P2B080: Implementing PRATIBIMB – an Icatch-supported Project to Train Traditional Birth Attendants in Remote Tribal Villages of Andhra Pradesh, India

Background: The Paderu area of Andhra Pradesh (A.P), India, is a remote tribal area with scattered villages without roads or vehicular access. Even though the Government of India promotes hospital-based deliveries, several deliveries still occur in villages and are conducted by traditional birth attendants (TBA) who are not medically trained and have less than a high school education. Therefore, we developed a program – PRATIBIMB, for training these TBAs, using elements of Helping Babies Breathe (HBB), Helping Babies Survive (HBS), and Helping Mothers Survive (HMS)-postpartum Hemorrhage.

Aim: The primary aim of PRATIBIMB was to assess the feasibility and efficacy of training low-literacy non-medical TBAs in remote tribal areas.

Methods: The project was funded by the NICE Foundation, Hyderabad, India, and the AAP's iCATCH Grant Program (Jan 2020 - Dec 2023).
Training: Master trainers (Nurse Midwives) were trained in training others on selected elements of HBB, HBS, and HMS (PRATIBIMB program). A 5-phase program was implemented over two years. (Figure 1). Phase 1 – was a 3-day training within the region for small groups of TBAs. Phases 2 and 3 were evaluations of knowledge retention and recall, after which modifications were made based on feedback and focus group discussions, and the curriculum was simplified to 10 essential modules. Phase 4 – was the implementation of the simplified program using more pictorial and culturally appropriate teaching strategies. Finally, phase-5 was a 2-day refresher based on the new strategy and providing resuscitation kits.
Evaluation: Knowledge testing and skill demonstration was evaluated using local dialect translators and verbal questions. Testing was done periodically, and modifications were made to the teaching modules based on discussions with trainees.

Results: We have completed training 80 TBAs from 40 villages in the Chintapalli Mandal of the ASR District -Paderu (Figure 1). After Phase 1 training, 68% of providers passed their test. However, in Phase 2 and 3 recall testing, which was done four to six months after the initial training, less than 20% of the trainees passed. Phase 4, with the assessment of the modified simplified program, was done for all 80 TBAs. The modules and performance scores after Phase 5 – Refresher session are shown in Figure 2.

Conclusion: We successfully trained 2 TBAs per village in 40 remote tribal areas of India. The use of simplified modules, visual education materials, verbal Q & A tests, and local-language translators for teaching and evaluations were critical in improving the results of PRATIBIMB training. A simplified, module-based version of HBB, HBS, and HMS can be successfully taught to non-medical, low-literacy TBAs in remote tribal areas. The effect of this training on changes in newborn outcomes is currently being monitored.