Referral of high-risk pregnant mothers by trained traditional birth attendants in Buikwe County, Mukono District, Uganda.

Traditional birth attendants (TBAs) represent an important component of the healthcare system in resource-limited settings, and are present at 50% of deliveries in developing countries. While several studies have been carried out on the effectiveness of TBAs in reducing maternal morbidity and mortality, very little attention has been given to the needs assessment of TBAs within the environment they practice. We conducted a cross-sectional study among trained TBAs (TTBAs) in the Mukono District of Uganda with needs assessment as one of the aims of the survey. A total of 48 TTBAs within the age range of 19-80 years were interviewed. Knowledge of the TTBAs regarding obstetric cases requiring referral and years of experience gathered were satisfactory. Among the 38 referred mothers, one maternal and fetal death intra-partum were recorded, yielding a case fatality rate of 2.6%. The single most important need of TTBAs was transportation. On average, the distance between the residence and the workplace of a TTBA was 7 km, and lack of transportation hampered the actual transfer of cases to a higher level of care. To remedy this, we recommend the introduction of a practical, cheap and sustainable single-ambulance-multiple-cellular phone system to facilitate prompt referral of complicated obstetric cases within the entire Health District.