title: The effectiveness of the TBA programme in reducing maternal mortality and morbidity in Malawi.
abstract: OBJECTIVE
  The main objective of this study was to assess the role of TBAs and the quality of their services in contributing to the reduction of maternal deaths in Malawi.
  
  
  METHODS
  This study used a qualitative research methodology involving key informant and in-depth interviews, observation and focus group interviews.
  
  
  RESULTS
  The study found that most of the people rely on traditional birth attendants although the quality of their services is poor due to illiteracy, their ailing age, lack of supplies and equipment and general absence of supervision. The study fiuther observed that although the hospital sees many pregnant women during antenatal care, very few women actually come back to the hospital for delivery. The study also found that there was high awareness among TBAs about what they were supposed to do but that their actual practices did not reflect compliance with their roles as assigned by the formal health system.
  
  
  CONCLUSIONS
  The study concludes that TBAs are an important source of maternal care especially in rural areas and that they need to be empowered to comply with the requirement of ensuring infection free deliveries. This entails adequate supervision and provision of supplies. The study further observed that the utilization levels of TBAs is far much greater that presently acknowledged suggesting severe inadequacies within the formal health system.
authors.affiliation: chool of Health Systems and Public Health University of Pretoria, South Africa. tbisika@yahoo.com
authors.forename: Thomas
authors.initials: T
authors.lastname: Bisika
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008295:Malawi; D008427:Maternal Health Services / Q000706:statistics & numerical data; D008428:Maternal Mortality / Q000639:trends*; D008875:Middle Aged; D008880:Midwifery / Q000193:education / Q000706:statistics & numerical data*; D011247:Pregnancy; D016730:Program Development; D015397:Program Evaluation; D036301:Qualitative Research; D018570:Risk Assessment; D014944:World Health Organization; D055815:Young Adult