PLAN Health Advocacy and Development Foundation is proud to support the groundbreaking work of its Technical Consultant on Community Health, Oluwatoyin Babarimisa on her PhD project at the Faculty of Nursing of the Nigeria’s premier university, the University of Ibadan. The project is focused on nurse-led referral process educational interventions among traditional birth attendants (TBA) as an innovation designed to equip the TBAs with the knowledge and skills for early assessment, identification and referral of high-risk pregnancies to skilled birth attendants in public healthcare facilities in Ibadan, Nigeria. This is expected to provide evidence for contributing to efforts for reducing Nigeria’s extremely high maternal mortality ratio of 1,047 deaths per 100,000 live births which has been significantly linked to traditional birth attendants handling high-risk pregnancies that they are not skilled to treat.

PLAN Foundation Staff, Oluwaseun Omikunle and Rachael Adeagbo as well as Students of Public Health at the Fountain University, Ede, Osun State currently serving as interns at PLAN Foundation, Kikelomo Keulere and Bushiro Olohunkemi serve as research assistants and data collectors on the project’s field work while PLAN Foundation provides funding support for the production of the charts of the simplified version of Coopland’s Scoring System translated into the local language and TBAs Calendar as well as the cost of the project field work.

This initiative is borne out of PLAN Foundation’s commitment to contributing to the body of knowledge towards improving the health and wellbeing of marginalized, hard-to-reach and hardly reached segments of society. It is also a demonstration of PLAN Foundation’s recognition of the need for closer collaboration between non-governmental organizations and academic institutions towards promoting the application of research and academic developments towards solving society’s daunting problems.

In this regard, PLAN Foundation has supported the development of a training curriculum on the provision of sexual and reproductive health services for women with disabilities in Oyo State for use at the Colleges of Health Technology as well as Colleges of Nursing Sciences as well as the Faculty of Nursing, University of Ibadan through the EMBASSY project being funded by AmplifyChange.

It is worthy of note that PLAN Foundation recently donated a signpost for the Faculty of Nursing, University of Ibadan in celebrating its upgrading to a faculty with 4 Departments from its previous status of the Department of Nursing in the institution.

The abstract below provides a concise description of the research work in progress:

Title: Referral Process Educational Intervention As a Strategy for Early Assessment and Transfer of High-Risk Obstetric Conditions Among Traditional Birth Attendants in Ibadan

Background: Nigeria has an extremely high maternal mortality ratio of 1,047 deaths per 100,000 live births significantly linked to traditional birth attendants not referring or delaying in referring high-risk obstetric conditions to medically skilled attendants. Various studies have shown that up to 67% of pregnant women in Nigeria deliver outside health facilities with skilled birth attendants.

Traditional Birth Attendants (TBAs) are therefore expected to play a crucial role in early identification and referral, but knowledge barriers, lack of widely accepted tools for assessment of high-risk obstetric conditions (HROC) and referral tracking tools hinder their effectiveness. 

Objective: To evaluate the impact of a referral process education intervention, incorporating a simplified and translated Coopland’s Scoring System and a novel TBA Calendar, on early assessment and transfer of high-risk obstetric conditions.

Methods: In this ongoing Quasi Experimental Research, 112 TBAs are participating, with 56 assigned to the control group and 56 to the intervention group. The intervention group receives education and training on the simplified and translated Coopland’s Scoring System and TBA Calendar. Data collection is currently underway, with outcomes including referral rates, timeliness, and accuracy.

This intervention study focuses on two key innovations: the translation of a simplified version of Coopland’s Scoring System into the local language and the creation of a Traditional Birth Attendants (TBAs) Calendar to monitor referral practices. The translation of Coopland’s Scoring System, a widely recognized tool for assessing high-risk pregnancies, into the local language is intended to facilitate better understanding and utilization by healthcare providers and TBAs. This adaptation is expected to improve the accuracy and timeliness of identifying high-risk obstetric conditions by the TBAs, thereby enabling prompt and appropriate referrals.

Additionally, the TBAs Calendar serves as a simple, user-friendly practical tool for tracking and documenting referral practices. This calendar is designed to aid in eliciting critical information such as the timing of referrals, reasons for referrals, and outcomes of referred cases. By systematically capturing this data, the calendar aims to provide insights into the referral patterns and identify areas for improvement in the referral process. Currently, the project is in the data collection phase, where baseline data on referral practices and maternal outcomes are being gathered.

This phase involves extensive fieldwork, including Focus Group Discussions, collection of data via questionnaires, and observations, to ensure comprehensive data collection. The collected data will be analyzed to assess the effectiveness of the translated scoring system and the TBAs Calendar in improving the referral process and maternal health outcomes. 

Results: Data collection is in progress, with preliminary results expected to show improved referral practices among the intervention group. Conclusion: This study aims to provide evidence on the effectiveness of a referral process education intervention for TBAs in enhancing early assessment and transfer of high-risk obstetric conditions. The findings will inform strategies to improve maternal and perinatal health outcomes in resource-limited settings.