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Social Science and Medicine. 1991; 33(8):959-62.An investigation on the "jidda," the traditional birth attendant (TBAs) of Yemen, was undertaken in 1989 because WHO training of TBAs in Yemen was regarded to have had mixed results. Information was collected through semistructured interviews between July and November 1989 in villages in the Anis region of the central highlands of Yemen: Taalibi, Hamaan Ali, Dhi Hud, Al Mashahidhah, and Al Masna'ah. Taalibi and Hamaan Ali were two of the original training sites, at which all 16 TBAs were trained. Of these, 14 TBAs plus approximately 28 untrained TBAs and village women were selected at random and interviewed. Quantitative data on the number of deliveries made before and after the training by 7 of the TBAs were made available. The term "jidda" was designated as the appropriate Yemini Arabic name for TBA and was generally accepted within the Primarily Health Care (PHC) terminology within Yemen. The term literally means grandmother. WHO policy assumes that the training of one or two TBAs in each village will provide all women with basic mother and child health care. Initially a confusing mixture of terms was used in the villages to refer to women who assist at deliveries. These terms included references to the woman who cut the cord. A final understanding was reached that the term "jidda" will mean WHO project-trained women. Nontrained women are called "those who cut the cord." The term "jidda" as a person with specialized knowledge and experience with deliveries is not connected to traditional terms for women, who of old, assisted at deliveries. Assistance at delivery is provided by variety of kin, neighbors, and related women living proximate to the women delivering. Remuneration is the promise of rewards in the afterlife. The job is not a fulltime occupation. The delivery process is describe, and it is clear that the assistant provides emotional support and literally cuts the cord. Providing an image of professionally and specialization and the bag of instruments to a few "jidda" has lead to inequality and confusion. "Jidda" still cut the cord, and the 7 trained "jidda" have not expanded their area outside if their neighborhoods. It is suggested that training be given to midwives and that research into the local situation occur prior to training activities in order for objectives to be achieved. In this situation less sophisticated training should be given to all women assisting in deliveries.
Arlington, Virginia, Management Sciences for Health, Technologies for Primary Health Care [PRITECH], 1991.  p. (USAID Contract No. DPE-5969-Z-00-7064-00)Representatives from several nongovernmental organizations visited Uganda in February-March 1991 to help the Control of Diarrheal Disease (CCD) program bolster its ability to advance case management, training, and supervision of health care professionals. Specifically, the team focussed its activities on determining a strategy to create a national level diarrhea training unit (DTU) centered around case management for medical officers, interns and residents, medical students, and nurses. Similarly, it participated in developing a strategy for training traditional healers in diarrhea case management and for inservice training for health inspectors (preventive health workers). The team presented a generic model for a training/support system to the DTU faculty and CDD program manager. The model centered on what needs to be done to ensure that the local clinic health worker manages diarrhea cases properly and instructs mothers effectively to manage diarrhea. Further, in addition to comprehensive case management, content included interpersonal communication at all levels supplemented by supervision and training skills. It encouraged a participatory approach for training. In addition, it strongly encouraged the DTU faculty and CDD program staff to follow up on training activities such as supporting trainees and reinforcing skills learned in the training course. The team met with relevant government, university, and donor representatives to learn more about existing or proposed CDD activities. Further, the CDD program asked team members to assist informally in the surveyor training session for the WHO/CDD Health Facilities Survey. The team also spoke to WHO/CDD staff about its plans and future activities. WHO/CDD was concerned that training in interpersonal skills not weaken the quality of training in diarrhea case management.
BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY. 1991 Apr; 98(4):345-8.Discusses dual concerns of the Royal College of Obstetricians and Gynaecologists (RCOG): that a widening gap between obstetric standards in Britain and those in the developing world exists and that the RCOG is unable to meet the needs of Third World doctors who come to the RCOG for postgraduate study. A meeting sponsored by Birthright and held at the Royal College of Obstetricians and Gynaecologists (RCOG) in June 1989 which explored aspects of Third World obstetric care reflects these concerns. The proceedings of the meeting have been published and verbatim recordings of the discussions are available on tape from the RCOG. Reports on maternal mortality/morbidity in the Third World indicate persistence of poor obstetrical practices and of common obstetrical complications. Suggestions for improvement include the redeployment of and the replanning of services within countries and an increase in health education for women. Access to care at the first referral institution level is seen as the key to the improvement of care. Problems of transport and communication create serious obstacles to the link between community care and the first referral institution. The goal of the World Health Organization (WHO) is to cut the Third World maternal mortality in half by the year 2000. To reach this goal WHO plans to field obstetric teams in Latin America, Africa and South Asia; to train nurse-midwives to perform life saving measures on their own initiative; and to employ community resources by training indigenous midwives to function as extensions of the health team. The RCOG will sponsor training designed for doctors who will work in developing countries.