Evaluating a clinical mentorship intervention on maternal and neonatal complications in primary health facilities in Blantyre district, Malawi: A longitudinal analysis of the Global Action in Nursing program.

BACKGROUND: While Malawi has made great strides increasing the number of facility-based births, maternal and neonatal mortality remains high. An intervention started in 2019 provided short-course training followed by year-long longitudinal bedside mentorship for nurse midwives at seven health facilities in Blantyre district. The intervention was initiated following invitation from the district to improve outcomes for patients during childbirth. This study examined the impact of the intervention on the reporting of obstetric and neonatal complications and related care. METHODS: Patient level data were collected from the District Health Information System 2 database from intervention and non-intervention facilities. Bivariate analysis explored the impact of longitudinal bedside mentorship on select District Health Information System 2 variables at six-month intervals. Outcomes were then analyzed using nonlinear quantile mixed models to better account for the impact of time and clustering at the facility level. RESULTS: Significant changes were found in the reporting of obstetric and neonatal complications over time at intervention facilities compared to non-intervention facilities. Intervention facilities showed statistically significant increases in the reporting of prolonged labor, pre/eclampsia, fetal distress, retained placenta, and premature labor. There was also a statistically significant decrease in the reporting of no complications in the multivariate model (95%CI: -0.8 to -0.2). In both the bivariate and multivariate models, the reporting of 'None' significantly decreased (0.8 % median), while the reporting of prematurity (0.2 % median) and asphyxia (0.3 % median) both significantly increased. The missingness of data at intervention facilities decreased to almost zero compared to non-intervention facilities. DISCUSSION: The increase in reported maternal and neonatal complications suggests improved early identification of complications at the facility level. The improved accuracy of patient data from intervention facilities shows the impact mentorship has on data quality which is crucial for the allocation of resources. By highlighting the apparent dose-response relationship of longitudinal bedside mentorship, this study will inform the broader use of mentorship in training programs. Future research is needed to explore the impact of longitudinal mentorship on quality of care.

Predictors of workforce retention among Malawian nurse graduates of a scholarship program: a mixed-methods study.

BACKGROUND: Malawi faces critical health care worker shortages of both physicians and nurses. The Global AIDS Interfaith Alliance (GAIA) began a nursing scholarship program in Malawi that requires graduates to work in the public sector for 4-5 years following graduation. The main objective of this study was to identify job satisfaction and retention factors of scholarship recipients after graduation. METHODS: We conducted a mixed-methods study consisting of 30 individual qualitative interviews and 56 quantitative surveys that evaluated job satisfaction, factors associated with retention, and impact of the GAIA Nursing Scholarship Program. Participants included GAIA scholarship recipients who had graduated. We used thematic analysis to analyze qualitative interviews. Kruskal-Wallis, Spearman correlation, and chi-squared tests were used to analyze survey data. RESULTS: The majority of survey and interview participants indicated it was unlikely that they would leave the public sector (70% and 90%, respectively). Most interview and survey participants cited a lack of supplies, inadequate human resources, and high workload as major challenges to their work. Poor working relationships with management or coworkers was significantly correlated with consideration of changing jobs in the next 6 months (correlation coefficient -0.28, P < .05 and -0.36, P < .01, respectively). Low salaries, high workload, poor accommodations, and a lack of appreciation were the most common reasons given for considering leaving the public sector while job security, desire to pursue further education, and public service agreement were primary motivations for continuing to work in the public system. Participants felt supported by GAIA staff and expressed a desire to serve their communities in return by working in government-supported health facilities. CONCLUSIONS: Despite the many challenges faced by public-sector nurses, low-income countries such as Malawi can employ non-remuneration strategies to retain nurses in the public sector, including adequate housing, availability of supplies, advancement opportunities, and positive work environments. Scholarship programs with close follow-up of graduates may also help increase retention.