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Women Birth. 2018 May 21. pii: S1871-5192(17)30737-0. doi: 10.1016/j.wombi.2018.04.016. [Epub ahead of print]

Review of educational interventions to increase traditional birth attendants' neonatal resuscitation self-efficacy.

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Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, United States. Electronic address:
College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas St, Charleston, SC 29425, United States.
Faculty of Nursing, Cumming School of Medicine, Department of Community Health Sciences, University of Calgary, 2500 University Dr. NW, Calgary, AB, T2N 1N4, Canada.
Ralph H. Johnson Veterans Affairs (VA) Medical Center, 1'09 Bee Street, Charleston, SC, 20401, United States; Department of Pediatrics, College of Medicine, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, 29425, United States.



Annually, up to 2.7 million neonatal deaths occur worldwide, and 25% of these deaths are caused by birth asphyxia. Infants born in rural areas of low-and-middle-income countries are often delivered by traditional birth attendants and have a greater risk of birth asphyxia-related mortality.


This review will evaluate the effectiveness of neonatal resuscitation educational interventions in improving traditional birth attendants' knowledge, perceived self-efficacy, and infant mortality outcomes in low-and-middle-income countries.


An integrative review was conducted to identify studies pertaining to neonatal resuscitation training of traditional birth attendants and midwives for home-based births in low-and-middle-income countries. Ten studies met inclusion criteria.


Most interventions were based on the American Association of Pediatrics Neonatal Resuscitation Program, World Health Organization Safe Motherhood Guidelines and American College of Nurse-Midwives Life Saving Skills protocols. Three studies exclusively for traditional birth attendants reported decreases in neonatal mortality rates ranging from 22% to 65%. These studies utilized pictorial and oral forms of teaching, consistent in addressing the social cognitive theory. Studies employing skill demonstration, role-play, and pictorial charts showed increased pre- to post-knowledge scores and high self-efficacy scores. In two studies, a team approach, where traditional birth attendants were assisted, was reported to decrease neonatal mortality rate from 49-43/1000 births to 10.5-3.7/1000 births.


Culturally appropriate methods, such as role-play, demonstration, and pictorial charts, can contribute to increased knowledge and self-efficacy related to neonatal resuscitation. A team approach to training traditional birth attendants, assisted by village health workers during home-based childbirths may reduce neonatal mortality rates.


Low-and-middle-income countries; Neonatal resuscitation; Self-efficacy; Traditional birth attendants; Training

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