Cyrille Huchon1, Catherine Arsenault2, Caroline Tourigny2, Aliou Coulibaly2, Mamadou Traore3, Alexandre Dumont4, Pierre Fournier5. 1. Centre de recherche du CHU Sainte Justine, Montréal, Canada; Axe de Santé Mondiale, CRCHUM, Université de Montréal, Montréal, Canada. 2. Axe de Santé Mondiale, CRCHUM, Université de Montréal, Montréal, Canada. 3. URFOSAME, Faculté de Médecine, Université de Bamako, Bamako, Mali. 4. Unité 216, Institut de recherche pour le développement, Paris, France. 5. Axe de Santé Mondiale, CRCHUM, Université de Montréal, Montréal, Canada. Electronic address: pierre.fournier@umontreal.ca.
Abstract
OBJECTIVE: To determine the factors associated with obstetric competency and clinical practice among obstetric care providers in referral health centers in Mali. METHODS: The present cross-sectional study was conducted between March and May 2012 among 140 obstetric care providers (obstetric nurses, midwives, and physicians) working in referral health centers in Mali. Emergency obstetric care knowledge and skills were evaluated with clinical vignettes developed using national Malian guidelines. The vignettes covered 5 areas of emergency obstetric care, and the results were used to generate a competency score. A backward stepwise random-effects model using a maximum likelihood estimator was applied to evaluate variables independently associated with competency score. RESULTS: Out of 100, the mean±SD score was 57.8±11.2 for obstetric nurses, 66.4±14.7 for midwifes, and 78.6±13.4 for physicians (P<0.001). Three variables were significantly associated with a higher competency score: professional qualification, working in an urban setting, and working in a health center with a smaller number of obstetric care providers. CONCLUSION: Increasing the in-service training of both rural staff and lower-level healthcare workers working in larger health centers via facility-based maternal death reviews might help to improve clinical practice and maternal health outcomes.
OBJECTIVE: To determine the factors associated with obstetric competency and clinical practice among obstetric care providers in referral health centers in Mali. METHODS: The present cross-sectional study was conducted between March and May 2012 among 140 obstetric care providers (obstetric nurses, midwives, and physicians) working in referral health centers in Mali. Emergency obstetric care knowledge and skills were evaluated with clinical vignettes developed using national Malian guidelines. The vignettes covered 5 areas of emergency obstetric care, and the results were used to generate a competency score. A backward stepwise random-effects model using a maximum likelihood estimator was applied to evaluate variables independently associated with competency score. RESULTS: Out of 100, the mean±SD score was 57.8±11.2 for obstetric nurses, 66.4±14.7 for midwifes, and 78.6±13.4 for physicians (P<0.001). Three variables were significantly associated with a higher competency score: professional qualification, working in an urban setting, and working in a health center with a smaller number of obstetric care providers. CONCLUSION: Increasing the in-service training of both rural staff and lower-level healthcare workers working in larger health centers via facility-based maternal death reviews might help to improve clinical practice and maternal health outcomes.