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IAA Journal of Scientific Research 11(1):16-28, 2024. www.iaajournals.org

©IAAJOURNALS ISSN:2736-7319
https://doi.org/10.59298/IAAJSR/2024/16.2898 IAAJSR:16.2898

Utilization and Effect of Traditional Birth Attendants among the

Pregnant Women in Kahoora Division Hoima District

Aruho Joab

Faculty of Clinical Medicine and Dentistry Kampala International University Western Campus Uganda

ABSTRACT
The study conducted in the Kahoora division of Hoima district in western Uganda examined the utilization and
effect of Traditional Birth Attendants (TBAs) among pregnant women. The study included traditional birth
attendants, pregnant women, and mothers, who consented. Data was collected through a questionnaire, with the
researcher's assistance. The majority of mothers were Banyoro, with the commonest age group being 30-35 years.
The majority were married and had a primary education level. The distance to health centers was mainly 5-10)
kilometers, with major costs ranging from 3001-5000 Uganda shillings. 67.3% of mothers visited TBAs twice, and
63.3% received no complications. The main reasons for choosing TBAs were cost-effectiveness and distance. 53.1%
of mothers learned about TBAs from relatives and friends, but 83.7% had used them but didn't recommend others.
The most common complications seen by TBAs were bleeding after birth and stillbirth, with 26.5% and 14.3%
respectively. 57.1% of TBAs didn't know the prevention of child transmission of HIV. All TBAs said the
government knew about their services, and the commonest challenge was over-bleeding. 53.1% of TBAs said their
services were worse compared to midwives' and doctors' services. The study concluded that TBAs remain vital in
communities, especially in the Kahoora division.
Keywords: Traditional Birth Attendants, Pregnant women, Mothers, Bleeding after birth, Stillbirth.

INTRODUCTION
In recent years, with changes in society and modern every 180 [6]. The developed regions recorded a
healthcare systems, a need to re-examine the total maternal death of 2,200 with a maternal
definition, role, and future of traditional birth mortality rate of 16 per 100,000 and a lifetime risk of
attendants (TBA) has emerged. The purpose of TBA 1 in every 3800. In 2008 estimates by WHO,
is for motherly and child health to identify the issues UNICEF, UNFPA and World Bank showed that
involved in TBA training and practices of TBA 50,000 Nigerian women died of pregnancy and
programs to guide dynamic healthcare policies. childbirth-related cases with a maternal mortality of
Maternal mortality and morbidity are some of the 840 per 100,000 live births. In 2010 the estimate
most important global health issues facing the world indicated a decline from 840 to 630 per 100,000 live
today. Worldwide, approximately 1000 women die births [7] The contribution of TBA in the
each day from pregnancy and childbirth-related improvement of maternal and child health especially
causes [1, 2]. In addition, 99% of these maternal in rural areas cannot be unrecognized. TBA has
deaths occur in the developing world, with sub- remained one of the alternatives of health resources
Saharan Africa accounting for over half of these for women of childbearing age in most local
deaths [3, 4]. Africa has a higher number of 190,000 communities of Nigeria. 88.8% of the respondents
maternal deaths with a maternal mortality rate of were aware of TBA services though only 39.3% of
620 per 100,000 live births and a lifetime risk of 1 in users and non-use are convinced of the opinion that
every 32 [5]. In the same trend, 287,000 global the measures used by TBA are effective. This
maternal deaths were recorded in 2010 with Sub- resulted in poor perception (58.1%) of the practice of
Saharan Africa having 56%, and South Asia at 26% TBA on improving maternal and child health by
both accounting for 85% global burden of maternal women of childbearing age. (E, C and P, 2014) TBA
mortality with a global maternal mortality rate of functions were: “taking normal delivery” (56.7%),
210 per 100,000 live births and lifetime risk 0f 1 in “providing antenatal services” (16.5%), “Performing

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caesarean section” (13.0%), “providing family Uganda had 343 WHO also targets to end
planning services” (8.2%), and “performing preventable deaths of newborns and children under 5
gynaecological surgeries” (5.6%). About (61.0%) of years of age, with all countries aiming to reduce
respondents believed that TBAs have adequate neonatal mortality to at least as low as 12 per 1000
knowledge and skills to care for them, however, birth and under-five mortality to at least as low as
approximately (69.7%) of respondents acknowledged 25 per 1000 live births which was averaging to 54.7
that complications could arise from TBA care. per 1000 in Uganda from 2005-2016 [10, 11]. TBAs
Services obtained from TBAs were: routine antenatal are not skilled attendants and so they are not
care (81.1%), normal delivery (36.1%), “special adequately trained or equipped to handle
maternal bath to ward off evil spirits” (1.9%), complicated cases. They only attend to normal
“concoctions for mothers to drink to make baby delivery. Their real ability to refer to emergencies is
strong” (15.1%), and family planning services (1.9%) questionable. They do not know the actual or
[8]. According to the World Health statics report appropriate places to refer cases to. They are not
in 2010, Uganda’s under-five mortality rate was 147 monitored or supervised and that makes them to be
per 1000 deaths in rural areas and 115 per 1000 lord of their own. They do not know their limits, and
deaths in urban areas in 2006. In addition to this make every attempt whether they will succeed or
Uganda was reported with few medical workers in not. TBAs are not hygienic, as they sometimes
the years 2000-2009 i.e. physicians were 3361, neglect hand washing, non-sterilization of
nurses and midwives were 37,625, dentistry instruments, environmental sanity not maintained
personnel were 440, pharmaceutical personnel were and others which will cause more harm than good to
762, and environment and public health workers them and their patients. They use herbs during
were 1042 [9]. In addition to this, the World Health delivery to facilitate dilatation which may lead to
Statistics 2017 showed the maternal mortality ratio infecting the mother and the baby [12–15]. There is
per 10000 live births in 2015 in Uganda was high, a need to understand key factors influencing
343. The proportion of births attended by skilled women’s health and health-seeking behaviour for the
personnel (20052016) was 57%. The under-five future improvement in maternal morbidity and
mortality and neonatal mortality was 54.6 per 1000 mortality. This study addresses these gaps in
births. knowledge and will provide a more comprehensive
The skilled health professional density from 2005- understanding of the factors influencing the health
2015 was less than 14.6 per 10000 people. By 2030, status of women in Uganda and ways to improve
WHO targets to reduce the global maternal ratio to reproductive health.
less than 70 per 100,000 live birth but in 2015
METHODOLOGY
Study design pregnant women and mothers in the Kahoora
The researcher used a cross-sectional survey design division in the Hoima district within the study
because the study intended to pick only some period, who will have consented. These respondents
representative sample elements of the cross-section were selected using random sampling on a first come
of the population. Quantitative and qualitative first serve basis.
approaches were adopted to enhance the Exclusion criteria
understanding of the meaning of numbers giving All traditional birth attendants, pregnant women
precise and testable expression to qualitative ideas. and mothers not willing, too ill, with mental illness
Area of Study were excluded.
The study was conducted in Kahoora in Hoima Sampling procedure
district in western Uganda. A sample refers to the proportion of the population
Study population (Enukoha et al, 2011). The formula (Burton Et al
The target population was traditional birth 1965 sample estimation), S=DN/T was used. S:
attendants, pregnant women and mothers in Sample size, D: Days spent collecting data, N:
Kahoora in Hoima district since the research was Number of people interviewed, T: Time taken
interested in examining the utilization and effect of interviewing a respondent.
Traditional Birth Attendants (TBAs) among Sample size estimation
pregnant women. The study population was The researcher used a sample size of 143
obtained according to selection criteria, that is respondents because it is accessible given the
inclusion and exclusion criteria. resources that are available and the population of
Inclusion criteria Kahoora makes this easy. The researcher selected
Two categories of respondents were included in the the sample using the sample size determination table
study. These were traditional birth attendants, formulated by Krejcie [16]. These were as follows;

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Table 1: Krejcie's table

Data Collection instruments Independent variables

The researcher used interviews and questionnaire These included; social-economic factors, perceived
type of instruments to collect data. accessibility, and perceived quality of care. Such as
Interviews women's status, illness, economic status, education
Interviews were used to collect in-depth information status, Family income, Distance, Transport, Cost,
about the topic follow-up with certain respondents Reputation, satisfaction with outcomes, and
to further investigate their responses and serve the satisfaction with service.
purpose of triangulation (Amin, 2005). Intervening variables
Questionnaires Presence of health facilities, presence of TBAs,
A questionnaire consisting of both closed and open- availability of resources
ended questions was used to collect data. The Data collection management
questionnaire was filled out by traditional birth A questionnaire consisting of both closed and open-
attendants, pregnant women and mothers with the ended questions was used to collect both qualitative
assistance of the researcher in case it is needed. and quantitative data. Qualitative data was collected
Dependent variables about pregnant women's practices, knowledge of
Deciding to seek care, identifying and reaching TBAs and the impact of TBAs. Quantitative data
health facilities, and receiving adequate and was collected about demographic characteristics,
appropriate. individual TBA factors and health-seeking
behaviour.

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Data analysis satisfied these concerns as follows. He first obtained
Statistical Package for SPSS or Excel was used for a letter from Kahoora division in Hoima district
data entry and analysis. Descriptive analysis was interviews before the commencement of the study.
done and presented in terms of mean, and median. The respondents were assured that their names and
The frequency was reported in terms of numbers and other personal information would not be disclosed.
percentages using tables. The respondents were free to withdraw anytime
Quality control during data collection. That is, the researcher
In order to ensure quality control questionnaires ensured as much as possible that participation in the
werepre-tested and adjustments will be made research was voluntary. The collected data was
accordingly. presented as a group instead of individual analysis.
Ethical Considerations The research respected the rights of the Kahoora
Privacy and confidentiality were the major ethical division in the Hoima district by conducting the
considerations in this research study. The research research objectively.

RESULTS
Pregnant Women and Mother Findings on TBAs
Table 2: A table showing mothers' socio-demographic findings
Tribe of mothers
Valid Frequency Per cent
Munyoro 89 89.8
Mukiga 7 8.2
Muganda 2 2.0
Total 98 100.0
Mothers’ age
15-19 6 6.1
20-25 19 20.4
26-29 22 22.4
30-35 37 38.8
36-40 8 8.2
above 40 6 4.1
Total 98 100.0
Level of education
Primary 44 44.9
Secondary 16 16.3
Uneducated 38 38.8
Total 98 100.0
Marital status
Married 41 40.8
Single 18 18.4
Divorced 39 38.8
Total 98 98.0
Missing system 2 2.0
Total 98 100.0

From the table above majority of the respondents Their education level was majorly primary and
were Banyoro accounting for 89.8% of the uneducated level accounting for 44.9% and 38.8%
respondents and the commonest age group was (30- respectively. And the majority were married
35) years accounting for 38.8% of the respondents. accounting for 40.8% of the respondents.

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Table 3: A table showing distances and costs to the health center
Distance from the nearest health center
Frequency Percent
Valid below 5km 8 16.3
5-10 km 23 46.9
11-15 km 12 24.5
above 15 km 6 12.2
Total 49 100.0
Cost to the health center
500-3000 10 20
3001-5000 30 60
5001-10000 5 10
above 10000 4 10
Total 49 100.0

From the table distance to health, centers were shillings accounting for 60% of the respondents that
mainly (5-10) Km accounting for 46.9% and costs participated.
were majorly in the range of (3001-5000) Uganda
Table 4: A table showing mothers' relationship with TBAs Recommending others
Frequency Per cent
Valid Yes 10 10.2
No 83 83.7
Total 93 93.9
Missing System 2 2
Total 98 100.0
Received complications
Valid Yes 32 32.7
No 62 63.3
Total 94 95.9
Missing System 4 4.1
Total 98 100.0
Reason for preferring TBAs
Valid cost-effective 36 36.7
Distance 30 30.6
cultural beliefs 10 10.2
forced by the husband 8 8.2
pressure from relatives 4 4.1
saves time, no need for 2 2.0
admissions
forced by the mother-in-law 2 2.0
Total 92 93.9
Missing System 6 6.1
Total cost-effective 98 100.0
Coming to know TBAs
relatives and friends 52 53.1
Radios 14 14.3
Posters 26 26.5
local leaders 2 2.0
TBAs 2 2.0
Total 96 98.0
Missing System 2 2.0
Total 98 100.0

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According to the table above majority received no majority of the respondents got to know about TBAs
complications accounting for 63.3% of the from relatives and friends accounting for 53.1% of
respondents. The main reasons why they preferred the respondents. Though most of the respondents
TBAs were cost-effectiveness and distance had used TBAs they didn’t recommend others
accounting to 36.7% and 30.6% respectively. The accounting for 83.7% of the respondents.

Table 5: Table showing the number of receiving TBAs services

Number of receiving TBAs Services
Frequency Per cent
Valid Once 20 20.4
Twice 66 67.3
Thrice 4 4.1
more than 3 8 8.2
Total 98 100.0

Figure 1: Pie chart illustrating number of receiving TBAs services

From the pie chart above majority of the respondents had visited the TBAs twice accounting for 67.3% of the
respondents.

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Information from TBAs
Table 6: A table showing information from TBAs
Years of experience
Frequency Per cent
Valid One 2 2.0
Two 4 4.1
Three 14 14.3
more than 3 78 79.6
Total 98 100.0
Way of learning about TBA practices
Valid from other traditional 68 69.4
attendants
from medical professional 30 30.6
Total 98 100.0
Services Offered
Valid ANC 12 12.2
Helping in giving birth 70 71.4
supportive health 8 8.2
helping complications 2 2.0
monitoring mother 4 4.1
Total 96 98.0
Missing System 2 2.0
Total 98 100.0
Number of women per month
Valid less than five 64 65.3
5-10 28 28.6
11-15 4 4.1
Total 96 98.0
Missing System 2 2.0
Total 98 100.0
Point of pregnant women starting coming to TBA
less than 3 months 6 6.1
3-9 month 56 57.1
After giving birth 32 32.7
Total 94 95.9
Missing System 4 4.1
Total 98 100.0
Place of delivering
delivery rooms 52 53.1
their homes 38 38.8
TBAs home 2 2.0
special rooms 2 2.0
Total 94 95.9
Missing System 4 4.1
Total 98 100.0

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From the table above most of the TBAs had the respondents. The majority of them started
experience above 3 years accounting for 79.6% of the visiting TBAs within a period of (3-9) months
respondents. The TBAs were mainly helpful in accounting for 57.1%. Most of the TBAs had
assisting mothers to deliver accounting for 71.4% of delivery rooms accounting for 53.1% of the
the respondents. They had mainly assisted less than respondents.
5 mothers in giving birth accounting for 65.3% of

Table 7: Table showing the period of learning about TBA Period of learning about TBA
Frequency Per cent
Valid 1990-1999 44 44.9
2000-2009 36 36.7
2010-2017 16 16.3
Total 96 98.0
Missing System 2 2.0
Total 98 100.0

Figure 2: A graph illustrating years TBAs started learning about TBAs

From the graph above TBAs got to learn about 69.4% and had started their practices from year
TBAs practices from other TBAs accounting for 1990-1999 accounting for 44.9% of the respondents.

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Table 8: A table showing TBA health conditions

Typical complications seen by TBAs
Frequency Percent
Valid bleeding before birth 2 2.0
bleeding after birth 26 26.5
Stillbirth 14 14.3
retained placenta 6 6.1
death of the mothers 2 2.0
neonatal infections developed at birth 2 2.0

Fetal distress 2 2.0

aneamic mothers 2 2.0
maternal death 6 6.1
poor transport means 6 6.1
prolonged labour 2 2.0
death of the mother 2 2.0
Total 72 73.5
Missing System 26 26.5
Total 98 100.0
Child transmission of HIV prevention by TBAs
Valid Yes 34 34.7
No 56 57.1
Total 90 91.8
Missing System 8 8.2
Total 98 100.0
Government knowledge of TBAs
Valid Yes 98 100.0
Challenges faced in helping a woman deliver
over bleeding 48 49.0
Death 16 16.3
interference by the local leaders to pay taxes 2 2.0
maternal stress 6 6.1
prolonged labour 4 4.1
Poor means of transport 8 8.2
Eclampsia 4 4.1
government intervention and receiving little or 2 2.0
no salary
Shortage of materials to use 4 4.1
Tears 2 2.0
Total 96 98.0
Missing System 2 2.0
Total 98 100.0
Traditional birthing services Vs midwives or doctors' services
Valid same 18 18.4
better 26 26.5
worse 52 53.1
Total 96 98.0
Missing System 2 2.0
Total 98 100.0

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From the table above the typical complication seen the respondents. 100% of TBAs said that the
by TBAs was bleeding after birth accounting for government knew about their services and the
26.5% and stillbirths making up 14.3% of the commonest challenge was bleeding with 49.0%.
respondents. Most didn’t know the prevention of 53.1% of TBAs said their services are worse
child transmission of HIV accounting for 57.1% of compared to midwives' and doctors' services.

Figure 3: Pie chart illustrating challenges faced by TBAs

According to the pie chart above the major challenge faced by TBAs was over-bleeding followed by death.
DISCUSSION
Pregnant women and mother findings on TBAs pregnant women and mothers in the study area. The
In this study, the majority of the mothers were research revealed that TBAs were appreciated in the
Banyoro, accounting for 89.8% of the respondents. It community for adhering to delivery norms and
was revealed that the most common age group always being available in emergencies. This aligns
utilizing Traditional Birth Attendants (TBAs) was with our study, which found that the majority of
(30-35) years, representing 38.8% of the mothers visited TBAs twice, representing 67.3% of
respondents. Their education levels were the respondents. Additionally, a significant number
predominantly primary and uneducated, accounting of mothers began visiting TBAs within a period of
for 44.9% and 38.8%, respectively. This indicates (3-9) months, accounting for 57.1%, indicating the
that education was influenced by TBAs, as mothers continued utilization of TBAs in the Kahoora
with higher education were less likely to use TBAs. division.
The majority of the mothers were married, According to Centenary Ebuehi's study, respondents
comprising 40.8% of the respondents. mentioned visiting TBAs because they were closer
In a study on factors influencing the utilization of to the mothers than Antenatal Care (ANC)
late antenatal care services in rural areas, specifically facilities[17]. The commonly cited reason for TBA
in Kisoro district by Centenary Gloria in 2010, it use was the difficulty in transportation, leaving
was established that TBAs were widely used by mothers with no alternative but to choose

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TBAs[18–20]. This aligns with our study, where Attendants for Pastoralist Communities of Afar,
the main reasons for preferring TBAs were cost- Ethiopia? Most TBAs said that if the lie is
effectiveness (36.7%) and proximity (30.6%). transverse or the hand comes first, they consider it
Centenary Gloria further revealed that respondents high risk. If the hand comes first they try to push up
considered TBAs more accessible and flexible for and if failed, they refer. In the case of transverse lies,
home deliveries compared to health units. However, they refer. The other dangerous signs during labour
some respondents expressed concerns that TBAs they mentioned were that if the labour is prolonged
were incompetent and not well-trained. In our study, for more than 2 days and the mother is too weak to
although most respondents had used TBAs, they did push [21, 22]. In addition to that, all said that the
not recommend them to others, accounting for major causes of maternal mortality are obstructed
83.7% of the respondents. labour because of mal-presentation and narrowing of
Information on TBAs the vagina because of circumcision, and postpartum
According to this study, most of the TBAs had haemorrhage [23]. They said that every woman of
experience above 3 years accounting for 79.6% of the childbearing age is circumcised and makes a vertical
respondents. This shows that there is a possibility of incision during labour. For post-partum
them knowing clearly what they are doing. They got haemorrhage in some areas they give some herb to
to learn about TBA practices from other TBAs stop and if not they refer the mother to health
accounting for 69.4% and had started their practices facilities. This study further revealed that the typical
from year 1990-1999 accounting for 44.9% of the complication seen by TBAs was bleeding after birth
respondents. The TBAs were mainly helpful in accounting for 26.5% and still making up 14.3% of
assisting mothers to deliver accounting for 71.4% of the respondents. Most TBAs didn’t know the
the respondents. They had mainly assisted less than prevention of child transmission of HIV accounting
5 mothers in giving birth accounting for 65.3% of for 57.1% of the respondents[24–26]. This creates a
the respondents. The majority of them started high chance of a child getting HIV. Despite all this
visiting TBAs within a period of (3-9) months 100% of TBAs said that the government knew about
accounting for 57.1%. Most of the TBAs had their services and the commonest challenge was
delivery rooms accounting for 53.1% of the bleeding with 49.0%. 53.1% of TBAs said their
respondents. In another study on why Traditional services are worse compared to midwives' and
Birth Attendants are Still First Choices of Delivery doctors' services.
CONCLUSION
The research reveals the importance of TBAs in building health programs and nurses' capacity, and
communities, particularly in the Kahoora division of creating community confidence. A village-to-health
Hoima Uganda. Although few mothers recommend facility-level transport system or camel camel-pulled
their use, the study highlights their significance to cart system could be designed for mothers referred
mothers. It recommends improving services offered to health centers or hospitals. A stand-by ambulance
by TBAs, especially in teaching them about child should be available in all health centers for transport
transmission of HIV at birth. The study also to hospitals. In the long run, emergency surgeons
highlights the issue of mothers being far from health should be assigned to major health centers to avoid
facilities, as delivery is an emergency. To address referrals to distant hospitals.
this, the study recommends expanding health posts,
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Pregnant Women in Kahoora Division Hoima District. IAA Journal of Scientific Research 11(1):16-28.
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