O Bayley1, T Colbourn1, B Nambiar1, A Costello1, F Kachale2, T Meguid3, C Mwansambo4. 1. UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH ; Parent and Child Health Initiative (PACHI). 2. Reproductive Health Unit, Box 30377, Lilongwe, LL3, Malawi. 3. Department of Obstetrics & Gynaecology, University of Namibia, School of Medicine, Windhoek, Namibia. 4. Parent and Child Health Initiative (PACHI) ; Kamuzu Central Hospital, Namgwagwa, Lilongwe, Malawi.
Abstract
AIM: Quality of service delivery for maternal and newborn health in Malawi is influenced by human resource shortages and knowledge and care practices of the existing service providers. We assessed Malawian healthcare providers' knowledge of management of routine labour, emergency obstetric care and emergency newborn care; correlated knowledge with reported confidence and previous study or training; and measured perception of the care they provided. METHODS: This study formed part of a large-scale quality of care assessment in three districts (Kasungu, Lilongwe and Salima) of Malawi. Subjects were selected purposively by their role as providers of obstetric and newborn care during routine visits to health facilities by a research assistant. Research assistants introduced and supervised the self-completed questionnaire by the service providers. Respondents included 42 nurse midwives, 1 clinical officer, 4 medical assistants and 5 other staff. Of these, 37 were staff working in facilities providing Basic Emergency Obstetric Care (BEMoC) and 15 were from staff working in facilities providing Comprehensive Emergency Obstetric Care (CEMoC). RESULTS: Knowledge regarding management of routine labour was good (80% correct responses), but knowledge of correct monitoring during routine labour (35% correct) was not in keeping with internationally recognized good practice. Questions regarding emergency obstetric care were answered correctly by 70% of respondents with significant variation depending on clinicians' place of work. Knowledge of emergency newborn care was poor across all groups surveyed with 58% correct responses and high rates of potentially life-threatening responses from BEmOC facilities. Reported confidence and training had little impact on levels of knowledge. Staff in general reported perception of poor quality of care. CONCLUSION: Serious deficiencies in providers' knowledge regarding monitoring during routine labour and management of emergency newborn care were documented. These may contribute to maternal and neonatal deaths in Malawi. The knowledge gap cannot be overcome by simply providing more training.
AIM: Quality of service delivery for maternal and newborn health in Malawi is influenced by human resource shortages and knowledge and care practices of the existing service providers. We assessed Malawian healthcare providers' knowledge of management of routine labour, emergency obstetric care and emergency newborn care; correlated knowledge with reported confidence and previous study or training; and measured perception of the care they provided. METHODS: This study formed part of a large-scale quality of care assessment in three districts (Kasungu, Lilongwe and Salima) of Malawi. Subjects were selected purposively by their role as providers of obstetric and newborn care during routine visits to health facilities by a research assistant. Research assistants introduced and supervised the self-completed questionnaire by the service providers. Respondents included 42 nurse midwives, 1 clinical officer, 4 medical assistants and 5 other staff. Of these, 37 were staff working in facilities providing Basic Emergency Obstetric Care (BEMoC) and 15 were from staff working in facilities providing Comprehensive Emergency Obstetric Care (CEMoC). RESULTS: Knowledge regarding management of routine labour was good (80% correct responses), but knowledge of correct monitoring during routine labour (35% correct) was not in keeping with internationally recognized good practice. Questions regarding emergency obstetric care were answered correctly by 70% of respondents with significant variation depending on clinicians' place of work. Knowledge of emergency newborn care was poor across all groups surveyed with 58% correct responses and high rates of potentially life-threatening responses from BEmOC facilities. Reported confidence and training had little impact on levels of knowledge. Staff in general reported perception of poor quality of care. CONCLUSION: Serious deficiencies in providers' knowledge regarding monitoring during routine labour and management of emergency newborn care were documented. These may contribute to maternal and neonatal deaths in Malawi. The knowledge gap cannot be overcome by simply providing more training.
Authors: S Miller; M Cordero; A L Coleman; J Figueroa; S Brito-Anderson; R Dabagh; V Calderon; F Cáceres; A J Fernandez; M Nunez Journal: Int J Gynaecol Obstet Date: 2003-07 Impact factor: 3.561
Authors: T Nolan; P Angos; A J Cunha; L Muhe; S Qazi; E A Simoes; G Tamburlini; M Weber; N F Pierce Journal: Lancet Date: 2001-01-13 Impact factor: 79.321
Authors: Bejoy Nambiar; Dougal S Hargreaves; Chelsea Morroni; Michelle Heys; Sonya Crowe; Christina Pagel; Felicity Fitzgerald; Susana Frazao Pinheiro; Delan Devakumar; Sue Mann; Monica Lakhanpaul; Martin Marshall; Tim Colbourn Journal: Bull World Health Organ Date: 2016-11-30 Impact factor: 9.408