Evaluating the neonatal outcomes of babies born by traditional birth attendants in Namutumba district, Uganda.

Abstract

This study evaluated the neonatal outcomes of babies born by Traditional Birth Attendants (TBAs) in Namutumba District, Uganda. The specific objectives were to determine the prevalence of home births attended by TBAs, to assess the suspected causes of neonatal morbidity and mortality among babies born under their care, and to evaluate the essential newborn care practices employed by TBAs. The research was guided by the Health Belief Model and the Three Delays Model, which explained how maternal perceptions, cultural beliefs, and systemic barriers influenced the choice of TBAs and neonatal outcomes. The study employed a cross-sectional descriptive and analytical design, integrating quantitative and qualitative approaches. A total sample of 175 respondents was selected, comprising 116 postpartum mothers (random sampling), 25 TBAs (snowball sampling), 17 health workers (purposive), and 17 Village Health Team members (purposive). Data was collected using questionnaires, interview guides, documentary review, and observation checklists. Data were analyzed using SPSS version 25, with descriptive statistics (frequencies and percentages) to summarize findings and chi-square tests to establish associations between socio demographic characteristics and delivery-related practices. The results revealed that 95.7% of mothers delivered at home, with 93.1% assisted by TBAs, while only 4.3% delivered at health centres. The main reasons were proximity (37.9%), lack of transport (26.7%), trust in TBAs (23.3%), and cost (12.1%). Neonatal outcomes indicated that although all 116 babies were born alive, 8.6% were not breathing well at birth, 5.2% failed to cry immediately, and 11 neonatal deaths (9.5%) occurred, the majority (72.7%) within the first 24 hours. Unsafe newborn care practices were common: 71% of babies were not breastfed within the first hour, most cords were treated with ash, charcoal, or herbs, and many babies were bathed immediately after birth, exposing them to hypothermia. Chi-square test results confirmed significant associations between key variables. Education was significantly associated with who assisted at delivery (χ² = 84.780, p = 0.000), with mothers of lower education heavily relying on TBAs. Religion was associated with place of delivery (χ² = 92.393, p = 0.000), with Christians and Muslims mainly using health centres not TBAs while minority groups exclusively relied on home deliveries. Number of children was significantly associated with perceived safety of TBAs (χ² = 74.574, p = 0.000), with multiparous women expressing more trust in TBAs. Occupation was significantly associated with the cost of delivery (χ² = 66.163, p = 0.000), with farmers more likely to pay TBAs than unemployed women. The study concluded that neonatal outcomes in Namutumba District remain poor due to overreliance on TBAs, unsafe newborn care practices, and structural barriers to accessing skilled care. The study recommended strengthening community health education, improving rural transport and referral systems, integrating TBAs as referral agents, training them in safe newborn care, enhancing respectful maternity care at health facilities, and equipping rural health centres with essential delivery and neonatal care kits. Key Words: Neonatal Outcomes, Traditional Birth Attendants (TBAs) Namutumba District, Uganda.