title: "We have been working overnight without sleeping": traditional birth attendants' practices and perceptions of post-partum care services in rural Tanzania.
abstract: BACKGROUND
  In many low-income countries, formal post-partum care utilization is much lower than that of skilled delivery and antenatal care. While Traditional Birth Attendants (TBAs) might play a role in post-partum care, research exploring their attitudes and practices during this period is scarce. Therefore, the aim of this study was to explore TBAs' practices and perceptions in post-partum care in rural Tanzania.
  
  
  METHODS
  Qualitative in-depth interview data were collected from eight untrained and three trained TBAs. Additionally, five multiparous women who were clients of untrained TBAs were also interviewed. Interviews were conducted in February 2013. Data were digitally recorded and transcribed verbatim. Qualitative content analysis was used to analyze data.
  
  
  RESULTS
  Our study found that TBAs take care of women during post-partum with rituals appreciated by women. They report lacking formal post-partum care training, which makes them ill-equipped to detect and handle post-partum complications. Despite their lack of preparation, they try to provide care for some post-partum complications which could put the health of the woman at risk. TBAs perceive that utilization of hospital-based post-partum services among women was only important for the baby and for managing complications which they cannot handle. They are poorly linked with the health system.
  
  
  CONCLUSIONS
  This study found that the TBAs conducted close follow-ups and some of their practices were appreciated by women. However, the fact that they were trying to manage certain post-partum complications can put women at risk. These findings point out the need to enhance the communication between TBAs and the formal health system and to increase the quality of the TBA services, especially in terms of prompt referral, through provision of training, mentoring, monitoring and supervision of the TBA services.
authors: School of Public Health and Social Sciences, Department of Development Studies, Muhimbili University of Health and Allied Sciences, P.O. Box 65454, Dar es Salaam, Tanzania. gmahiti2011@gmail.com.
authors: Gladys R
authors: GR
authors: Mahiti
authors: School of Public Health and Social Sciences, Department of Development Studies, Muhimbili University of Health and Allied Sciences, P.O. Box 65454, Dar es Salaam, Tanzania. angwarakiwara@yahoo.com.
authors: Angwara D
authors: AD
authors: Kiwara
authors: School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. kcolumba@yahoo.com.
authors: Columba K
authors: CK
authors: Mbekenga
authors: Division of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, Sweden. anna-karin.hurtig@epiph.umu.se.
authors: Anna-Karin
authors: AK
authors: Hurtig
authors: Division of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, Sweden. isabel.goicolea@epiph.umu.se.
authors: Isabel
authors: I
authors: Goicolea
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003142:Communication; D005260:Female; D006801:Humans; D008427:Maternal Health Services; D008875:Middle Aged; D008880:Midwifery / Q000193:education / Q000379:methods* / Q000592:standards; D011181:Postnatal Care / Q000379:methods* / Q000592:standards; D011247:Pregnancy; D011644:Puerperal Disorders / Q000175:diagnosis / Q000628:therapy*; D036301:Qualitative Research; D012017:Referral and Consultation; D019035:Rural Health Services; D012424:Rural Population; D013636:Tanzania
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