Healthcare workers' clinical knowledge on maternal and newborn care in Ethiopia: findings from 2016 national EmONC assessment.

BACKGROUND: Improving maternal and newborn health indicators are key if Ethiopia is to achieve the Sustainable Development Goals. To do so, women need access to skilled attendance at birth and emergency obstetric and newborn care. To maximize their impact, understanding gaps in workers' knowledge is required to remedy the weakness. This assessment determines knowledge levels of clinical management of maternal and newborn healthcare and factors that influence knowledge. METHODS: This study used data from the National Emergency Obstetric and Neonatal Care assessment conducted in 2016. Provider knowledge for MNH was assessed by interviewing providers. Respondents were scored on each question by calculating the number of correct responses provided out of the total possible answers, and standardizing this to a scale of 100. Mixed linear regression was used to determine individual and contextual factors associated with the score. RESULTS: A total of 3800 interviews with complete data were included in this study. Most respondents were diploma midwives (73%), BSc midwives (11%) and diploma nurses (10%). On average, midwives scored 60 out of 100 on the question regarding the primary aspects of focused antenatal care and elements of a birth plan. Half of the midwives and health officers, and one-third of nurses knew to provide a loading dose of magnesium sulphate. Midwives scored 90% on the steps of active management of third stage of labor. In the mixed linear regression, working in a private for profit facility, health center/clinic, rural area, or in a facility with a protocol on referral/counter referral predicted lower knowledge scores. More positive scores were associated with work environments that had a computer, internet, and protocols on safe abortion care, management of selected obstetric topics, integrated management of pregnancy, childbirth, postnatal, and newborn, care for low birth weight including kangaroo mother care, and treatment of infection in young infants. CONCLUSION: With regard to most knowledge related questions, health officers and midwives scored similarly. Providers scored substantially better on routine intrapartum and newborn care than on aspects related to care for complications. A substantial proportion of providers indicated that they would never give a loading dose of magnesium sulphate.

Factors associated with health care provider knowledge on abortion care in Ethiopia, a further analysis on emergency obstetric and newborn care assessment 2016 data.

BACKGROUND: Abortion is one of the major direct causes of maternal death, accounting for 7.9% globally. In Africa, 5.5 million women have unsafe abortions annually. Although maternal deaths due to complications of abortion have declined in Ethiopia, women still die from complications. Few studies have focused on providers' clinical knowledge. This study investigates the level of health workers' knowledge of comprehensive abortion care and its determinants in Ethiopia. METHODS: Data from the national emergency obstetric and newborn care (EmONC) assessment was used. A total of 3804 facilities that provided institutional deliveries in the 12 months before the assessment were included. Provider knowledge was assessed by interviewing a single provider from each facility. Criteria for selection included: having attended the largest number of deliveries in the last one or two months. A summary knowledge score was generated based on the responses to three knowledge questions related to immediate complications of unsafe abortion, how a woman should be clinically managed and what the counselling content should contain. The score was classified into two categories (< 50% and > =50%). Logistic regression was used to determine individual and facility-level factors associated with the summary knowledge score. RESULT: A total of 3800 providers participated and the majority were midwives, nurses and health officers. On average, providers identified approximately half or fewer of the expected responses. The multivariate model showed that midwives and nurses (compared to health officers), being female, and absence of training or practice of manual vacuum aspiration were associated with lower knowledge levels. Important facility level factors protective against low knowledge levels included employment in Addis Ababa, being male and having internet access in the facility. CONCLUSION: To increase knowledge levels among providers, pre- and in-service training efforts should be particularly sensitive to female providers who scored lower, ensure that more midlevel providers are capable of performing manual vacuum aspiration as well as provide special attention to providers in the Gambella.

How well does pre-service education prepare midwives for practice: competence assessment of midwifery students at the point of graduation in Ethiopia.

BACKGROUND: Midwifery support and care led by midwives is the most appropriate strategy to improve maternal and newborn health. The Government of Ethiopia has recently improved the availability of midwives by scaling up pre-service education. However, the extent to which graduating students acquire core competencies for safe and effective practice is not known. The purpose of this study was to evaluate the quality of midwifery education by assessing the competence of graduating midwifery students. METHODS: We conducted a cross-sectional study to assess the competence of students who completed basic midwifery education in Ethiopia in 2013. We interviewed students to obtain their perceptions of the sufficiency and quality of teachers and educational resources and processes. We assessed achievement of essential midwifery competencies through direct observation, using a 10-station Objective Structured Clinical Examination (OSCE). We calculated average percentage scores of performance for each station and an average summary score for all stations. Chi-square test, independent sample t test, and linear regression analysis were used to assess the statistical significance of differences and associations. RESULTS: We assessed 484 graduating students from 25 public training institutions. Majority of students rated the learning environment unfavorably on 8 out of 10 questions. Only 32 % of students managed 20 or more births during training, and just 6 % managed 40 or more births. Students' overall average competence score was 51.8 %; scores ranged from 32.2 % for manual vacuum aspiration to 69.4 % for active management of the third stage of labor. Male gender, reporting sufficient clinical experience, and managing greater numbers of births during training were significant predictors of higher competence scores. CONCLUSIONS: The quality of pre-service midwifery education needs to be improved, including strengthening of the learning environment and quality assurance systems. In-service training and mentoring to fill competence gaps of new graduates is also essential.