title: From home deliveries to health care facilities: establishing a traditional birth attendant referral program in Kenya.
abstract: OBJECTIVE
  To assess the effectiveness of a traditional birth attendant (TBA) referral program on increasing the number of deliveries overseen by skilled birth attendants (SBA) in rural Kenyan health facilities before and after the implementation of a free maternity care policy.
  
  
  METHODS
  In a rural region of Kenya, TBAs were recruited to educate pregnant women about the importance of delivering in healthcare facilities and were offered a stipend for every pregnant woman whom they brought to the healthcare facility. We evaluated the percentage of prenatal care (PNC) patients who delivered at the intervention site compared with the percentage of PNC patients who delivered at rural control facilities, before and after the referral program was implemented, and before and after the Kenya government implemented a policy of free maternity care. The window period of the study was from July of 2011 through September 2013, with a TBA referral intervention conducted from March to September 2013.
  
  
  RESULTS
  The absolute increases from the pre-intervention period to the TBA referral intervention period in SBA deliveries were 5.7 and 24.0% in the control and intervention groups, respectively (p < 0.001). The absolute increases in SBA delivery rates from the pre-intervention period to the intervention period before the implementation of the free maternity care policy were 4.7 and 17.2% in the control and intervention groups, respectively (p < 0.001). After the policy implementation the absolute increases from pre-intervention to post-intervention were 1.8 and 11.6% in the control and intervention groups, respectively (p < 0.001).
  
  
  CONCLUSIONS
  The percentage of SBA deliveries at the intervention health facility significantly increased compared to control health facilities when TBAs educated women about the need to deliver with a SBA and when TBAs received a stipend for bringing women to local health facilities to deliver. Furthermore, this TBA referral program proved to be far more effective in the target region of Kenya than a policy change to provide free obstetric care.
authors.affiliation: School of Medicine, MSC09 5040, 1 University of New Mexico, Albuquerque, NM, 87131, USA. atomedi@salud.unm.edu.|Department of Family and Community Medicine, School of Medicine, Albuquerque, NM, USA. atomedi@salud.unm.edu.
authors.forename: Angelo
authors.initials: A
authors.lastname: Tomedi
authors.affiliation: School of Medicine, MSC09 5040, 1 University of New Mexico, Albuquerque, NM, 87131, USA.
authors.forename: Sophia R
authors.initials: SR
authors.lastname: Stroud
authors.affiliation: School of Medicine, MSC09 5040, 1 University of New Mexico, Albuquerque, NM, 87131, USA.
authors.forename: Tania Ruiz
authors.initials: TR
authors.lastname: Maya
authors.affiliation: School of Medicine, MSC09 5040, 1 University of New Mexico, Albuquerque, NM, 87131, USA.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Plaman
authors.affiliation: School of Public Health, University of Nairobi, Nairobi, Kenya.
authors.forename: Mutuku A
authors.initials: MA
authors.lastname: Mwanthi
mesh_terms: D000328:Adult; D003906:Developing Countries; D005260:Female; D006284:Health Plan Implementation; D006700:Home Childbirth / Q000009:adverse effects* / Q000191:economics; D006801:Humans; D007630:Kenya; D008483:Medical Assistance / Q000331:legislation & jurisprudence; D008880:Midwifery / Q000191:economics; D009042:Motivation; D010342:Patient Acceptance of Health Care / Q000208:ethnology; D010353:Patient Education as Topic; D018743:Perinatal Care / Q000191:economics / Q000331:legislation & jurisprudence; D011247:Pregnancy; D011295:Prenatal Care / Q000191:economics / Q000331:legislation & jurisprudence; D012017:Referral and Consultation / Q000191:economics; D019035:Rural Health Services / Q000191:economics / Q000331:legislation & jurisprudence; D000078329:Workforce
references.citation: Lancet. 2006 Oct 7;368(9543):1284-99
references.pmid: 17027735
references.citation: Am J Public Health. 1985 Feb;75(2):156-60
references.pmid: 3966621
references.citation: Lancet. 2010 May 8;375(9726):1609-23
references.pmid: 20382417
references.citation: Int J Gynaecol Obstet. 2009 Oct;107 Suppl 1:S5-18, S19
references.pmid: 19815202
references.citation: BMC Public Health. 2011 May 21;11:360
references.pmid: 21599994
references.citation: Int J Gynaecol Obstet. 2013 Feb;120(2):152-5
references.pmid: 23195287
references.citation: Lancet. 2011 Apr 30;377(9776):1523-38
references.pmid: 21496906
references.citation: BMJ. 2011 Dec 01;343:d7102
references.pmid: 22134967