Upgrading traditional midwifery in Sierra Leone: an overview with special reference to Koinadugu District
Ross, J.
Midwifery 4(2): 58-69
1988
ISSN/ISBN: 0266-6138 PMID: 3386542 DOI: 10.1016/s0266-6138(88)80003-2Document Number: 367812
A comprehensive view of the training of traditional midwives (TBAs) in the Koinadugu District of Sierra Leone, including the historical and social setting, legal aspects of practice, selection of candidates, course content, transcultural modifications and effects of training on the status of the TBAs is reported. The District in the northeast of the country is the largest, with 200,000 people, most remote, with few roads and little radio contact, and has 1 hospital, in Kabala. The infant mortality rate is estimated to be 245/1000. TBA training has been done since 1930. Now 3 levels of trained paramedical personnel are trained: Village Maternity Assistants (given 18 months' training), Maternal and Child Health Aide (88 trained as of 1974, intended to staff Health Centers, none in Koinadugu), and TBAs. In Koinadugu District there are 1 Dr., 7 nurse-midwives, 3 VMAs, and 71 TBAs, 30 of whom practice in or near the capital. The TBA course is based on the WHO curriculum, given over 3 weeks. Emphasis is placed on cord care (25% of infant deaths are due to tetanus), hygiene, reproductive biology, stages of labor, assessment of blood loss, prenatal care, nutrition, and safe family planning practices. Much time is devoted to evaluating current beliefs in order adapt training without degrading TBAs' status. Some difficulties encountered were lack of financing for the program (cancelled in 1984), informing villages by local news criers, selecting candidates, and handling social conflicts. After training the TBAs received a graduation ceremony, a certificate, and a midwifery kit. They are expected to replenish supplies from client fees, although villagers refuse to pay government trained TBAs, and supplies are unavailable.