Medical Sociology of Traditional Birth Attendant Referral Networks and Emergency Obstetric Transfer Timing in Rural Tanzanian Districts: A Social-Network Estimation of Brokerage Position and Referral Delay

Traditional birth attendant (TBA) referral networks in rural Tanzania route women toward emergency obstetric care through chains of interpersonal ties whose structural properties may shape transfer timing, yet the causal effect of a TBA's brokerage position on delay has not been identified in existing scholarship. The framework specifies a two-level model with between-cluster standard deviation of 6.0, residual standard deviation of 4.5, and an intraclass correlation of 0.640, and evaluates power across 2000 replications per design cell for cluster counts of 8, 16, 24 and 32 and effect sizes of 3, 5 and 8 percentage points. The design achieves 80 per cent power to detect a 5 percentage point effect at 56 clusters. The contribution is a transferable template that links medical-sociological theory on network brokerage to a credible identification strategy, and that specifies the cluster counts and effect magnitudes at which a district-level evaluation of TBA referral reform would be informative.