Traditional birth attendant training for improving health behaviours and pregnancy outcomes.

BACKGROUND: Between the 1970s and 1990s, the World Health Organization promoted traditional birth attendant (TBA) training as one strategy to reduce maternal and neonatal mortality. To date, evidence in support of TBA training remains limited and conflicting. OBJECTIVES: To assess effects of TBA training on health behaviours and pregnancy outcomes. SEARCH STRATEGY: We searched the Trials Registers of the Cochrane Pregnancy and Childbirth Group and Cochrane Effective Practice and Organisation of Care Group (EPOC) (June 2006); electronic databases representing fields of education, social, and health sciences (inception to June 2006); the internet; and contacted experts. SELECTION CRITERIA: Published and unpublished randomized controlled trials (RCT), controlled before/after and interrupted time series studies comparing trained and untrained TBAs or women cared for/living in areas served by TBAs. DATA COLLECTION AND ANALYSIS: Three authors independently assessed study quality and extracted data. MAIN RESULTS: Four studies, involving over 2000 TBAs and nearly 27,000 women, are included. One cluster-randomized trial found significantly lower rates in the intervention group regarding stillbirths (adjusted OR 0.69, 95% confidence interval (CI) 0.57 to 0.83, P < 0.001), perinatal death rate (adjusted OR 0.70, 95% CI 0.59 to 0.83, P < 0.001) and neonatal death rate (adjusted OR 0.71, 95% CI 0.61 to 0.82, P < 0.001). Maternal death rate was lower but not significant (adjusted OR 0.74, 95% CI 0.45 to 1.22, P = 0.24) while referral rates were significantly higher (adjusted OR 1.50, 95% CI 1.18 to 1.90, P < 0.001). 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, P = 0.95). Similarly, the mean number of monthly referrals did not differ between groups (P = 0.321). One RCT found a significant difference in advice about introduction of complementary foods (OR 2.07, 95% CI 1.10 to 3.90, P = 0.02) but no significant difference for immediate feeding of colostrum (OR 1.37, 95% CI 0.62 to 3.03, P = 0.44). Another RCT found no significant differences in frequency of postpartum haemorrhage (OR 0.94, 95% CI 0.76 to 1.17, P = 0.60) among women cared for by trained versus TBAs. AUTHORS' CONCLUSIONS: The potential of TBA training to reduce peri-neonatal mortality is promising when combined with improved health services. However, the number of studies meeting the inclusion criteria is insufficient to provide the evidence base needed to establish training effectiveness.

Grandmothers raising grandchildren: are they at increased risk of health problems?

Many grandparents faced with the need to raise their grandchildren have health risks that could destabilize any family structure established for the child. This is especially problematic for grandparents of color who have higher health risk factors that their white counterparts. This article describes the physical and mental health status and behaviors of 100 African American grandmothers who are the primary caretakers for their grandchildren. The findings suggest the physical functioning of the grandmothers is at a level that could jeopardize the quality of life with their grandchildren. In spite of their diminished physical capacity, the grandmothers reported that their emotional state is equal to or better than the general population. Suggestions for community practice are provided.

A multimodal intervention for grandparents raising grandchildren: results of an exploratory study.

This article describes the results of an exploratory study of a multimodal, home-based intervention designed to reduce psychological stress, improve physical and mental health, and strengthen the social support and resources of grandparents raising grandchildren. The six-month intervention included home visits by registered nurses, social workers, and legal assistants; the services of an attorney; and monthly support group meetings. The intervention resulted in improved mental health scores, decreased psychological distress scores, and increased social support scores. Participants also experienced improvement in the level of public benefits received and in their legal relationships with their grandchildren. Implications of these findings for practice are highlighted.

Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group.

OBJECTIVE: Because of the pressure for timely, informed decisions in public health and clinical practice and the explosion of information in the scientific literature, research results must be synthesized. Meta-analyses are increasingly used to address this problem, and they often evaluate observational studies. A workshop was held in Atlanta, Ga, in April 1997, to examine the reporting of meta-analyses of observational studies and to make recommendations to aid authors, reviewers, editors, and readers. PARTICIPANTS: Twenty-seven participants were selected by a steering committee, based on expertise in clinical practice, trials, statistics, epidemiology, social sciences, and biomedical editing. Deliberations of the workshop were open to other interested scientists. Funding for this activity was provided by the Centers for Disease Control and Prevention. EVIDENCE: We conducted a systematic review of the published literature on the conduct and reporting of meta-analyses in observational studies using MEDLINE, Educational Research Information Center (ERIC), PsycLIT, and the Current Index to Statistics. We also examined reference lists of the 32 studies retrieved and contacted experts in the field. Participants were assigned to small-group discussions on the subjects of bias, searching and abstracting, heterogeneity, study categorization, and statistical methods. CONSENSUS PROCESS: From the material presented at the workshop, the authors developed a checklist summarizing recommendations for reporting meta-analyses of observational studies. The checklist and supporting evidence were circulated to all conference attendees and additional experts. All suggestions for revisions were addressed. CONCLUSIONS: The proposed checklist contains specifications for reporting of meta-analyses of observational studies in epidemiology, including background, search strategy, methods, results, discussion, and conclusion. Use of the checklist should improve the usefulness of meta-analyses for authors, reviewers, editors, readers, and decision makers. An evaluation plan is suggested and research areas are explored.

Psychological distress in grandmother kinship care providers: the role of resources, social support, and physical health.

OBJECTIVE: The purpose of the present study was to investigate predictors of psychological distress in grandmother kinship care providers. More specifically, it was hypothesized that social support, family resources, and physical health would predict psychological distress in grandmothers raising grandchildren. METHOD: One hundred and two grandmothers raising grandchildren in parent-absent homes completed the Brief Symptom Inventory, Short Health Form-36, Family Resource Scale, Family Support Scale, and a questionnaire requesting background and demographic data. RESULTS: Results indicated that psychological distress was predicted by family resources, participants' physical health, and to a lesser extent, social support. CONCLUSION: The findings indicate that family resources, social support, and physical health affected psychological distress in grandmothers raising grandchildren. Grandmothers who reported fewer resources, less social support, and poorer physical health tended to experience higher levels of psychological distress. This study suggests that greater attention be given to interventions aimed to decrease psychological distress and improve the financial resources and physical health of grandmothers raising grandchildren.