The training of traditional birth attendants in Ghana: experience of the Danfa Rural Health Project.

Three quarters of deliveries in Ghana are still attended by untrained personnel, including traditional birth attendants (TBA's), and maternal mortality remains high. The Ministry of Health is exploring ways of improving this situation. Recently, training traditional birth attendants to improve maternal and child health practices and promote family planning has been considered. Most TBA's in rural Ghana are elderly illiterate farmers. The Danfa Project has identified and trained 57 of these TBA's with the objective of developing a programme that might be replicated elsewhere in the country. This paper describes the design of the programme and problems encountered and makes recommendations to others who may be considering similar programmes in other countries.

PIP: 57 traditional birth attendants were identified and trained by the Danfa Project in rural Ghana in an effort to improve maternal and child health practices and promote family planning. A plan was also developed for follow-up and continuing education of these traditional birth attendants (TBAs). The Danfa Comprehensive Rural Health and Family Planning Project is a 9-year research, service, and teaching project undertaken jointly by the University of Ghana Medical School and the University of California at Los Angeles. The following objectives of the TBA training program were defined: 1) to motivate and train the TBAs to monitor women during the antepartum period and to recognize and refer high risk woman or those with serious complications of pregnancy or delivery; 2) to train the TBAs to perform safer deliveries; 3) to train the TBAs in the proper care of the cord; and 4) to enlist the aid of the TBA in the promotion of improved maternal and child health practices and family planning in their villages. The syllabus - outlined here - emphasizes the teaching skills which are needed to meet the stated objectives. The most important aspect of the training program is the continuing support and supervision of the trained TBAs. Problem areas of the program are related to supervision, transportation, non-participation, age of the TBAs, and remuneration. The following were included among the recommendations to those contemplating the training of TBAs in Africa: 1) training should be continuous; 2) emphasis should be on motivating the younger TBAs and those who perform the greatest number of deliveries; and 3) the training program should be simple and emphasize only those basic scientific midwifery skills which would help the TBAs gain self-confidence and make deliveries safer.

The Danfa family planning program in rural Ghana.

PIP: The objectives of the Danfa Family Planning Program in rural Ghana are to provide family planning services to the people in the region and to conduct research into ways of making these services as effective and accessible as possible within given resource limitations. The effort is made to describe the planning and operating experience of the program during its 1st 2 1/2 years. In order to test the hypotheses and satisfy service, research, and teaching objectives, the region in which the project operates was divided into 4 areas with each area receiving different service inputs. This division was related to the following arguments with the 4th area used as a control area to learn how much family planning occurs in the absence of special health, education, and family planning programs: 1) couples will want to limit the number of their children only if they perceive that they need no longer fear that several of them will die before reaching adulthood; 2) the most cost-effective approach is to provide family planning services in conjunction with an intensive educational program promoting good health practices and family planning but without comprehensive health services; and 3) by amking family planning services available without concern for comprehensive health services or a special education program, adequate acceptance of family planning and a favorable fertility change at minimum cost will be achieved. The 4 research areas covering about 200 square miles are located in a rural region 8-50 miles north of Accra, the capital of Ghana, and have a population of 60,000. It was learned that it is easier to operate a family planning program in this region of rural Ghana than had originally been anticipated and that education about the benefits of family planning and the methods available along with accessibility to services are 2 elements that are crucial to the success of a family planning program in this setting.^ieng

Attitudes and practices of traditional birth attendents in rural Ghana: implications for training in Africa.

PIP: In the Danfa Project area of rural Ghana a survey of the characteristics, attitudes, and practices of traditional birth attendants was conducted. In 1973, 6 months following the start of the family planning program, a questionnaire was administered to a sample of the traditional birth attendants registered. Interviews were carried out in the local language by public health nurses familiar with the area. 82 interviews were completed. Differences in interview responses between areas were negligible and combined results are reported for the 3 areas surveyed. There were 2 types of traditional birth attendants -- herbalists who engaged in midwifery as only part of their medical practice and those who limited their practice to midwifery. The traditional birth attendants usually gave correct or neutral advice and most recognized the benefits of rapid referral to hospitals for seious problems. They were supportive of family planning and very interested in improving their skills. However, a number of factors must be considered in organizing training programs. Special adult educational methods must be used. In order to achieve adequate coverage 1 must train large numbers of traditional birth attendants who perform an average on only 7 deliveries per year and who are widely scattered in remote rural villages. This creates extensive problems, particularly in transportation and follow-up supervision. Combining training of traditional birth attendants with other village health programs or community development projects could be the answer.^ieng

Clinical measurement of trend in fertility of women attending family planning clinics in Ghana.

1. The need for a simple method of measuring trend in fertility in family planning programme has been stated. 2. The theory of the numerator analysis of age and parity or age and number of living children and its variants the "three area" and the "four quadrant methods" have also been stated. 3. The data from the Korle Bu Teaching Hospital have been analysed. 4. The finding was that the proportion of women of the high fertility group is reducing while that of women in lower fertility is increasing with time. 5. The relevance of this type of analysis to national family planning programme has been emphasised.

Stillbirth and its prevention in Ghana.

141 cases of still birth have been studied including 114 post mortem examination. Various aspects of stillbirth (foetal death) of international significance have been discussed and suggestions have been made to help to reduce the stillbirth rate in Ghana.

The acute abdomen during pregnancy: report of three unusual cases

The details of three cases are presented in which surgical emergencies arose during the course of pregnancy. These consisted of torsion of the spleen, traumatic rupture of the spleen and a volvulus with internal hernia involving large and small bowel. Details of management are discussed as well as the implications of such conditions during pregnancy. (AU)