Knowledge and Skills of Healthcare Providers in Sub-Saharan Africa and Asia before and after Competency-Based Training in Emergency Obstetric and Early Newborn Care

Ameh, Charles ORCID: https://orcid.org/0000-0002-2341-7605, Kerr, Robert, Madaj, Barbara ORCID: https://orcid.org/0000-0002-4073-3191, Mdegela, Mselenge ORCID: https://orcid.org/0000-0002-0374-6583, Kana, Terry ORCID: https://orcid.org/0000-0002-1501-6860, Jones, Susan, Lambert, Jaki, Dickinson, Fiona ORCID: https://orcid.org/0000-0002-5298-9127, White, Sarah ORCID: https://orcid.org/0000-0001-5535-8075 and van den Broek, Nynke ORCID: https://orcid.org/0000-0001-8523-2684 (2016) 'Knowledge and Skills of Healthcare Providers in Sub-Saharan Africa and Asia before and after Competency-Based Training in Emergency Obstetric and Early Newborn Care'. PLoS ONE, Vol 11, Issue 12, e0167270.

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Abstract

Background
Healthcare provider training in Emergency Obstetric and Newborn Care (EmOC&NC) is a component of 65% of intervention programs aimed at reducing maternal and newborn mortality and morbidity. It is important to evaluate the effectiveness of this.

Methods
We evaluated knowledge and skills among 5,939 healthcare providers before and after 3–5 days ‘skills and drills’ training in emergency obstetric and newborn care (EmOC&NC) conducted in 7 sub-Saharan Africa countries (Ghana, Kenya, Malawi, Nigeria, Sierra Leone, Tanzania, Zimbabwe) and 2 Asian countries (Bangladesh, Pakistan). Standardised assessments using multiple choice questions and objective structured clinical examination (OSCE) were used to measure change in knowledge and skills and the Improvement Ratio (IR) by cadre and by country. Linear regression was performed to identify variables associated with pre-training score and IR.

Results
99.7% of healthcare providers improved their overall score with a median (IQR) increase of 10.0% (5.0% - 15.0%) for knowledge and 28.8% (23.1% - 35.1%) for skill. There were significant improvements in knowledge and skills for each cadre of healthcare provider and for each country (p<0.05). The mean IR was 56% for doctors, 50% for mid-level staff and nurse-midwives and 38% for nursing-aides. A teaching job, previous in-service training, and higher percentage of work-time spent providing maternity care were each associated with a higher pre-training score. Those with more than 11 years of experience in obstetrics had the lowest scores prior to training, with mean IRs 1.4% lower than for those with no more than 2 years of experience. The largest IR was for recognition and management of obstetric haemorrhage (49–70%) and the smallest for recognition and management of obstructed labour and use of the partograph (6–15%).

Conclusions
Short in-service EmOC&NC training was associated with improved knowledge and skills for all cadres of healthcare providers working in maternity wards in both sub-Saharan Africa and Asia. Additional support and training is needed for use of the partograph as a tool to monitor progress in labour. Further research is needed to assess if this is translated into improved service delivery.

Item Type:	Article
Subjects:	W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 84 Health services. Delivery of health care WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WQ Obstetrics > Pregnancy Complications > WQ 240 Pregnancy complications (General) WQ Obstetrics > Obstetric Surgical Procedures > WQ 400 General works WQ Obstetrics > WQ 500 Postnatal care
Faculty: Department:	Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):	https://doi.org/10.1371/journal.pone.0167270
SWORD Depositor:	JISC Pubrouter
Depositing User:	JISC Pubrouter
Date Deposited:	19 Jan 2017 12:24
Last Modified:	08 Sep 2020 09:44
URI:	https://archive.lstmed.ac.uk/id/eprint/6486

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