die in childbirth are attended by traditional birth attendants (TBAs). Whether they fare better when such an attendant is trained remains uncertain; even the World Health Organization seems to have tempered its enthusiasm for TBA training recently. With some nations outlawing the practice of TBAs and others actively promoting it, there seems to be no consensus on what to do about this major and continuing workforce in maternity care. By themselves TBAs cannot reduce maternal mortality, whether they are trained or not. They need skilled, equipped and available support. As the professional group who must co-operate with TBAs and provide that support, midwives must, collectively and individually, assess, state and act on their attitude towards TBAs.     

Ambulatory care training in cardiology: redefining the traditional arena of learning

Fiscal restraint, consolidation of resources and services, and restructuring have led to changes in the case mix of teaching hospitals, which places limitations on the education of medical trainees in this environment and has sparked growing interest in the teaching of clinical medicine in the ambulatory care setting. Early attempts to emphasize ambulatory care in training programs, and the strengths and weaknesses of this teaching forum are reviewed, and a model of its application to the discipline of cardiology is offered.     

Changing patterns of corneal disease and associated vision loss at a rural African hospital following a training programme for traditional healers

AIMS/BACKGROUND: Use of African traditional eye medicines (TEM) is associated with the presence of corneal disease, delay in presentation, and vision loss. An interactive training programme was conducted with traditional healers in Chikwawa District, Malawi and changes in the pattern of corneal disease assessed in patients presenting to the district hospital after the training. METHODS: All patients presenting to the district hospital with corneal disease for a 15 month period before intervention and a 12 month period after intervention were enrolled in the study. Interviews and examinations were carried out by the same person using a standardised, pretested form. RESULTS: Among the 175 pre-intervention and 97 post-intervention patients, delay in presentation improved only slightly. Blindness among patients reporting the use of TEM decreased from 44% to 21%; bilateral corneal disease in patients using TEM decreased from 31% to 10%. Multivariate analysis demonstrates that poor vision in corneal disease patients continues to be associated with TEM use and distance from the district hospital. CONCLUSION: As there were no other relevant eye health programmes in the district it is believed that this collaborative eye care programme with the traditional healers was likely to have been responsible for many of the changes in the pattern of corneal disease in the district. Although the changing patterns are encouraging and are likely to improve with additional collaboration, distance to a district hospital will continue to be a barrier to timely use of Western eye care services.     

Catecholamine release in the newborn infant at birth

Catecholamines were determined by a fluorimetric technique in umbilical blood which was collected from newborn infants immediately after birth. The mean catecholamine concentration was 62.1 nmol/liter in the umbilical artery and 29.3 nmol/liter in the umbilical vein of newborn full term infants delivered uneventfully. This value is considerably higher than in resting adults. Similar levels of catecholamines were seen after elective cesarean sections, whereas considerably higher levels were found after breech deliveries. In the full term asphyxiated infants about a 4-fold increase of the catecholamine concentration was found in both the umbilical arterial and venous blood. The amine concentration level correlated inversely to the pH below 7.25 (10 log catecholamine concentration versus pH, r = -0.71). Preterm infants had, in general, lower amine levels than full term infants both after uneventful deliveries and after intrauterine asphyxia. The catecholamine levels were considerably increased in the newborn infants who showed some kind of abnormal fetal heart rate variation during the last hour before birth; in particular baseline changes were associated with high levels whereas only a moderate increase was seen after loss of beat-to-beat variation.     

Shock of birth. Evaluation of neurologic status of term newborn in the first 48 hours of life

The shock of birth is a transient depression of muscle tone and deep tendon reflexes seen in newborn babies shortly after birth. We evaluated the shock of birth in a sample of 313 consecutive term newborns at 4, 24 and 48 hours of life. We correlated neurologic findings on examination with maternal, obstetric and perinatal data. Special attention was given to the relationship between the mode of delivery and shock of birth. Of the maternal data, factors associated with the shock of birth were obstetric gestational age, previous gestations, abortion or previous vaginal deliveries. Presence of stained amniotic fluid at birth was associated with the shock of birth. There was also a correlation between shock of birth and newborn sex, birth weight, thoracic circumference and the Battaglia and Lubchenco classification. The shock of birth lasted less than 24 hours in 70% of the newborns and less than 48 hours in 84.3%. We conclude that the mode of delivery, vaginal or cesarean section, did not influence the shock of birth. We also established the duration and factors associated with this phenomenon.     

Specialist registrar training: ideas for a five year programme

Proposals for specialist registrar training in accident and emergency medicine in Mid-Trent Region are outlined. These may provide a framework for other schemes as well as stimulating further ideas.     

Some reactions to a dry-land training programme for dinghy sailors

A dry-land winter training programme for dinghy-sailors is described. Individual elements include circuit training, specific exercises for muscle strength and endurance, and distance running. Ten international-class sailors followed a progressive regimen of this type for 14 weeks after completion of the 1973 season. Excess weight and skinfold thicknesses were reduced, while muscle strength, endurance and anaerobic capacity increased. Aerobic power remained substantially unchanged, although a smaller oxygen debt was incurred in reaching maximum effort. Team members were enthusiastic about the benefits gained from the training, commenting on their greater tolerance of the hiking position and all proposed to continue or to increase their efforts during subsequent winters. Racing results during 1974 were also an improvement on the 1973 record. However, it was difficult to link physiological gains to improvements in the relative rankings of individual competitors under either light or high wind conditions; the main factor changing relative standings seems to have been the additional year of competitive experiences in younger team members.     

Psycho-social work conditions as risk factors for premature birth and newborn hypotrophy

On the basis of the studies carried out the authors verified a hypothesis that psychosocial work conditions and occupational stress are risk factors for premature birth and newborn hypotrophy. The following aspects were considered in the evaluation of psycho-social work conditions: (a) work-related psychological demands; (b) the extent to what an employee is able to control the situation at work; (c) occupational stress arising from the discrepancy between work-related demands and the extent of control over the work situation; and (d) interpersonal relations at work. The analysis covered 219 cases of premature births and 159 cases of newborn hypotrophy. The control group comprised 586 women sampled randomly who gave birth at term to a healthy baby with correct birth weight. The authors found that ill interpersonal relations and a low level of control over the situation at work elevate the risk of giving birth to a baby with hypotrophy, while good interpersonal relations and a high level of control over the situation at work play a protective role. The effect of these psycho-social factors applied only to hypotrophy of a newborn and it was related neither to other features of occupational work nor to biomedical factors. It seems that this kind of factors may have generally less pronounced impact on premature birth.     

Evaluation of a preventive self-management programme for problem drinkers.

31 Ss (average age 39 yrs) participated in either of 2 variations of a self-management, controlled drinking program: Type R used regular techniques; Type E used those methods and taught Ss additional strategies for coping with life stresses related to drinking. Results show that a significant reduction occurred for all Ss over the 1-yr treatment period. Type E Ss were significantly more likely to be drinking in a nonhazardous fashion than Type R Ss. (French summary) (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mentoring in the context of a training programme for young unemployed adults with physical disability

We describe a modified method for antegrade placement of periurethral collagen in incontinent men. In this technique, a flexible cystoscope is used to guide the placement of a specially designed needle into the bladder neck and external sphincter region via an antegrade transvesical approach. The 19-gauge, 28-cm long needle is passed suprapubically without a sheath. The procedure may be performed with local anesthesia and intravenous sedation only and takes less than 30 minutes.     

Home birth and short-stay delivery. Lessons in health care financing for providers of health care for women

The current restructuring of the U.S. health care delivery system is driven primarily by economic forces. Although primary care providers may understand the roles of technology and advocacy in fostering fundamental change, they may not be familiar with the issues related to financing of health care and, thus, may not fully appreciate the extent to which economic factors influence the character of their professional lives and the services they provide. Analysis of the loss of the home birth option in the 1950s provides a method for understanding and influencing the factors driving health care restructuring today. In examining short-stay delivery in the 1990s, this article also addresses ways in which managed health care systems may improve or restrict women's access to a variety of primary care services.