Traditional Birth Attendants in the Sengerema District Northwest of Tanzania: Whom they Serve and why their Delivery Practices Matter

Research Article

Austin J Public HealthEpidemiol. 2016; 3(4): 1045.

Traditional Birth Attendants in the Sengerema District Northwest of Tanzania: Whom they Serve and why their Delivery Practices Matter

Konje ET1,2*, Magayane A¹, Matovelo D³ and Dewey D2,4

¹Department of Biostatistics & Epidemiology, Catholic University of Health and Allied Sciences, Tanzania

²Department of Community Health Sciences, University of Calgary, Canada

³Department of Obstetrics and Gynecology, Catholic University of Health and Allied Science, Tanzania

4Behavioral Research Unit, Department of Paediatrics and Owerko Centre, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada

*Corresponding author: Behavioral Research Unit, Department of Paediatrics and Owerko Centre, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Canada

Received: April 29, 2016; Accepted: July 14, 2016; Published: July 18, 2016


Introduction: Reduction of maternal deaths due to preventable and manageable causes remains a public health challenge in Sub-Saharan Africa. In Northwest Tanzania, the emergency obstetric care services that are available are relatively poor and home delivery is commonly practiced. The aim of this study was to investigate the characteristics of women who delivered at home and delivery practices of Traditional Birth Attendants (TBAs) in the Sengerema District Northwest of Tanzania.

Methods: This descriptive cross sectional study recruited postpartum women who delivered at home, and TBAs from Sengerema District. Fifty TBAs identified by the community health workers and 160 postpartum women participated in face-to-face interviews in their homes.

Results: The majority of participants delivered their first born at home and displayed limited knowledge on pregnancy danger signs. Home delivery was considered feasible and acceptable by participants due to the accessibility, affordability and availability of TBAs services in their communities. None of the TBAs had formal midwifery training and their use of protective gear was low (32%) with majority of TBAs assisting delivery with bare hands. The use of herbal medicines and massaging were frequently reported by the TBAs to manage severe bleeding, prolonged or obstructed labour, and retained placenta.

Conclusion: Poor knowledge of the danger signs that are indicative of potential birth complications among women and accessibility to and affordability of health care services could be associated with home delivery practice. TBAs had no formal training in midwifery and their practices could place women and their infants at risk for complications during and following delivery.

Keywords: Maternal health; Pregnancy complications; Practices; Traditional birth attendants


ANC: Antenatal Care; BEmONC: Basic Emergency Obstetric and Newborn Care; DMO: District Medical Office; IQR: Inter Quartile Range; TBAs: Traditional Birth Assistants


In 2013, approximately 286,000 women died during childbirth worldwide; 62% of these deaths were women from Sub-Saharan Africa [1]. Tanzania, a country in Sub-Saharan Africa, is making slow progress in reducing of maternal mortality [1,2]. Currently, the maternal mortality rate is 410 per 100,000 live births [2]. Most maternal deaths occur during delivery or within a few hours after delivery. They are frequently due to preventable or manageable causes such as hemorrhage (27%), hypertensive disorder (14%), sepsis (11%), unsafe abortion (8%) and other complications (10%) [3,4].

Accessibility to and availability of quality obstetric services remain a public health challenge in many areas of Tanzania but particularly in rural settings where most of health facilities are dispensaries [5-7]. Many dispensaries are difficult for women to access for delivery because of the poor roads in rural areas and the lack of affordable and reliable local transport. Further, dispensaries typically employ a limited number of health professionals (trained staff) and frequently experience shortages in basic supplies, essential drugs, and equipments [5,7,8]. As a result, many dispensaries may not be able to offer even Basic Emergency Obstetric and Newborn Care (BEmONC).

Provision of free reproductive and child health care services remains a key strategy for improving maternal and child health in Tanzania [9]. In poor rural communities, few women attend the four recommended prenatal visits. As a result, the majority of these women are not provided with potentially lifesaving services such as health education, immunization, prenatal supplements and treatments for infections [2,10].

In Tanzania, more than half of pregnant women deliver at home with the assistance of Traditional Birth Attendants (TBAs) [2]. Research studies have reported limited knowledge of obstetric danger signs among TBAs [11,12]. Due to the number of women who deliver with the assistance of a TBA, the unpredictability of labor and delivery complications, and poor existing referral systems, TBAs’ practices are of public health interest. Therefore, the aims of this study were twofold. Firstly, to determine the characteristics of postpartum women who delivered at home. Secondly, to investigate TBAs’ birth practices related to obstetric complications. This study will provide detailed information on the present conditions of home delivery in Tanzania and could suggest opportunities for improving maternal and child health at the community level.


Study settings

Sengerema district is one of seven districts in Mwanza region. It is composed of 35 wards, 15 of which were purposively selected for inclusion in this study because of their accessibility (that is, the research team was able to access these wards via local roads). The main ethnic groups that inhabited Sengerema district are the Sukuma and Zinza. In the district, there is one hospital, nine health centers, 62 dispensaries, and one maternity waiting home. Based on expected deliveries, the Sengerema hospital records indicated that 36.6% of pregnant women delivered at health facilities with the assistance of skilled personnel in 2014. The current maternal mortality rate in Sengerema is 282 per 100,000 live births [13]. According to the TBA district coordinator, 135 TBAs are officially registered at the district medical office.

Study design & population

A descriptive cross sectional study was conducted that included TBAs and women who gave birth under their care within 6 months prior to data collection in August, 2014.

Sample size and sampling procedure

It was very difficult to trace all of the TBAs from the TBAs’ registry; therefore, all identified and accessible TBAs in Sengerema District between August, 2014 and October, 2014 were invited to participate. A total of 53 TBAs were approached and 50 (~94%) agreed to participate in the study (no sampling procedure was implemented after identifying these TBAs). Thus, approximately 37% of the registered TBAs in Sengerema District consented to participate in this study.

With the assistance of these TBAs and community health workers, postpartum mothers with infants less than 6 months of age who delivered at home were identified. A total of 164 mothers who resided in Sengerema district at the time of data collection were traced and 160 (~98%) of them consented to participate.

Prior to the interviews, informed consent was obtained from the TBAs and the postpartum women. This study received approval from the Catholic University of Health and Allied Sciences, BUGANDO Mwanza. Permission to do the study was also sought and granted by the District Medical Officer - Sengerema District, the TBA coordinator, and local leaders in Sengerema District with support from Pathfinder International.

Data collection procedures

Face-to-face interviews were conducted with the TBAs and the women who gave birth under their care using a pre-tested structured questionnaire. Postpartum women were asked questions regarding pregnancy danger signs, antenatal care services, facility delivery, and their reasons for home delivery. The TBAs were asked about management of common labor and birth-related complications, including severe bleeding, prolonged or obstructed labour, and retained placenta. World Health Organisation provides definitions for these complications but adjustments that took into account the local context was considered. For example, postpartum hemorrhage is considered when a woman loses more than 500ml of blood in the first 24 hours after delivery [14]. As it is not practical for TBAs to determine that a woman has lost more than 500 ml of blood, postpartum hemorrhage was, described as a woman wetting several pieces of clothing “locally referred as Kanga” after delivering, which is viewed as abnormal by TBA [15]. A delay in placental delivery of more than 30 minutes was used to as the definition for retained placenta [16]. Prolonged and obstructed labor was identified as labor that does not proceed to stage II (Fully cervix dilation that ends with baby delivery) after more than 18 hours.

Data analysis

All questionnaires were checked for completeness in the field. Open ended questions were manually coded before data entry and were entered into a computer using EPI data version 3.1. Data cleaning was done prior to data analysis. The cleaned data set was exported to STATA version 11 for data analysis. Simple statistics were computed including means, standard deviations, and percentages. These data provided information on the general characteristics of the TBAs and postpartum women, and maternal health during pregnancy. Due to small sample sizes in some of the cells, simple associations between the socio-demographic characteristics of TBAs and management of individual complications were examined using Fisher’s exact test at 0.05 level of significant.


General characteristics for postpartum women who delivered at home

The mean age of the women who participated in this study was 26 years (SD = 4.98 years). Of 160 women who participated, 93.13% were between 18 years and 34 years of age, and the majority were currently married (88.75%). The majority (82.50%) of these women had attained a primary education level and reported being small scale farmers (81.25%). While eleven percent of postpartum women reported that they were traditional healers (Table 1a). More than a half of participants reported that their first birth was a home delivery (55%). Almost all of the women (98%) attended an antenatal care clinic at least once. The median parity was 4 (IQR=3), with majority of women having 4 to 6 children.