Assessment of knowledge of evidence‐based maternal and newborn care practices among midwives and nurses in six provinces in Indonesia

Evaluation of an obstetric and neonatal care upskilling program for community health workers in Papua New Guinea

BACKGROUND

60% of women in Papua New Guinea (PNG) give birth unsupervised and outside of a health facility, contributing to high national maternal and perinatal mortality rates. We evaluated a practical, hospital-based on-the-job training program implemented by local health authorities in PNG between 2013 and 2019 aimed at addressing this challenge by upskilling community health workers (CHWs) to provide quality maternal and newborn care in rural health facilities.

METHODS

Two provinces, the Eastern Highlands and Simbu Provinces, were included in the study. In the Eastern Highlands Province, a baseline and end point skills assessment and post-training interviews 12 months after completion of the 2018 training were used to evaluate impacts on CHW knowledge, skills, and self-reported satisfaction with training. Quality and timeliness of referrals was assessed through data from the Eastern Highlands Province referral hospital registers. In Simbu Province, impacts of training on facility births, stillbirths and referrals were evaluated pre- and post-training retrospectively using routine health facility reporting data from 2012 to 2019, and negative binomial regression analysis adjusted for potential confounders and correlation of outcomes within facilities.

RESULTS

The average knowledge score increased significantly, from 69.8% (95% CI:66.3-73.2%) at baseline, to 87.8% (95% CI:82.9-92.6%) following training for the 8 CHWs participating in Eastern Highlands Province training. CHWs reported increased confidence in their skills and ability to use referral networks. There were significant increases in referrals to the Eastern Highlands provincial hospital arriving in the second stage of labour but no significant difference in the 5 min Apgar score for children, pre and post training. Data on 11,345 births in participating facilities in Simbu Province showed that the number of births in participating rural health facilities more than doubled compared to prior to training, with the impact increasing over time after training (0-12 months after training: IRR 1.59, 95% CI: 1.04-2.44, p-value 0.033, > 12 months after training: IRR 2.46, 95% CI:1.37-4.41, p-value 0.003). There was no significant change in stillbirth or referral rates.

CONCLUSIONS

Our findings showed positive impacts of the upskilling program on CHW knowledge and practice of participants, facility births rates, and appropriateness of referrals, demonstrating its promise as a feasible intervention to improve uptake of maternal and newborn care services in rural and remote, low-resource settings within the resourcing available to local authorities. Larger-scale evaluations of a size adequately powered to ascertain impact of the intervention on stillbirth rates are warranted.

Knowledge Sharing for Maternal Health at a Public Hospital in South Africa

Purpose: This paper investigates knowledge sharing for maternal health in one of the major public referral hospitals in South Africa–the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Poor knowledge on maternal health continues to present a global challenge, particularly in developing countries where maternal mortality remains very high. Design/methodology/approach: A qualitative study and case study design were conducted to obtain an in-depth understanding of knowledge sharing for maternal health in one of the major public referral hospitals in South Africa. Convenience sampling of 35 pregnant women was undertaken. In-depth face-to-face interviews were employed to the point of saturation. Findings: The findings revealed elementary knowledge sharing for maternal health and several challenges to knowledge sharing. Limitations: This paper focuses on knowledge sharing at the antenatal care unit. Although effective knowledge sharing during antenatal phase may enhance post-natal care, it will have been beneficial to also understand the post-natal perspective of knowledge sharing. Furthermore, issues of representativeness may result from the use of convenience sampling. However, the purpose of this study is not to generalise the results but to provide an in-depth understanding of knowledge sharing for maternal health in a public hospital in South Africa and suggests a dynamic interactive strategy to enhance knowledge sharing that may effectively improve maternal health. Practical implication: Strategies for knowledge sharing for maternal health were established. The paper concluded that increasing knowledge sharing on safe motherhood practices would translate into safer pregnancy outcomes and would subsequently lead to lower maternal mortality. Knowledge sharing is critical in improving maternal health in a developing country like South Africa, where maternal deaths during pregnancy, childbirth and the puerperium remain a significant public health issue. Goal 3 of the 17 Sustainable Development Goals (SDGs) developed in 2015 seeks to promote good health and well-being and to reduce the global maternal mortality ratio (MMR) to fewer than 70 maternal deaths per 100,000 live births by 2030. Knowledge sharing is crucial in reducing the MMR. Originality/value: Studies conducted on knowledge sharing in the health sector have focused mainly on health professionals and the use of technology for mobile health. This paper adds to the body of knowledge-on-knowledge management and healthcare services, with specific focus on knowledge sharing and maternal care. Knowledge sharing for maternal health will reduce pregnancy, childbirth and motherhood-related health risks.

Influence of Structured Training Programme on Healthcare Workers’ Knowledge of Recommended Postnatal Care Services in Nigeria

Introduction

The lack of continuous training of maternal and child healthcare providers has been identified as one of the factors contributing to the poor quality of maternal and child healthcare services in Nigeria.

Objectives

The study aimed to evaluate the level of postnatal care-related knowledge among healthcare workers in Osun State and the impact of a structured training program on their learning.

Method

A quasi-experimental research design using pre-test and post-test control groups was utilized in this study. One hundred and sixty-one healthcare workers were recruited from six Local Government Areas (LGA) and randomized into intervention and control groups. The healthcare workers in the intervention group (n = 82) were exposed to a 3-day structured training program. A structured questionnaire was used to collect data before, immediately, and 3-months after the training. Data were analyzed using descriptive statistics, multiple linear regression, t-test, and repeated measure analysis of variance (ANOVA) with posthoc pairwise comparison.

Results

The mean ages of healthcare workers in the intervention and control groups are 40.96 ± 6.91 and 42.52 ± 7.58, respectively. At baseline, the mean knowledge score of the intervention and control groups were 60.0 ± 11.6 and 63.7 ± 10.4, respectively. There is a significant difference in the mean knowledge score of healthcare workers in the intervention group compared with those in the control group immediately after the training (t = 12.04, p < .001) and after 3-months of data collection training (t = 5.92, p < .001). A multivariate linear regression confirmed the positive effect of group membership (intervention vs. control) on the post-test knowledge among respondents (p < .001).

Conclusion

An educational training significantly improved the knowledge of healthcare workers on the recommended postnatal care.

Health care provider's perceptions of factors that influence infant mortality in Papua Indonesia: A qualitative study

BACKGROUND

High infant mortality remains a global health problem, particularly in less developed countries. Indonesia has one of the highest infant mortality rates in Southeast Asia. Known factors relate to documented medical conditions and do not necessarily explain their origin.

AIM

To identify and explore factors that contribute to infant mortality in Papua, Indonesia, through the lens of health workers' perceptions.

METHODS

A qualitative descriptive approach using semi-structured interviews was used. Twelve Indonesian health workers participated. Interviews were audio-recorded and transcribed, and then analysed thematically.

FINDINGS

Five main themes were generated: beliefs and practices related to pregnancy, birth, and infants; infant health factors; maternal health factors; barriers to seeking, receiving and providing infant health care; and enablers and strategies for improving infant health.

DISCUSSION

Cultural factors were perceived as contributing to poor health outcomes by shaping decisions, help seeking behaviour and health care access. Poverty, health literacy, road access and transport, shortage of health staffing, and health equipment and medicines exacerbate poor health outcomes.

CONCLUSION

Cultural knowledge and sensitivity are central to the provision and acceptance of health care by local families in Papua, Indonesia. Recommendations include: improving cultural sensitivity and cultural safety of service; implementing community health promotion to enhance maternal and infant health; improving community participation in health care planning and delivery; and enhancing collaboration between national, provincial, regency and local governments.

Integrated review of healthcare provider postnatal newborn care recommendations in Sub-Saharan Africa

AIMS

To (1) identify formal and informal healthcare provider knowledge and counselling on newborn care recommendations; (2) identify care guidelines used; and (3) determine healthcare provider training regarding recommendations.

BACKGROUND

In sub-Saharan Africa, many newborn deaths occur in the community between days two to 42 of life.

INTRODUCTION

Formal and informal healthcare providers, including nurses and community health workers, counsel newborn caregivers but little is known about their recommendations.

METHODS

Integrative review of studies conducted 2000-2018 after search of PubMed, CINAHL, Embase, and African healthcare journals. Study quality was assessed and findings synthesized.

FINDINGS

Twelve qualitative, quantitative, or mixed-methods studies (quality good to poor) from seven countries were included. Eleven reported on one to three recommendations; one study reported on eight recommendations. Knowledge or counselling on feeding, cord care, recognizing illness, referrals, informal treatment, home visits, immunizations, follow-up examinations, thermal care, low birthweight, and bed net usage were reported. Formal healthcare providers gave recommendations in only two studies. Four studies documented use of guidelines. Six studies reported on training.

DISCUSSION

Studies were primarily descriptive, limiting quality. Feeding and cord care recommendations were prioritized. Care guidelines were underutilized. Additional training on recommendations is needed. These findings regarding healthcare providers align with other regions with high neonatal mortality.

CONCLUSION

Research is needed to improve and sustain knowledge, counselling, and guideline usage among providers to address neonatal mortality.

IMPLICATIONS FOR NURSING

The unique role of nurses to promote newborn health appears under-researched. Nurse professionalization and specialization may contribute to sustained knowledge of and counselling on newborn recommendations.

IMPLICATIONS FOR HEALTH POLICY

As countries adopt universal health care, policies that enable formal providers to encourage maternal-newborn engagement in newborn health promotion before transition to the community are needed. Collaboration between formal and informal providers may improve dissemination of recommendations and contribute to gains in newborn health.