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Adegoke A.A.,Maternal and Newborn Health Unit | Abubakar A.,Newborn and Child Health Initiative PRRINN MNCH | Van Den Broek N.,Maternal and Newborn Health Unit
Midwifery | Year: 2013

Objective: to assess the level, type and content of pre-service education curricula of health workers providing maternity services against the ICM global standards for Midwifery Education and Essential competencies for midwifery practice. We reviewed the quality and relevance of pre-service education curricula of four cadres of health-care providers of maternity care in Northern Nigeria. Design and setting: we adapted and used the ICM global standards for Midwifery Education and Essential competencies for midwifery practice to design a framework of criteria against which we assessed curricula for pre-service training. We reviewed the pre-service curricula for Nurses, Midwives, Community Health Extension Workers (CHEW) and Junior Community Health Extension Workers (JCHEW) in three states. Criteria against which the curricula were evaluated include: minimum entry requirement, the length of the programme, theory: practice ratio, curriculum model, minimum number of births conducted during training, clinical experience, competencies, maximum number of students allowable and proportion of Maternal, Newborn and Child Health components (MNCH) as part of the total curriculum. Findings: four pre-service education programmes were reviewed; the 3 year basic midwifery, 3 year basic nursing, 3 year Community Health Extension Worker (CHEW) and 2 year Junior Community Health Extension Worker (JCHEW) programme. Findings showed that, none of these four training curricula met all the standards. The basic midwifery curriculum most closely met the standards and competencies set out. The nursing curriculum showed a strong focus on foundations of nursing practice, theories of nursing, public health and maternal newborn and child health. This includes well-defined modules on family health which are undertaken from the first year to the third year of the programme. The CHEW and JCHEW curricula are currently inadequate with regard to training health-care workers to be skilled birth attendants. Key conclusions: although the midwifery curriculum most closely reflects the ICM global standards for Midwifery Education and Essential competencies for midwifery practice, a revision of the competencies and content is required especially as it relates to the first year of training. There is an urgent need to modify the JCHEW and CHEW curricula by increasing the content and clinical hands-on experience of MNCH components of the curricula. Without effecting these changes, it is doubtful that graduates of the CHEW and JCHEW programmes have the requisite competencies needed to function adequately as skilled birth attendants in Health Centres, PHCs and MCHs, without direct supervision of a midwife or medical doctor with midwifery skills. © 2012 Elsevier Ltd.


Ameh C.,Maternal and Newborn Health Unit | Adegoke A.,Maternal and Newborn Health Unit | Hofman J.,Maternal and Newborn Health Unit | Ismail F.M.,Somaliland Nursing and Midwifery Association | And 2 more authors.
International Journal of Gynecology and Obstetrics | Year: 2012

Objective: To provide and evaluate in-service training in "Life Saving Skills - Emergency Obstetric and Newborn Care" in order to improve the availability of emergency obstetric care (EmOC) in Somaliland. Methods: In total, 222 healthcare providers (HCPs) were trained between January 2007 and December 2009. A before-after study was conducted using quantitative and qualitative methods to evaluate trainee reaction and change in knowledge, skills, and behavior, in addition to functionality of healthcare facilities, during and immediately after training, and at 3 and 6 months post-training. Results: The HCPs reacted positively to the training, with a significant improvement in 50% of knowledge and 100% of skills modules assessed. The HCPs reported improved confidence in providing EmOC. Basic and comprehensive EmOC healthcare facilities provided 100% of expected signal functions - compared with 43% and 56%, respectively, at baseline - with trained midwives performing skills usually performed by medical doctors. Lack of drugs, supplies, medical equipment, and supportive policy were identified as barriers that could contribute to nonuse of new skills and knowledge acquired. Conclusion: The training impacted positively on the availability and quality of EmOC and resulted in "up-skilling" of midwives. © 2012 International Federation of Gynecology and Obstetrics.


Ameh C.,Maternal and Newborn Health Unit | Msuya S.,Maternal and Newborn Health Unit | Hofman J.,Maternal and Newborn Health Unit | Raven J.,Maternal and Newborn Health Unit | And 2 more authors.
PLoS ONE | Year: 2012

Background: Ensuring women have access to good quality Emergency Obstetric Care (EOC) is a key strategy to reducing maternal and newborn deaths. Minimum coverage rates are expected to be 1 Comprehensive (CEOC) and 4 Basic EOC (BEOC) facilities per 500,000 population. Methods and Findings: A cross-sectional survey of 378 health facilities was conducted in Kenya, Malawi, Sierra Leone, Nigeria, Bangladesh and India between 2009 and 2011. This included 160 facilities designated to provide CEOC and 218 designated to provide BEOC. Fewer than 1 in 4 facilities aiming to provide CEOC were able to offer the nine required signal functions of CEOC (23.1%) and only 2.3% of health facilities expected to provide BEOC provided all seven signal functions. The two signal functions least likely to be provided included assisted delivery (17.5%) and manual vacuum aspiration (42.3%). Population indicators were assessed for 31 districts (total population = 15.7 million). The total number of available facilities (283) designated to provide EOC for this population exceeded the number required (158) a ratio of 1.8. However, none of the districts assessed met minimum UN coverage rates for EOC. The population based Caesarean Section rate was estimated to be <2%, the maternal Case Fatality Rate (CFR) for obstetric complications ranged from 2.0-9.3% and still birth (SB) rates ranged from 1.9-6.8%. Conclusions: Availability of EOC is well below minimum UN target coverage levels. Health facilities in the surveyed countries do not currently have the capacity to adequately respond to and manage women with obstetric complications. To achieve MDG 5 by 2015, there is a need to ensure that the full range of signal functions are available in health facilities designated to provide CEOC or BEOC and improve the quality of services provided so that CFR and SB rates decline. © 2012 Ameh et al.


Adegoke A.,Maternal and Newborn Health Unit | Utz B.,Maternal and Newborn Health Unit | Msuya S.E.,Maternal and Newborn Health Unit | van den Broek N.,Maternal and Newborn Health Unit
PLoS ONE | Year: 2012

Background: Availability of a Skilled Birth Attendant (SBA) during childbirth is a key indicator for MDG5 and a strategy for reducing maternal and neonatal mortality in Africa. There is limited information on how SBAs and their functions are defined. The aim of this study was to map the cadres of health providers considered SBAs in Sub Saharan Africa (SSA); to describe which signal functions of Essential Obstetric Care (EmOC) they perform and assess whether they are legislated to perform these functions. Methods and Findings: Key personnel in the Ministries of Health, teaching institutions, referral, regional and district hospitals completed structured questionnaires in nine SSA countries in 2009-2011. A total of 21 different cadres of health care providers (HCP) were reported to be SBA. Type and number of EmOC signal functions reported to be provided, varied substantially between cadres and countries. Parenteral antibiotics, uterotonic drugs and anticonvulsants were provided by most SBAs. Removal of retained products of conception and assisted vaginal delivery were the least provided signal functions. Except for the cadres of obstetricians, medical doctors and registered nurse-midwives, there was lack of clarity regarding signal functions reported to be performed and whether they were legislated to perform these. This was particularly for manual removal of placenta, removal of retained products and assisted vaginal delivery. In some countries, cadres not considered SBA performed deliveries and provided EmOC signal functions. In other settings, cadres reported to be SBA were able to but not legislated to perform key EmOC signal functions. Conclusions: Comparison of cadres of HCPs reported to be SBA across countries is difficult because of lack of standardization in names, training, and functions performed. There is a need for countries to develop clear guidelines defining who is a SBA and which EmOC signal functions each cadre of HCP is expected to provide. © 2012 Adegoke et al.


Raven J.H.,Maternal and Newborn Health Unit | Tolhurst R.J.,International Health Group | Tang S.,International Health Group | van den Broek N.,Maternal and Newborn Health Unit
Midwifery | Year: 2012

Objective: to review published papers and reports examining quality of care in maternal and newborn health to identify definitions and models of quality of care. Design: literature review. Search strategy: electronic search of MEDLINE and organisational databases for literature describing definitions and models of quality used in health care and maternal and newborn health care. Relevant papers and reports were reviewed and summarised. Findings: there is no universally accepted definition of quality of care. The multi-faceted nature of quality is widely acknowledged. In the literature quality of care is described: from the perspective of health care providers, managers and patients; dimensions within the health care system; using elements such as safety, effectiveness, patient-centeredness, timeliness, equity and efficiency; and through the provision of care and experience of care. Key conclusions: the importance of ensuring good quality of care for women and newborn babies is well recognised in the literature, however, there is currently no agreed single and comprehensive definition described. Several models were identified, which can be combined to form a comprehensive framework to help define and assess quality of care or lack of quality. Approaches to quality of care that are specifically important for maternal and newborn health were identified and include a rights based approach, adopting care that is evidence-based, consideration of the mother and baby as interdependent and the fact that pregnancy is on the whole a healthy state. Implications for practice: a model of quality of maternal and newborn health care using perspectives, characteristics, dimensions of the system and elements of quality of care specific to maternal and newborn health is proposed, which can be used as a basis for developing quality improvement strategies and activities, and incorporating quality into existing programmes. © 2011 Elsevier Ltd.


Raven J.,Maternal and Newborn Health Unit | Hofman J.,Maternal and Newborn Health Unit | Adegoke A.,Maternal and Newborn Health Unit | Van Den Broek N.,Maternal and Newborn Health Unit
International Journal of Gynecology and Obstetrics | Year: 2011

Objective: To gain an overview of approaches, methodologies, and tools used in quality improvement of maternal and newborn health in low-income countries. Methods: Electronic search of MEDLINE and organizational databases for literature describing approaches, methodologies, and tools used to improve the quality of maternal and newborn health care in low-income countries. Relevant papers and reports were reviewed and summarized. Results: Developing a culture of quality is an important requisite for successful quality improvement. Methodologies to improve quality include the development of standards and guidelines and the performance of mortality, near-miss, and criterion-based audits. Tools for data collection and process description were identified, and examples of work to improve quality of care are provided. Conclusion: The documented experience with the identified approaches, methodologies, and tools indicates that none is sufficient by itself to achieve a desirable improvement in quality of care. The choice of methodologies and tools depends on the healthcare system and its available resources. There is a lack of studies that describe the process of quality improvement and a need for research to provide evidence of the effectiveness of the identified methods and tools. © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.


Utz B.,Maternal and Newborn Health Unit | Siddiqui G.,Maternal and Newborn Health Unit | Adegoke A.,Maternal and Newborn Health Unit | Van Den Broek N.,Maternal and Newborn Health Unit
Acta Obstetricia et Gynecologica Scandinavica | Year: 2013

Objective To identify which cadres of healthcare providers are considered to be skilled birth attendants in South Asia, which of the signal functions of emergency obstetric care each cadre is reported to provide and whether this is included in their training and legislation. Design Cross-sectional, descriptive study. Setting Bangladesh, India, Nepal and Pakistan. Sample Thirty-three key informants involved in training, regulation, recruitment and deployment of healthcare providers. Methods Between November 2011 and March 2012, structured questionnaires were sent out to key informants by email followed up by face-to-face or telephone interviews. Main outcome measures Mapping of definitions and roles of healthcare providers in four South Asian countries to assess which cadres are skilled birth attendants. Results Cadres of healthcare providers expected to provide skilled birth attendance differ across countries. Although most identified cadres administer parenteral antibiotics, oxytocics and perform newborn resuscitation; administration of anticonvulsants varies by country. Manual removal of the placenta, removal of retained products of conception and assisted vaginal delivery are not provided by all cadres expected to provide skilled birth attendance. Conclusion Key signal functions of emergency obstetric care are often provided by medical doctors only. Provision of such potentially life-saving interventions by more healthcare provider cadres expected to function as skilled birth attendants can save lives. Ensuring better training and legislation are in place for this is crucial. © 2013 Liverpool School of Tropical Medicine. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons on behalf of Nordic Federation of Societies of Obstetrics and Gynecology.


Raven J.,Maternal and Newborn Health Unit | Utz B.,Maternal and Newborn Health Unit | Roberts D.,Liverpool Womens Hospitals Foundation Trust | Van Den Broek N.,Maternal and Newborn Health Unit
BJOG: An International Journal of Obstetrics and Gynaecology | Year: 2011

A training package designed to train health care providers in the management of common obstetric and newborn complications using a competency based 'skills and drills' approach is used in Bangladesh and India as one of the interventions under the 'Making it Happen' programme. The programme was commenced in 2009 and aims to reduce maternal and newborn mortality and morbidity by improving health care providers' capacity to deliver Essential (Emergency) Obstetric and Newborn Care (EOC&NC) thus increasing the availability and quality of these services. Preliminary results indicate that the training package has improved knowledge and skills of trained health care providers and ensures more signal functions of EOC are provided. © 2011 RCOG.


Ameh C.A.,Maternal and Newborn Health Unit | Bishop S.,North West Deanery | Kongnyuy E.,Maternal and Newborn Health Unit | Grady K.,Wythenshawe Hospital | Van Den Broek N.,Maternal and Newborn Health Unit
Maternal and Child Health Journal | Year: 2011

To assess the availability of, and challenges to the provision of emergency obstetric care in order to raise awareness and assist policy-makers and development partners in making appropriate decisions to help pregnant women in Iraq. Descriptive and exploratory study based on self-administered questionnaires, an in-depth interview and a Focus Group Discussion. The setting was 19 major hospitals in 8 out of the 18 Governorates and the participants were 31 Iraqi doctors and 1 midwife. The outcome measures were availability of emergency obstetric care (EOC) in hospitals and challenges to the provision of EOC. Only 26.3% (5/19) of hospitals had been able to provide all the 8 signal functions of comprehensive emergency obstetric care in the previous 3 months. All the 19 hospitals provided parenteral antibiotics and uterine evacuation, 94.7% (18/19) were able to provide parenteral oxytocics and perform manual removal of retained placenta, magnesium sulphate for eclampsia was available in 47.4% (9/19) of hospitals, 42.1% (8/19) provided assisted vaginal delivery, 26.5% (5/19) provided blood transfusion and 89.5% (17/19) offered Caesarean section. The identified challenges for health care providers include difficulties travelling to work due to frequent checkpoints and insecurity, high level of insecurity for patients referred or admitted to hospitals, inadequate staffing due mainly to external migration and premature deaths as a result of the war, lack of drugs, supplies and equipment (including blood for transfusion), and falling standards of training and regulation. Most women and their families do not currently have access to comprehensive emergency obstetric care. Health care providers recommend reconstruction and strengthening of all components of the Iraqi health system which may only be achieved if security returns to the country. © 2009 Springer Science+Business Media, LLC.


Utz B.,Maternal and Newborn Health Unit | Kana T.,Maternal and Newborn Health Unit | van den Broek N.,Maternal and Newborn Health Unit
Midwifery | Year: 2015

Objective: the use of simulation training in obstetrics is an important strategy to improve health-care providers' competence to manage obstetric cases. As an increasing number of international programmes focus on simulation training, more information is needed about the practical aspects of planning for and organising skills laboratories. Methods: systematic review of peer reviewed literature published between January 2000 and June 2014. Thematic summary of 31 papers meeting inclusion criteria. Findings: skills laboratories need to reflect the clinical working environment and are ideally located at or near a health-care facility. A mix of low and high fidelity manikins combined with patient actors is recommended to be used with clear instructions, scenario setting and short lectures including audio-visual teaching aids. Motivated trainers are vital and a focus on 'team training' in smaller groups is beneficial. Practical information needed to set up and run a skills laboratory is provided with a proposed outline of a skills laboratory for obstetric simulation training. Conclusions and implications for practice: obstetric skills laboratories can play a substantial role in increasing competency and confidence of staff via 'skills and drills' type training. When considering setting up skills laboratories, this can be simply done using low fidelity manikins in the first instance with training facilitated by motivated trainers using realistic clinical scenarios. Overall, the review findings highlight the need for better documentation of factors that promote and/or are barriers to the effective use of skills laboratories. Synopsis: 31 papers detailing the planning and organisation of skills laboratories were reviewed in order to assess the factors necessary for their effectiveness and the vital role they play in increasing staff competencies. Setting up obstetric skills laboratories is worthwhile but requires in-depth planning. © 2014 The Authors.

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