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Healthcare (Basel). 2018 Jun 9;6(2). pii: E60. doi: 10.3390/healthcare6020060.

Impact of Standardized Prenatal Clinical Training for Traditional Birth Attendants in Rural Guatemala.

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Saving Mothers, New York, NY 10022, USA.
Saving Mothers, New York, NY 10022, USA.
Saving Mothers, New York, NY 10022, USA.
Ministerio de Salud Pública y Asistencia Social, Santiago Atitlán, Sololá 07019, Guatemala.
Saving Mothers, New York, NY 10022, USA.


In low-and-middle-income countries (LMICs), traditional birth attendant (TBA) training programs are increasing, yet reports are limited on how those programs affect the prenatal clinical abilities of trained TBAs. This study aims to assess the impact of clinical training on TBAs before and after a maternal health-training program. A prospective observational study was conducted in rural Guatemala from March to December 2017. Thirteen participants conducted 116 prenatal home visits. Data acquisition occurred before any prenatal clinical training had occurred, at the completion of the 14-week training program, and at six months post program completion. The paired t-test and McNemar’s test was used and statistical analyses were performed with R Version 3.3.1. There was a statistically significant improvement in prenatal clinical skills before and after the completion of the training program. The mean percentage of prenatal skills done correctly before any training occurred was 25.8%, 62.3% at the completion of the training program (p-value = 0.0001), and 71.0% after six months of continued training (p-value = 0.034). This study highlights the feasibility of prenatal skill improvement through a standardized and continuous clinical training program for TBAs. The improvement of TBA prenatal clinical skills could benefit indigenous women in rural Guatemala and other LMICs.


Guatemala; birth attendant; clinical skills; education; indigenous health; maternal mortality; prenatal care; rural

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