title: Audit of Childbirth Emergency Referrals by Trained Traditional Birth Attendants in Enugu, Southeast, Nigeria.
abstract: BACKGROUND
  The essence of training traditional birth attendants (TBAs) is to attend to women in uncomplicated labor and to refer them immediately to hospitals when complications develop.
  
  
  OBJECTIVE
  The aim was to audit childbirth emergency referrals by trained TBAs to a specialist hospital in Enugu, Nigeria.
  
  
  METHODS
  A retrospective study of 205 childbirth emergencies referred to Semino Hospital and Maternity (SHM), Enugu by trained TBAs from August 1, 2011 to January 31, 2014. Data analysis was descriptive and inferential at 95% confidence level.
  
  
  RESULTS
  Most of the patients (185/205, 90.2%) were married and (100/205, 48.8%) had earlier booked for antenatal care in formal health facilities. There were obstetric danger signs or previous bad obstetric histories (pregnancies with unfavorable outcome) in 110 (110/205, 53.7%) women on admission at SHM. One hundred and fifteen (115/205, 56.1%) women walked into the hospital by themselves while 50 (50/205, 24.39%) could not walk. The fetal heart sounds were normal in 94 (94/205, 45.6%), abnormal in 65 (65/205, 31.8%) and absent in 42 (42/205, 20.4%) of the women on admission. Five healthy babies were delivered by the TBAs before referring their mothers. Delays of more than 12 h had occurred in 155 (155/205, 76.6%) of the women before referrals. Prolonged labor (100/205, 48.8%), obstructed labor (40/205, 19.5%), attempted vaginal birth after previous cesarean delivery (40/205, 19.5%) and malpresentation (30/205, 14.6%) were the common indications for referrals. The maternal mortality and perinatal mortality ratios were 610/100,000 live births and 228/1000 total births respectively.
  
  
  CONCLUSIONS
  Delays at TBA centers are common before referral and most patients are referred in poor clinical state. Further training and re-training of the TBAs with more emphasis on recognition of obstetric danger signs and bad obstetric histories may help in screening high-risk patients for prompt referral to hospitals before complications develop.
authors.affiliation: Department of Obstetrics and Gynecology, College of Medicine, Enugu State University of Science and Technology, Abakpa Nike, Enugu, Nigeria ; Semino Hospital and Maternity, Abakpa Nike, Nigeria.
authors.forename: I I
authors.initials: II
authors.lastname: Okafor
authors.affiliation: Department of Community Medicine, College of Medicine, Enugu State University of Science and Technology, Enugu, Nigeria.
authors.forename: S U
authors.initials: SU
authors.lastname: Arinze-Onyia
authors.affiliation: Department of Histopathology, College of Medicine, Enugu State University of Science and Technology, Enugu, Nigeria.
authors.forename: Sar
authors.initials: S
authors.lastname: Ohayi
authors.affiliation: Semino Hospital and Maternity, Abakpa Nike, Nigeria.
authors.forename: J I
authors.initials: JI
authors.lastname: Onyekpa
authors.affiliation: Department of Obstetrics and Gynecology, College of Medicine, University of Nigeria Enugu Campus/University of Nigeria Teaching Hospital Ituku/Ozalla, Enugu, Nigeria.
authors.forename: E O
authors.initials: EO
authors.lastname: Ugwu
keywords: Childbirth emergencies; Delay; Outcomes; Referrals; Trained traditional birth attendants