Knowledge of intrapartum care among obstetric care providers in rural Kenya.

BACKGROUND: Kenya did not meet its maternal mortality ratio (MMR) target under the Millennium Development Goals. The aim of this study was to examine the gaps in knowledge of intrapartum care among obstetric care providers (OCPs) in rural Nandi County, Kenya. METHODS: This cross-sectional study in 2015 surveyed 326 nurses, midwives, clinical officers and physicians about their knowledge, attitudes and practices related to normal labor and childbirth, immediate newborn care and management of obstetric complications. RESULTS: Self-reported intrapartum knowledge among OCPs was insufficient according to accepted international standards. The mean total knowledge score for all OCPs based on a validated 30-question inventory was 62% (range 23-90%). Only 14 providers (4%) scored as 'competent' (a score ≥80%). Scores were higher for OCPs who had received pre- and postemployment emergency obstetric care training and those with higher levels of confidence in their skills. Survey respondents identified a lack of knowledge as one of the greatest barriers to high-quality patient care. CONCLUSIONS: Increasing training opportunities for OCPs may improve the quality of obstetric care provided to women in Kenya and other high-MMR locations in sub-Saharan Africa and enable progress toward achieving the ambitious Sustainable Development Goals target for maternal survival.

Lifestyle behaviors, chronic diseases, and ratings of health between black and white adults with pre-diabetes.

PURPOSES: The purposes of this study were to assess differences in lifestyle behaviors and other health-related factors between black and white adults with pre-diabetes and to identify predictors for lifestyle behaviors. METHODS: Using the 2007 and 2009 data from the Behavioral Risk Factor Surveillance System (BRFSS), an annual cross-sectional survey of randomly selected samples from each state, black (n = 1156) and white (n = 9539) adults with pre-diabetes were compared on lifestyle behaviors, general health practices, perceptions of health, chronic diseases, and access to care. Predictors for participating in regular physical activity and adequate intake of fruits and vegetables were identified for each racial and gender group using multiple regression procedures. RESULTS: Less than 40% of the adults with pre-diabetes participated in regular physical activity, and less than a quarter had adequate intake of fruits and vegetables; only 20% met the body weight recommendations. Compared to whites, blacks were more likely to be overweight/obese (86% vs 79%) and less likely to engage in regular physical activity (29% vs 40%). Except for adequate intake of fruits and vegetables, each racial and gender group had different predictors for regular physical activity. For black males, the predictors included impaired physical health and coronary heart disease/stroke. For black females, the predictors were younger age and routine checkup. CONCLUSIONS: Significant disparities exist between blacks and whites in lifestyle behaviors and other health-related factors. Targeted intervention strategies are needed to motivate blacks to modify behaviors to prevent or delay the development of diabetes.