Transition to skilled birth attendance Table 1. Summary of findings: meta-analysis of effectiveness of TBA training Finding TBA behaviour Safe delivery Clean delivery Cord care Maternal nutrition Breastfeeding Immunization Knowledge of TBA (14-15) Referral, antenatal care Referral, obstetric complications Behaviour of TBA (14-15) Referral, antenatal care Referral, obstetric complications Maternal behaviour (14-15) Antenatal care-use Emergency obstetric care-use Perinatal outcomes (13) Overall mortality Mortality due to birth asphyxia Mortality due to pneumonia Pregnancy Universal Promote Antenatal care Tetanus toxoid Breastfeeding Care-seeking Quality clinical care (demand for) Situational IPT for malaria No. of studies reporting outcomes Pooled treatment group (comparison group) 16 15 16 6 10 13 3 6 6 13 10 2 17 3 2 3,929 (5,864) 2,566 (4,062) 2,502 (2,996) 905 (842) 1,170 (1,663) 1,826 (2,122) 193 (477) 441 (786) 626 (650) 5,976 (5,991) 4,919 (3,368) 2,812 (1,567) 15,286 (12,786) 6,217 (5,170) 5,333 (4,995) Effect size mean (SEM) 0.35 (0.08)* 0.72 (0.12)* 0.41 (0.08)* 0.42 (0.13)* 0.70 (0.17)* 0.55 (0.10)* 0.97 (0.29)* 0.37 (0.21) 0.39 (0.14)* 0.30 (0.08)* 0.33 (0.07)* 0.21 (0.09)* 0.07 (0.01)* 0.11 (0.05)* 0.08 (0.02)* 95% CI 0.19-0.51 0.49-0.96 0.24-0.57 0.16-0.68 0.37-1.30 0.35-0.74 0.40-1.55 -0.05-0.78 0.12-0.67 0.15-0.45 0.19-0.46 0.03-0.38 0.04-0.09 0.02-0.21 0.04-0.12 Labour, birth–1st 24 hours Universal Provide Safe delivery Hygiene/PMTCT Thermal care Clean cord care Resuscitation Breastfeeding Care-seeking Postnatal >24 hours Universal Promote Skin and cord hygiene Breastfeeding Care-seeking Extra Care of LBW babies Extra home-visits Provide ARI management 475 Increase over baseline (%) 44 103 53 53 100 73 177 – 47 36 38 22 8 11 8 *p<0.05 CI=Confidence interval; SEM=Standard error of mean; TBA=Traditional birth attendant lysis suggest that trained TBAs can contribute to MDG 4 through participation in key evidence-based interven- tions (Fig. 1). For example, at 90% coverage, universal, extra, and situational interventions would result in a re- duction of 15-32% in newborn mortality while improv- ing maternal health (1). There are no comparable data Fig. 1. Family and community interventions that reduce newborn mortality while improving maternal health*: what trained TBAs can do *Adapted from Darmstadt et al., 2005 (1). Interventions @ 90% coverage result in an estimated 15-32% reduction in newborn mortality ARI=Acute respiratory infection; IPT=Intermittent presumptive treatment; LBW=Low birth-weight; PMTCT=Prevention of maternal-to-child transmission of HIV