Safe Mothers in Low-income Emergency Settings (SMiLES)

Using “Lay Epidemiology” to evaluate the scope of training traditional birth attendants: Local Community Research Findings

5 October 2023

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The data indicate that the region’s high rate of complications and maternal mortality may be attributed to the added stress and trauma caused by displacement and conflict. 29 (83%) of the 35 respondents knew someone who had experienced complications associated with pregnancy, and the testimonials received reflect the impact of displacement, conflict, and loss on maternal health.

Why South West Cameroon and Maternal Health?

The SMiLES project comprises a partnership between the Welisane Foundation (a Cameroon-based NGO) and Public Health Pathways (a UK-based NGO). SMiLES brings together local and global knowledge. We harnessed the insights of TBAs, community members, and local academics.

We focused on Meanja, Muyaka, and Ekona (MME) in South West Cameroon, where the ongoing Anglophone Crisis impacted maternal health services. In recent years, 9 out of 10 health facilities in MME resulted in limited access to health services, raising the urgency for this project. This impact has deepened financial constraints, which are the primary reason for delays in decision-making in medical care.

When asked about who women consult for maternal health advice, 24 (66%) of 36 respondents cited health professionals, 9 (25%) local women with lived experience, and 3 (9%) family members. The unprocessed data provided contextual understanding of why women seek different services. For example, “Most women I know go to the hospital whereas, some few who cannot afford or are forced into the interior to consult local and experienced birth attendants.” and, “They go to the hospital. But because of the crisis and the fact that most of the women gave birth in the bushes, they were attended to by women in the community.”

Using “lay epidemiology” to define community needs

Local community members, humanitarian practitioners, and health leaders advised us of local priorities to enable us to co-develop a survey designed to allow the community to define their needs. 

“Lay epidemiology” is a term used to describe the use of community-based knowledge and experiences in the field of public health. We used this approach to ensure the following: 

  • active participation of communities in collecting, analysing, and using data related to health and illness. 
  • genuinely involve communities and give them a voice in shaping their own health and wellbeing.
  • recognise that communities often have unique perspectives and insights into the health challenges they face 

To our knowledge, this is the first survey conducted in South West Cameroon using a “Lay epidemiology” approach. 

The community was asked about their views on TBAs and whether they thought they would benefit from training with professional medical practitioners. 31 (89%) of the 35 respondents agreed, with one respondent stating, “Yes, they could because in the absence of professional medical practitioners, most women turn to TBAs,” and another respondent stating, “Very well because they already have the zeal and gift, with the education they will do it marvellously.”

Funded to bridge local and global expertise

The Public Health Pathways (“PHP”) involved joined from Singapore, Peru, Nigeria, Bermuda, Uganda, and the United Kingdom to support our colleagues in Cameroon. The team trained at The London School of Hygiene and Tropical Medicine, Kings College London, Birkbeck College, University College London, and Imperial College London.

In 2021, The Ashworth Charitable Trust provided a grant for the research phase of the SMiLES project. This funding enabled us to explore the hypothesis that Traditional Birth Attendants (“TBAs”) have the support of their community to receive training working alongside professional medical practitioners to build on existing local capacity, knowledge systems, connections, and trust within the community.

The community was asked about their views on TBAs and whether they thought they would benefit from training with professional medical practitioners. 31 (89%) of the 35 respondents agreed, with one respondent stating, “Yes, they could because in the absence of professional medical practitioners, most women turn to TBAs,” and another respondent stating, “Very well because they already have the zeal and gift, with the education they will do it marvellously.”

Not just a project. A pathway to sustainable change.

The survey shows that the community prefers hospitals over Traditional Birth Attendants (“TBAs”) and supports training for TBAs. It is understood that training TBAs does not overcome the need for improved access to quality maternal health facilities. However, the conflict is ongoing and between periods of escalated violence and de-escalated violence. Further, it is difficult to extrapolate from such a small sample.

Nonetheless, until there is stability, the key recommendation is that training TBAs in midwifery is beneficial to increase the capacity of the community to support pregnant women and births, improve links with healthcare facilities, and increase trust through greater integration into the healthcare system.

This research will be used to plan an intervention that addresses the challenges faced by communities in accessing maternal healthcare services in South West Cameroon through training Traditional Birth Attendants (“TBAs”) in midwifery.

By identifying the key factors affecting access to healthcare, the study provides valuable insights into how to improve the delivery of healthcare services in the region and reduce maternal mortality.

The results of this study can inform the development of targeted interventions that address the medical, social, and structural challenges faced by communities in the region and provide a roadmap for improving access to quality maternal healthcare services.

Recommendations from the team

Iman Hameed, Singapore

TBA

Boris Mbia, Cameroon

TBA

TBA

TBA

Jade Robinson, Bermuda

TBA

Final thoughts

“TBA”

Theo Richardson-GoolCEO of Public Health Pathways

“TBA”

Mokwe Welisane NkengFounder and President of the Welisane Foundation

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