AimThe aim of the study was to investigate health workers' perception of the quality of, and factors which impact provision of quality emergency obstetric care. MethodsThis exploratory, descriptive qualitative study was conducted at Mwanza district hospital in Malawi. Qualitative data was obtained through 14 individual in-depth interviews with the health workers involved in the management of women who experienced major obstetric complications. ResultsThe health workers' overall perception of the quality of emergency obstetric care provided was poor. The poor quality of care was identified as related to client related factors and facility/staff factors. Client factors which emerged as contributing to poor quality care were; the client delay in seeking care: reliance on TBAs, reliance on traditional medications, and lack of awareness regarding signs of an obstetric emergency. Facility/ staff themes which emerged as contributing to the poor care were; inadequate resources, inadequate staffing, poor teamwork, and inadequate knowledge/supervision. ConclusionThe findings of this study reveal that health care workers rate the quality of emergency obstetric care they provide as poor. They were able to identify structure and process factors which contribute to this overall poor quality emergency obstetric care provided. These were attributed to health care system problems and client problems. Only through addressing the contributing factors will true improvement of management of obstetric emergencies occur.

Background: Sub-Saharan Africa has the world's highest rates of maternal and perinatal mortality and accounts for two-thirds of new HIV infections and 25% of preterm births. Antenatal care, as the entry point into the health system for many women, offers an opportunity to provide life-saving monitoring, health promotion, and health system linkages. Change is urgently needed, because potential benefits of antenatal care are not realized when pregnant women experience long wait times and short visits with inconsistent provisioning of essential services and minimal health promotion, especially for HIV prevention. This study answers WHO's call for the rigorous study of group antenatal care as a transformative model that provides a positive pregnancy experience and improves outcomes.Methods: Using a hybrid type 1 effectiveness-implementation design, we test the effectiveness of group antenatal care by comparing it to individual care across 6 clinics in Blantyre District, Malawi. Our first aim is to evaluate the effectiveness of group antenatal care through 6 months postpartum. We hypothesize that women in group care and their infants will have less morbidity and mortality and more positive HIV prevention outcomes. We will test hypotheses using multi-level hierarchical models using data from repeated surveys (four time points) and health records. Guided by the consolidated framework for implementation research, our second aim is to identify contextual factors related to clinic-level degree of implementation success. Analyses use within and across-case matrices. Discussion: This high-impact study addresses three global health priorities, including maternal and infant mortality, HIV prevention, and improved quality of antenatal care. Results will provide rigorous evidence documenting the effectiveness and scalability of group antenatal care. If results are negative, governments will avoid spending on less effective care. If our study shows positive health impacts in Malawi, the results will provide strong evidence and valuable lessons learned for widespread scale-up in other low-resource settings. Positive maternal, neonatal, and HIV-related outcomes will save lives, impact the quality of antenatal care, and influence health policy as governments make decisions about whether to adopt this innovative healthcare model. Trial registration: ClinicalTrials.gov registration number NCT03673709. Registered on September 17, 2018.

The positive effects of the CenteringPregnancy group antenatal care (ANC) model on perinatal outcomes in the United States has led to its adaptation and implementation in many low‐ and middle‐income countries. Facilitative discussions are a core component of this group ANC model. Facilitator training lays a critical foundation for delivery of this paradigm‐shifting model as practitioners learn to adapt their approach to health education from didactive to facilitative. However, there is little rigorous research focused on best practices for training group health care facilitators and none that is guided by a theoretical framework. Kolb's experiential learning theory offers a theoretical framework to guide the development of training workshops that allow trainees to experience, reflect on, and practice the facilitation skills needed to deliver this evidence‐based intervention. This article describes an experiential learning‐based training workshop that was implemented as part of an ongoing effectiveness‐implementation trial of a Centering‐based group ANC model in Blantyre District, Malawi. We provide a blueprint for conducting group ANC facilitator trainings that, in addition to imparting knowledge, effectively builds confidence and buy‐in to this paradigm‐changing approach to ANC delivery. This blueprint can be adapted for use in designing and implementing group health care across settings in the United States and globally.

National standards for the identification and management of obstetric emergencies have been established in Malawi. This study was conducted to determine the level of compliance with national standards and protocols. A cross-sectional descriptive prospective study was conducted. A total of 799 deliveries occurred during the observation period. Management of 42 women who experienced emergency obstetric complications was observed. Emergency complications observed included 12 with eclampsia/pre-eclampsia, 11 cases of postpartum hemorrhage, 8 cases of obstructed labour, 6 cases of ruptured uterus and 5 women with puerperal sepsis. Nine patients died secondary to obstetric emergencies. This study revealed inconsistent and poor compliance with national standards for management of pre-eclampsia and postpartum hemorrhage (PPH). Compliance rates ranged from 0–67% for management of pre-eclampsia/eclampsia, and 9–81% for management of postpartum hemorrhage. This study reveals that there is need for stricter adherence to national standards.

A midwife is the only health worker most of the women of the childbearing group in Malawi will ever rneet in their lifetime. A midwife plays an essential role in the promotion of health and provision of care to these women. It is therefore, very important that midwives be available for the well being of these women. However, mere presence of midwives is not adequate for women's optimal health.