A Delphi Study of Expert Consensus on Best Practices for Traditional Birth Attendant Support in Maternal Health Systems

References

[1] Adegoke, A. A., & van den Broek, N. (2021). Skilled birth attendance-lessons learnt and challenges: A review. African Journal of Reproductive Health, 25(4), 102–114.

[2] Adegoke, A., & van den Broek, N. (2021). Skilled birth attendants: Who is who? A descriptive study of definitions and roles from nine sub-Saharan African countries. Human Resources for Health, 19(1), 15–28.

[3] Afolabi, B. B., Ezechi, O. C., & Odimegwu, C. (2022). Determinants of maternal health care utilization in Nigeria: Pathways and policy implications. BMC Health Services Research, 22(3), 144–157.

[4] Afolabi, M. O., Oladipo, R. A., & Musa, H. (2022). Barriers to effective referral of obstetric emergencies in rural Nigeria. BMC Pregnancy and Childbirth, 22(1), 321–333.

[5] Barkhordari, A., et al. (2023). Delphi-based approaches for consensus in healthcare training models. Journal of Health Research, 37(2), 118–129.

[6] Barkhordari, A., et al. (2023). Delphi-based approaches for consensus in healthcare training models. Journal of Health Research, 37(2), 118–129.

[7] Barkhordari, H., Fard, R., & Esfandiari, A. (2023). Consensus-based approaches in public health: The Delphi method in practice. Journal of Public Health Research, 12(2), 88–101.

[8] Barkhordari, R., Khalilzadeh, H., & Ali, N. (2023). Institutional support and sustainability of community-based health interventions. Global Health Research and Policy, 8(2), 55– 64.

[9] Barkhordari, S., et al. (2023). Consensus methodologies in health systems research: A review of Delphi applications. Health Research Policy and Systems, 21(4), 310–324.

[10] Bhandari, A., & Hallowell, J. (2021). Delphi- based consensus building in community health programs. Public Health Nursing, 38(4), 532– 541.

[11] Bhandari, R., & Hallowell, M. (2021). Collaborative communication and stakeholder engagement in community health. Health Policy and Planning, 36(5), 623–633.

[12] Bhandari, R., & Hallowell, M. (2021). Mitigating power imbalance through anonymity in expert consensus research. Qualitative Health Research, 31(5), 879–895.

[13] Bhandari, R., & Hallowell, M. (2021). Mitigating power imbalance through anonymity in expert consensus research. Qualitative Health Research, 31(5), 879–895.

[14] Bhandari, S., & Hallowell, M. (2021). Mentorship and professional development in healthcare systems. Journal of Health Management, 23(2), 115–128.

[15] Ekechi, C., Nwachukwu, I., & Agada, L. (2023). Community midwifery and traditional birth attendants in Nigeria: Challenges and opportunities. African Journal of Reproductive Health, 27(1), 50–63.

[16] Eze, J. N., Okafor, I., & Eke, G. (2021). Cultural determinants of childbirth practices among rural Nigerian women. African Journal of Reproductive Health, 25(4), 74–85.

[17] Eze, P., Uche, E., & Nwankwo, I. (2021). Socio- cultural determinants of maternal health- seeking behavior in rural Nigeria. International Journal of Maternal and Child Health, 9(2), 74– 82.

[18] Federal Ministry of Health (FMoH). (2020). National policy on community health practice in Nigeria. Abuja: FMoH.

[19] International Confederation of Midwives (ICM). (2022). Global standards for midwifery education. The Hague: ICM.

[20] International Confederation of Midwives (ICM). (2022). Global standards for midwifery education (Revised 2022). The Hague: ICM.

[21] Ismail, N., & Taliep, N. (2023). The Delphi method as a participatory design tool in African public health studies. BMC Public Health, 23(1), 422.

[22] Ismail, Z., & Taliep, N. (2023). Using the Delphi method for consensus building in maternal health research. Global Health Action, 16(2), 203–214.

[23] Iwu, C. A., Uwakwe, K., Oluoha, U., Duru, C., & Nwaigbo, E. (2021). Empowering traditional birth attendants as agents of maternal and neonatal immunization uptake in Nigeria: A repeated measures design. BMC Public Health, 21(287).

[24] Lawal, A., Salawu, W., Makanjuola, O., Ambali, A., Alabi, O., Obateru, P., & Lawal, L. (2023). The knowledge and utilization of traditional birth attendants by women in a rural community of Ilorin, Northern Nigeria. International Journal of Tropical Disease & Health, 44(16), 1–8.

[25] Leininger, M. M., & McFarland, M. R. (2019). Culture care diversity and universality: A worldwide nursing theory (3rd ed.). Jones & Bartlett Learning.

[26] Leininger, M., & McFarland, M. (2019). Culture care diversity and universality: A worldwide nursing theory. Jones & Bartlett Learning.

[27] Masava, A., Osei, P., & Bature, T. (2023). Integrating traditional and modern maternal care systems: Evidence from West Africa. BMC Pregnancy and Childbirth, 23(9), 812–826.

[28] Masava, D. M., et al. (2023). Applications of the Delphi technique in developing health system interventions in Africa. PLoS Global Public Health, 3(2), e0001427.

[29] Masava, D. M., et al. (2023). Applications of the Delphi technique in developing health system interventions in Africa. PLoS Global Public Health, 3(2), e0001427.

[30] Masava, H., Otieno, P., & Mboya, E. (2023). Cultural integration and community participation in maternal health mentorship models. Journal of Global Health Studies, 12(3), 115–129.

[31] Masava, M. N., Otieno, R. A., & Wambui, J. (2023). Application of Delphi in developing health system interventions in sub-Saharan Africa. African Health Sciences, 23(1), 17–28.

[32] Mbaruku, G., Mselle, L., & Manongi, R. (2019). Improving aseptic techniques among community birth attendants in Tanzania. Midwifery, 75(1), 79–86.

[33] Mbaruku, G., van Roosmalen, J., & Kimario, G. (2019). Improving obstetric care in resource- limited settings: Lessons from Tanzania. The Lancet Global Health, 7(3), e356–e364.

[34] Mogaji, A. O., Akintayo, A. O., & Bello, H. S. (2024). Mentorship as a strategy for improving TBA practices in Nigeria: Gaps and opportunities. Journal of Reproductive Health and Development, 15(2), 211–226.

[35] Mogaji, H. A., et al. (2024). Mentorship and training frameworks for traditional health practitioners in sub-Saharan Africa. African Journal of Reproductive Health, 28(1), 55–69.

[36] Mogaji, H. A., et al. (2024). Mentorship and training frameworks for traditional health practitioners in sub-Saharan Africa. African Journal of Reproductive Health, 28(1), 55–69.

[37] Mogaji, H. A., Oyebanjo, S. A., & Adeyemi, F. K. (2024). Evaluating mentorship strategies for community-based health workers in Nigeria. Journal of African Health Studies, 12(1), 65–80.

[38] Mogaji, T. A., Olatunji, A., & Ahmed, M. (2024). Mentorship gaps and informal maternity care in Nigeria: A qualitative review. BMC Health Services Research, 24(2), 334– 349.

[39] Nursing and Midwifery Council of Nigeria (NMCN). (2023). Code of professional conduct for nurses and midwives in Nigeria. Abuja: NMCN Press.

[40] Nursing and Midwifery Council of Nigeria (NMCN). (2023). Standards for midwifery practice in Nigeria. Abuja: NMCN.

[41] Officer, The Guardian. (2024, July 1). Rat soup, snails and oracles: why Nigeria’s traditional midwives still have a vital role to play. The Guardian.

[42] Ogunjimi, L., Adegbite, F., & Aremu, F. (2022). Integrating traditional medicine into modern healthcare systems in Africa: A review. African Journal of Primary Health Care, 14(2), 51–60.

[43] Ogunjimi, L., Ekechi, C., & Adeoye, A. (2022). Cultural sensitivity and maternal care delivery in Nigeria. Social Science & Medicine, 306, 115–121.

[44] Ogunjimi, O., Akpabio, M., & Ekanem, B. (2020). Traditional birth attendants and maternal health outcomes in Nigeria. Nigerian Journal of Public Health, 34(3), 201–210.

[45] Ogunyemi, A. O., Odeyemi, K. A., Okusanya, B. O., Olorunfemi, G., Simon, M., Balogun, M. R., & Akanmu, A. S. (2024). Impact of training and case manager support for traditional birth attendants in the linkage of care among HIV- positive pregnant women in southwest Nigeria: A 3-arm cluster randomized control trial. BMC Pregnancy and Childbirth, 24, 153.

[46] Okafor, I. J., Eze, P., & Nwafor, C. (2020). Referral delays and maternal outcomes in rural Nigeria. International Journal of Gynecology & Obstetrics, 148(1), 82–89.

[47] Okafor, I. P., Anyaehie, U. S. B., & Okezie, O. (2020). Maternal health challenges and emergency referral practices in Nigeria. International Journal of Obstetrics and Gynaecology, 150(2), 154–161.

[48] Otache, I., Mba, C., & Ugo, N. (2025). Maternal care practices and the role of traditional birth attendants in Rivers State, Nigeria. International Journal of Community Medicine and Public Health, 12(1), 10–22.

[49] Otache, M. E., Agbo, P., & Ibezim, S. (2025). Traditional birth attendants and maternal health in Nigeria: Bridging the gap between culture and care. Journal of African Reproductive Health, 19(1), 67–82.

[50] Otache, P. O., et al. (2025). Socio-cultural dynamics influencing maternal and neonatal care in rural Nigeria. International Journal of Community Health, 12(3), 187–203.

[51] Otache, P., Anaba, A., & Worlu, F. (2025). Traditional birth attendants in Nigeria: Challenges and opportunities for health system integration. Journal of Reproductive Health, 29(1), 45–58.

[52] Owoseni, J. S., & Owumi, B. E. (2013). The impact of traditional birth attendants on maternal and child health in Ikole LGA of Ekiti State, Nigeria. Journal of Obstetrics and Gynaecology of India, 63(2), 102–106.

[53] Potter, P. A., & Perry, A. G. (2022). Fundamentals of nursing (10th ed.). Elsevier.

[54] Potter, P. A., & Perry, A. G. (2022). Fundamentals of nursing (11th ed.). Elsevier.

[55] Proctor, B. (2008). Clinical supervision: A cooperative exercise in accountability. In A. T. Michael & S. Wheeler (Eds.), Supervision in nursing practice (pp. 22–34). Routledge.

[56] Proctor, B. (2008). Group supervision: A guide to creative practice. Nursing Times, 104(15), 58–61.

[57] Sanni, O., Onasoga, Y., & Aawal, M. L. (2025). The primary roles of traditional birth attendants in childbirth support: A contemporary perspective from Nigeria. IPS Journal of Public Health, 5(3), 284–289.

[58] Thaddeus, S., & Maine, D. (1994). Too far to walk: Maternal mortality in context. Social Science & Medicine, 38(8), 1091–1110.

[59] Thaddeus, S., & Maine, D. (1994). Too far to walk: Maternal mortality in context. Social Science & Medicine, 38(8), 1091–1110.

[60] United Nations (UN). (2022). Sustainable development goals report 2022. New York: United Nations.

[61] United Nations (UN). (2022). Sustainable Development Goals Report 2022. New York: UN. World Health Organization (WHO). (2020). Framework for strengthening quality midwifery education for universal health coverage. Geneva: WHO.

[62] World Health Organization (WHO). (2019). Recommendations on optimizing the role of community-based health workers in maternal and newborn care. WHO Press.

[63] World Health Organization (WHO). (2020). Strengthening quality midwifery education for universal health coverage 2030: Framework for action. Geneva: WHO Press.

@article{1712885,
      author = {Sanni Olasumbo, Yinka Onasoga, Muhammed Aawal Ladan},
      title = {A Delphi Study of Expert Consensus on Best Practices for Traditional Birth Attendant Support in Maternal Health Systems},
      journal = {Iconic Research And Engineering Journals},
      year = {2025},
      volume = {9},
      number = {6},
      pages = {1720-1732},
      issn = {2456-8880},
      url = {https://www.irejournals.com/formatedpaper/1712885.pdf},
      abstract = {Traditional Birth Attendants (TBAs) continue to serve as critical maternal healthcare providers in rural and riverine communities of Nigeria, particularly where access to skilled birth attendants remains limited. Despite the expansion of formal healthcare services, over 60% of deliveries in some regions still occur under the supervision of TBAs (WHO, 2022). However, gaps in infection control, emergency referral, and obstetric management underscore the urgent need for a structured mentorship model that aligns traditional birthing practices with evidence-based maternal care. This study employed a qualitative Delphi consensus approach to gather expert opinions on best practices for strengthening TBA support systems in Rivers State, Nigeria.A purposive panel of 25 experts such as six TBAs, five midwives, four obstetricians, three community health extension workers (CHEWs), and four reproductive health policymakers, participated in three iterative Delphi rounds. Data from Round One were thematically analyzed to identify key domains, while Rounds Two and Three utilized a 5-point Likert scale to establish consensus. Consensus was defined as ?70% agreement among panelists. An 88% response rate was achieved (22/25 participants). Thematic analysis revealed five major domains for effective mentorship: infection prevention and aseptic technique; emergency referral and transport systems; communication and respect for cultural birthing practices; supervision and supportive monitoring; and continuous training with feedback mechanisms. Consensus was achieved on 30 of 38 statements (79%), with the strongest agreement on TBA integration into community health systems (95%), infection control and emergency referral training (91%), and cultural respect (89%). The validated mentorship model comprised four key components: foundational training, supervised practice, referral and feedback systems, and structured monitoring and evaluation. This study provides a contextually grounded, evidence-informed mentorship framework for TBAs, serving as a bridge between traditional and formal maternal healthcare. Its implementation is expected to strengthen collaborative maternal health delivery, enhance safety outcomes, and contribute to achieving Sustainable Development Goal 3 on reducing maternal mortality in Nigeria.},
      keywords = {Traditional Birth Attendants, Delphi Method, Mentorship, Maternal Health, Consensus Building, Nigeria},
      month = {December},
      doi = {https://doi.org/10.64388/IREV9I6-1712885}
  }