title: Handling postpartum haemorrhage- obstetrics between tradition and modernity in post-war Sierra Leone.
abstract: OBJECTIVE
  How traditional birth attendants (TBAs) in post-war Sierra Leone explain, handle and prevent postpartum haemorrhage (PPH) and their potential role in a better management of PPH to reduce maternal mortality in this low resource setting.
  
  
  METHODS
  Semi-quantitative interviews about knowledge and measures in PPH and participant observation with 140 Sierra Leonean birth attendants, divided in three groups: (A) TBAs who never attended any official training course (n = 82); (B) TBAs who attended at least one official training course (n = 48); and (C) officially trained birth attendants (n = 10).
  
  
  RESULTS
  There are several observable gaps in the knowledge of TBAs about PPH compared to modern obstetrics, however similar procedures exist. Herbal medicine is applied; metaphysical convictions about PPH remain present. Training courses show an impact. Officially trained birth attendants demonstrate knowledge deficiencies and lack resources and infrastructure to manage PPH adequately.
  
  
  CONCLUSIONS
  Morbidity and mortality of PPH in Sierra Leone is related to several factors and not solely to the ignorance of TBAs. TBAs still play an important role for many women there. Hence improvement of the formal health sector should be combined with life-saving programmes integrating TBAs in the care for the pregnant, delivering and breastfeeding mothers.
authors.affiliation: Department for Obstetrics and Gynecology, Gemeinschaftskrankenhaus Herdecke, Germany miriam.d.braeuer@gmail.com.
authors.forename: Miriam Dorothea
authors.initials: MD
authors.lastname: Bräuer
authors.affiliation: Emergency Surgical Centre, Freetown, Goderich, Sierra Leone.
authors.forename: Jorge
authors.initials: J
authors.lastname: Antón
authors.affiliation: Surgical Department, Government Hospital Bo, Sierra Leone.
authors.forename: Peter Matthew
authors.initials: PM
authors.lastname: George
authors.affiliation: Medical anthropologist and retired physiotherapist, Honorary member of AGEM, the German Society for Medical Anthropology.
authors.forename: Liselotte
authors.initials: L
authors.lastname: Kuntner
authors.affiliation: Department of Obstetrics and Gynecology, Fürst-Stirum-Klinik Bruchsal, Teaching Hospital of the University of Heidelberg, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Wacker
mesh_terms: D000328:Adult; D002983:Clinical Competence; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D029001:Herbal Medicine / Q000379:methods; D006801:Humans; D008428:Maternal Mortality; D008880:Midwifery / Q000193:education / Q000592:standards*; D009774:Obstetrics / Q000379:methods*; D006473:Postpartum Hemorrhage / Q000517:prevention & control / Q000628:therapy*; D011247:Pregnancy; D012807:Sierra Leone; D014857:Warfare
keywords: Postpartum haemorrhage; Sierra Leone; low resource setting; maternal mortality; traditional birth attendants