In this study we aimed to assess the level of health worker knowledge regarding essential standard components of maternal and newborn care. Health officers and midwives scored similarly and higher than nurses on most knowledge questions. Substantial proportion of providers who indicated that they would never give a loading dose of magnesium sulphate. Only average scores were observed regarding health workers’ knowledge on routine newborn care. All provider cadres scored substantially better on aspects of routine intrapartum and newborn care than on aspects of care for intrapartum or newborn complications, which might be expected given that the vast majority of the health workers were mid-level practitioners. Nevertheless, all were front-line providers who are faced with maternal and newborn complications, if only to stabilize and refer them to doctors and specialists posted at hospitals. Knowledge levels were higher among providers posted in hospitals, suggesting they might have greater exposure to women and newborns with complications and to more highly skilled staff.
Magnesium sulphate was expected to be provided in all type of cadres under this study, however, there was a substantial proportion of providers who indicated that they would never give a loading dose of magnesium sulphate; among nurses, this was one in five respondents. Magnesium sulphate has been on the World Health Organization’s (WHO) essential medicines list since 1996, and it is an affordable drug [10]. However, magnesium sulphate has not achieved widespread usage in developing countries. This is due to lack of public awareness of the drug, lack of adequate service-provider training, and not all facilities had magnesium sulphate in stock [11, 12].
Only average scores were observed regarding health workers’ knowledge on routine newborn care. This means that women in the postnatal period may not receive adequate information on immediate newborn care, hygienic cord care, timing of first bath for the newborn, and care for newborns with low birth weight.
A study undertaken in Mali to determine individual and contextual factors associated with emergency obstetric and neonatal care services suggests that the existence of clinical guidelines or protocols is an important factor associated with knowledge of healthcare providers [7]. Even if they used small sample size compared with us, similarly, the present study showed a significant positive association between the existence of guidelines in the workplace and knowledge. It could be that healthcare professionals actually read and know the guidelines better when they have them at hand. In contrast with the current study, female gender revealed a significant positive association with provider knowledge in Rwanda where the focuse were the final-year medical students at university suggesting female students had a higher likelihood of demonstrating retention and competency compared with their male counterparts [13]. In a study on knowledge of birth preparedness and complication readiness among doctors, nurses and midwives in Benin, awareness and training on birth preparedness and educational status were significant predictors of knowledge [14]. This study used small sample size compared to our study which is around four hundred health care providers.
The national reach and the large number of health providers included in the study were important strengths of this study. But it was not without some limitations. The assessment was based on respondents’ reports, rather than direct observation, which might have led to some reporting error. Most of the questions had multiple correct answers that required spontaneous responses; this may have biased scores towards the lower end because of respondents’ fatigue (due to interview or lack of sleep if on night duty), or the interviewer was in a hurry and failed to adequately probe and encourage the provider to think of other responses. If, for example, all questions had been posed as multiple choice answers, the scores might have been higher.
Steps were taken to ensure the quality of the data collected. All data collectors received the same two-week training. Regular supervision of questionnaire completion, along with using electronic data collection approaches contributed to high quality. In addition, the electronic transfer system we utilized regularly reviewed the quality of the data and provided feedback while the data collectors were still in the field.
Our findings suggest that in-service and refresher trainings and dissemination of tailored clinical guidelines for the management of maternal and newborn care are vital to update health workers’ knowledge levels and self-confidence in their skills, which may lead to them serving the community better. Since the workers in hospitals had higher scores than workers from health centers, it is recommended that healthcare workers do rotations in hospitals; also, it would be important to ensure access to internet and to clinical guidelines in all facilities.
Although midwives made up the bulk of the sample of respondents, where there are no midwives and nurses or health officers are expected to attend births, we see that nurses were the least knowledgeable. This is both an argument to ensure midwives at every health center and that nurses get more specialized obstetric training. The study compared knowledge scores among midwives, nurses and health officers who have different pre-service training backgrounds. However, during practice all health workers are expected to offer standard care in the provision of maternal and newborn services.
This study have a number of policy implications. Clinical decision making involves combining the knowledge arising from one’s clinical expertise that would be improved by provision of guidelines, patient preferences, and research evidence within the context of available resources including computer and internet.