Obstetric competence among referral healthcare providers in Mali

Self-perceived competence in managing obstetric emergencies among recently graduated physicians from Lima, Peru

OBJECTIVE

This study aimed to examine the self-perception of competencies in obstetric emergencies among recently graduated physicians from universities in Lima, Peru; and to identify its associated factors.

METHODS

An analytical study was conducted, with the study population comprising newly graduated doctors who attended the "VI SERUMS National Convention" in 2017. We used Poisson regressions to assess the factors associated with the self-perception of competencies in obstetric emergencies, calculating prevalence ratios (PR) and their 95% confidence intervals (95% CI).

RESULTS

We analyzed a population of 463 newly graduated physicians (mean age: 25.9 years), of which 33.3% reported feeling competent in obstetric emergencies. In the adjusted analyses, we found that having a previous health career (PR: 1.77, 95% CI: 1.12-2.81), having completed the internship in EsSalud hospitals (PR: 1.48, 95% CI: 1.31-1.68), and completing a university externship (PR: 1.62, 95% CI: 1.34-1.96) were associated with a higher prevalence of self-perceived competence in obstetric emergencies.

CONCLUSION

Our findings suggest that certain academic factors, such as completing an externship and internship in specific hospital settings, may enhance the competencies or competence self-perception of recently graduated physicians in obstetric emergencies. Further studies are needed to confirm these results and identify other factors that may impact physicians' competencies in this field.

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.

Assessment of clinical decision-making among healthcare professionals performing caesarean deliveries in Burkina Faso

OBJECTIVE

To identify the factors associated with quality decision-making of healthcare professionals in managing complicated labour and delivery in referral hospitals of Burkina Faso.

METHODS

We carried out a six-month observational cross-sectional study among 123 healthcare professionals performing caesareans in 22 hospitals. Clinical decision-making was evaluated using hypothetical patient vignettes framed around four main complications during labour and delivery and developed using guidelines validated by an expert committee. The results were used to generate a quality decision-making score. A multivariate linear regression analysis was used to identify the factors independently associated with the score.

RESULTS

Out of 100, the mean ± SD quality decision-making score was 63.84 ± 7.21 for midwives, 65.58 ± 6.90 for general practitioners (GPs), and 71.94 ± 6.70 for gynaecologist-obstetricians (p < 0.001). Quality decision-making score was higher among professionals with more than seven years' work experience and those with the highest level of professional qualification. Working in a service where partograms are regularly reviewed by peers dramatically increased the skills of professionals.

CONCLUSION

The simple dissemination of written clinical guidelines is not sufficient to maintain high-quality decision-making among healthcare professionals in Burkina Faso. Midwives may have some better scores than GPs if duly retrained and supervised. Increasing in-service training and supervision of both junior staff and lower-qualified healthcare professionals might help to improve obstetric practices in referral hospitals of Burkina Faso.

Using task analysis to generate evidence for strengthening midwifery education, practice, and regulation in Ethiopia

PURPOSE

Realizing aspirations for meeting the global reproductive, maternal, newborn, and child health goals depends not only on increasing the numbers but also on improving the capability of midwifery workforce. We conducted a task analysis study to identify the needs for strengthening the midwifery workforce in Ethiopia.

METHODS

We conducted a cross-sectional study of recently qualified midwives in Ethiopia. Purposively selected participants from representative geographic and practice settings completed a self-administered questionnaire, making judgments about the frequency of performance, criticality, competence, and location of training for a list of validated midwifery tasks. Using Statistical Package for the Social Sciences, Version 20, we computed the percentages and averages to describe participant and practice characteristics. We identified priority preservice education gaps by considering the tasks least frequently learned in preservice, most frequently mentioned for not being trained, and had the highest not capable response. Identification of top priorities for in-service training considered tasks with highest "not capable" and "never" done responses. We determined the licensing exam blueprint by weighing the composite mean scores for frequency and criticality variables and expert rating across practice categories.

RESULTS

One hundred and thirty-eight midwives participated in the study. The majority of respondents recognized the importance of midwifery tasks (89%), felt they were capable (91.8%), reported doing them frequently (63.9%), and learned them during preservice education (56.3%). We identified competence gaps in tasks related to obstetric complications, gynecology, public health, professional duties, and prevention of mother to child transmission of HIV. Moreover, our study helped to determine composition of the licensing exam for university graduates.

CONCLUSION

The task analysis indicates that midwives provide critical reproductive, maternal, newborn, and child health care services and supports continuing investment in this cadre. However, there were substantial competence gaps that limit their ability to accelerate progress toward health development goals. Moreover, basing the licensure exam on task analysis helped to ground it in national practice priorities.

A tool to improve competence in the management of emergency patients by rural clinic health workers: a pilot assessment on the Thai-Myanmar border

Background

Shoklo Malaria Research Unit has been providing health care in remote clinics on the Thai-Myanmar border to refugee and migrant populations since 1986 and 1995, respectively. Clinics are staffed by local health workers with a variety of training and experience. The need for a tool to improve the competence of local health workers in basic emergency assessment and management was recognised by medical faculty after observing the case mix seen at the clinic and reviewing the teaching programme that had been delivered in the past year (Jan-13 to March-14).

Aims

To pilot the development and evaluation of a simple teaching tool to improve competence in the assessment and management of acutely unwell patients by local health workers that can be delivered onsite with minimal resources.

Methods

A structured approach to common emergencies presenting to rural clinics and utilizing equipment available in the clinics was developed. A prospective repeated-measures observed structured clinical examination (OSCE) assessment design was used to score participants in their competence to assess and manage a scenario based ‘emergency patient’ at baseline, immediately post-course, and 8 weeks after the delivery of the teaching course. The assessment was conducted at 3 clinic sites and staff participation was voluntary. Participants filled out questionnaires on their confidence with different scenario based emergency patients.

Results

All staff who underwent the baseline assessment failed to carry out the essential steps in initial emergency assessment and management of an unconscious patient scenario. Following delivery of the teaching session, all groups showed improved competence in both objective assessment and subjective confidence levels.

Conclusions

Structured and practical teaching and learning with minimal theory in this resource limited setting had a positive short-term effect on the competence of individual staff to carry out an initial assessment and manage an acutely unwell patient. Health-worker confidence likewise improved. Workplace assessments are needed to determine if this type of skills training impacts upon mortality or near miss mortality patients at the clinic.

Electronic supplementary material

The online version of this article (doi:10.1186/s13031-015-0041-x) contains supplementary material, which is available to authorized users.