A Cochrane review included 6 studies with a total of 1345 traditional birth attendants (TBAs) and nearly 32 000 women. One cluster-randomized trial found significantly lower rates in the intervention group regarding stillbirths (adjusted OR 0.69, 95% CI 0.57 to 0.83), perinatal death rate (adjusted OR 0.70, 95% CI 0.59 to 0.83) and neonatal death rate (adjusted OR 0.71, 95% CI 0.61 to 0.82). Maternal death rate was lower but not significant (adjusted OR 0.74, 95% CI 0.45 to 1.22) while referral rates were significantly higher (adjusted OR 1.50, 95% CI 1.18 to 1.90).
Three large cluster-randomised trials compared TBAs who received additional training in initial steps of resuscitation with TBAs who had received basic training in safe, clean delivery and immediate newborn care. There was no significant difference in the perinatal death rate between the intervention and control clusters (adjusted OR 0.79, 95% CI 0.61 to 1.02; 1 trial) and no significant difference in late neonatal death rate between intervention and control clusters (adjusted RR 0.47, 95% CI 0.20 to 1.11; 1 trial). The neonatal death rate, however, was 45% lower in intervention compared with the control clusters (one study, 22.8% versus 40.2%, adjusted RR 0.54, 95% CI 0.32 to 0.92).There was no significant difference between the additionally trained TBAs vs trained TBAs for stillbirths (mean weighted adjusted RR 0.99, 95% CI 0.76 to 1.28; 2 trials) or early neonatal death rate (mean weighted adjusted RR 0.83, 95% CI 0.68 to 1.01; 3 trials).
A controlled before/after study among women who were referred to a health service found perinatal deaths decreased in both intervention and control groups with no significant difference between groups (OR 1.02, 95% CI 0.59 to 1.76). Similarly, the mean number of monthly referrals did not differ between groups. One RCT found a significant difference in advice about introduction of complementary foods (OR 2.07, 95% CI 1.10 to 3.90) but no significant difference for immediate feeding of colostrum (OR 1.37, 95% CI 0.62 to 3.03). Another RCT found no significant differences in frequency of postpartum haemorrhage (OR 0.94, 95% CI 0.76 to 1.17) among women cared for by trained versus TBAs.Comment: The quality of evidence is downgraded by study quality (unclear sequence generation and allocation concealment, no blinding), and by inconsistency (heterogeneity in interventions and outcomes).