Tools
Tools
Shikuku, Duncan (2024) Improving the Quality of Midwifery Education in Kenya, Thesis (Doctoral), Liverpool School of Tropical Medicine.
![[img]](https://archive.lstmed.ac.uk/style/images/fileicons/text.png) |
Text
D Shikuku_Thesis_12.11.2024_final.pdf - Accepted Version Restricted to Repository staff only until 21 February 2025. Download (4MB) |
Abstract
Introduction
Midwifery education and training in low resourced countries is substandard, and graduates are often inadequately prepared for maternity care. Pre-service midwifery curriculum is deficient, faculty is ineffective with no/limited opportunities for continuous professional development (CPD) and clinical teaching and practice settings are insufficient. My thesis implemented and evaluated the key midwifery education strengthening interventions using the World Health Organization’s seven-step action plan to strengthen quality midwifery education in Kenya (and Nigeria).
Methods
Mixed research methods were applied.
Study 1: A quasi-experimental controlled trial measured the effectiveness of pre-service emergency obstetric and newborn care (EmONC) training intervention package on the knowledge and skills of final year midwifery students in Kenya.
Study 2: A cluster randomized controlled trial (cRCT) in 20 midwifery colleges assessed the effectiveness of an EmONC-enhanced pre-service midwifery curriculum delivered by trained and mentored midwifery educators on the quality of education and student performance in Kenya.
Study 3: A nested qualitative study within the cRCT explored the experiences of and barriers to implementing the updated curriculum by midwifery educators, students and mentors in Kenya.
Study 4: A systematic review of literature appraised the national CPD programmes for midwifery educators in low- and middle-income countries.
Study 5: A mixed methods research design was used to design, implement and evaluate the feasibility of a midwifery educator CPD programme in Kenya and Nigeria.
Quantitative data were analysed using SPSS version 28. Qualitative data were analysed using the thematic framework applying Braun and Clarke’s six step criteria.
Results
Study 1: Knowledge and skills scores of midwifery students in the intervention colleges were significantly higher compared to those in the control group.
Study 2: The observed teaching skill scores of educators in the intervention arm were significantly higher compared with those of controls at endline. Scores for students in the intervention arm were
significantly higher than those in control arm for knowledge and the three maternal and newborn care skills assessed.
Study 3: Updated curriculum was relevant to improve practice, (ii) training and mentoring valued as CPD opportunities for midwifery educators. Institutional barriers identified included (i) midwifery
faculty shortage and heavy workload vs high student population, and (ii) inadequate clinical support for students to promote effective learning.
Study 4: Main CPD approach identified was twinning (international collaborations employing the train-the-trainer approach). No formal CPD program managed by a national nursing/midwifery regulator or
international midwifery body was identified.
Study 5: Educators’ knowledge, practical skills and confidence in applying selected pedagogical skills significantly improved. Technological (individual and institutional) challenges were identified.
Conclusion
Multiple pre-service EmONC interventions, including curriculum update, institutional strengthening and faculty development opportunities improved educators’ competencies and enhanced student learning thereby improving the quality of midwifery education. To successfully scale-up, sustain and institutionalize the investments, a policy and regulatory framework is needed. Further research on the cost-effectiveness of the interventions is needed for adapting in other similar low resource settings.
Statistics
Actions (login required)
 |
Edit Item |