Indonesia is made up of more than 13000 islands with defined ecological, ethnic, socioeconomic and cultural co nditions and which developed rapidly. Much has been achieved but maternal and child health remains still a problem especially in rural areas. So far the problem of perinatal care was given less attention although death in the early neonatal period comprises of almost 60% of infant death. West-Java is the province where the intervention study has been carried out. The main issue in West-Java is the high infant mortality rate and fertility rates. It was higher compared to other provinces in Java, the most developed island of Indonesia. Factors such as infrastructure and the associated maldistribu tion of health care facilities may play a role in the low performance of West-Java. lnspite of better socioeconomic conditions, the health status of West-Java is st ill behind other provinces in Java. The vital statistics report in 1990 shows that infant mortality in West-Java is 84 per thousand livebirths leaving WestJava on the 24th rank of 27 provinces of Indonesia. The traditional birth attendant is the most important source of support in pregnancy, child birth and early child care. In West-Java 80-90 % of deliveries take place at home by traditional birth attendants. Because of this high coverage it is important to include TBAs in the provision of perinatal care. A review of the available literature has shown that training TBAs does not result in the expected outcomet-The reason is the difficulty to train them because of their semi-illite racy and old age. More studies were reported evaluating their behaviour and impact on mortality which is mostly low. Less attention is given to ways in which the TBAs were trained and no information is available about the level of supervision . The Tanjungsari study is an intervention study where TBAs were trained in the identification of risk in pregnant women and to conduct appropriate action. The risk approach is the basic concept of the training. The study area Tanjungsari is a subdistrict with more than 90 000 population served by one health center, one medical doctor and one midwife. For the purpos e of the study subdistrict Tanjungsari is divided into 2 areas, the northern part is the intervention area, while the southern part is the control area. Both areas are separated by a main road dividing the subdistrict into two areas. Since 1950 the Minist ry of Health has conducted nationwide training for TBAs organized th rough the health center. All TBAs in Tanjungsari had received the conventional governmental training. Subsequent training in risk identification was given only to TBAs from the intervention area. The training consists of identification of risk conditions and TBAs were instructed to motivate women for refe rral if a risk condition was identified, these TBAs were called "Risk approach trained TBA or Ra.TBAs". In the control area the TBAs did not receive any additional training, they were called" Conventional trained TBAs or Conv.TBAs". Birth attendants not classified in the TBA groups were included in "Others", these are the midwives and MOs. To be able to identify risk, every woman needs to have at least one time contact with a health care provider, therefore coverage is the most important factor in the risk approach. The instruments used in the intervention study for identification and screening were the "Mother and Child Card", the "colored weighing scales" and the "problem action guideline". These instruments were developed using appropriate technology . During a study period of two years, 4400 women were registered, 2.6 percent were lost to follow-up and 4108 singleton births were available for analysis. Effect and outcome measures were made using the method recommended by Reynolds and Gaspari (1990). Subjects were clients of Ra.TBAs, Conv.TBAs and "Others". The main reason to analyze the results by birth attendant was because birth attendants were not confined to an area, when they are popular they will travel outside their geographic boundaries or patients will come from other areas for delivery

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H.K.A. Visser (Henk) , J.A. Kusin
Erasmus University Rotterdam
Erasmus MC: University Medical Center Rotterdam

Alisjahbana-Kartadiredja, A. (1993, October 28). The implementation of the risk approach on pregnancy outcome by traditional birth attendants : the Tanjungsari study in West-Java, Indonesia. Retrieved from