Background Midwives are the key skilled birth attendants in Afghanistan. Rapid assessment of public and private midwifery education schools was conducted in 2017 to examine compliance with national educational standards. The aim was to assess midwifery education to inform Afghanistan Nurses and Midwives Council and other stakeholders on priorities for improving quality of midwifery education. Methods A cross-sectional assessment of midwifery schools was conducted from September 12–December 17, 2017. The Midwifery Education Rapid Assessment Tool was used to assess 29 midwifery programs related to infrastructure, management, teachers, preceptors, clinical practice sites, curriculum and students. A purposive sample of six Institute of Health Sciences schools, seven Community Midwifery Education schools and 16 private midwifery schools was used. Participants were midwifery school staff, students and clinical preceptors. Results Libraries were available in 28/29 (97%) schools, active skills labs in 20/29 (69%), childbirth simulators in 17/29 (59%) and newborn resuscitation models in 28/29 (97%). School managers were midwives in 21/29 (72%) schools. Median numbers of students per teacher and students per preceptor were 8 (range 2–50) and 6 (range 2–20). There were insufficient numbers of teachers practicing midwifery (132/163; 81%), trained in teaching skills (113/163; 69%) and trained in emergency obstetric and newborn care (88/163; 54%). There was an average of 13 students at clinical sites in each shift. Students managed an average of 15 births independently during their training, while 40 births are required. Twenty-four percent (7/29) of schools used the national 2015 curriculum alone or combined with an older one. Ninety-one percent (633/697) of students reported access to clinical sites and skills labs. Students mentioned, however, insufficient clinical practice due to low case-loads in clinical sites, lack of education materials, transport facilities and disrespect from school teachers, preceptors and clinical site providers as challenges. Conclusions Positive findings included availability of required infrastructure, amenities, approved curricula in 7 of the 29 midwifery schools, appropriate clinical sites and students’ commitment to work as midwives upon graduation. Gaps identified were use of different often outdated curricula, inadequate clinical practice, underqualified teachers and preceptors and failure to graduate all students with sufficient skills such as independently having supported 40 births.
Background Little is known whether women’s knowledge of perceived severity of illness and sociodemographic characteristics of women influence healthcare seeking behavior for maternal health services in Afghanistan. The aim of this study was to address this knowledge gap. Methods Data were used from the Afghanistan Health Survey 2018. Women’s knowledge in terms of danger signs or symptoms during pregnancy was assessed. The signs or symptoms were bleeding, swelling of the body, headache, fever, or any other danger sign or symptom (e.g., high blood pressure). A categorical variable of knowledge score was created. The outcome variables were defined as ≥ 4 ANC vs. 0–3 ANC; ≥ 4 PNC vs. 0–3 PNC visits; institutional vs. non-institutional deliveries. A multivariable generalized linear model (GLM) was used. Results Data were used from 9,190 ever-married women, aged 13–49 years, who gave birth in the past two years. It was found that 56%, 22% and 2% of women sought healthcare for institutional delivery, ≥ 4 ANC, ≥ 4 PNC visits, respectively, and that women’s knowledge is a strong predictor of healthcare seeking [odds ratio (OR)1.77(1.54–2.05), 2.28(1.99–2.61), and 2.78 (2.34–3.32) on knowledge of 1, 2, and 3–5 signs or symptoms, respectively, in women with ≥ 4 ANC visits when compared with women who knew none of the signs or symptoms. In women with ≥ 4 PNC visits, it was 1.80(1.12–2.90), 2.22(1.42–3.48), and 3.33(2.00–5.54), respectively. In women with institutional deliveries, it was 1.49(1.32–1.68), 2.02(1.78–2.28), and 2.34(1.95–2.79), respectively. Other strong predictors were women’s education level, multiparity, residential areas (urban vs. rural), socioeconomic status, access to mass media (radio, TV, the internet), access of women to health workers for birth, and decision-making for women where to deliver. However, age of women was not a strong predictor. Conclusion Our findings suggest that pregnant women’s healthcare seeking behaviour is influenced by women’s knowledge of danger signs and symptoms during pregnancy, women’s education, socioeconomic status, access to media, husband’s, in-laws’ and relatives’ decisions, residential area, multiparity, and access to health workers. The findings have implications for promoting safe motherhood and childbirth practices through improving women’s knowledge, education, and social status.
Background Midwives are the key skilled birth attendants in Afghanistan. Rapid assessment of public and private midwifery education schools was conducted in 2017 to examine compliance with national educational standards. Aim was to assess midwifery education to inform Afghanistan Nurses and Midwives Council and other stakeholders priorities for improving quality of midwifery education. Methods A cross-sectional assessment was conducted from September 12–December 17, 2017, using a modified Midwifery Education Rapid Assessment Tool to assess education quality aspects related to infrastructure, management, teachers, preceptors, clinical practice sites, curriculum and students in 29 midwifery schools. A purposive sample of six Institute of Health Sciences schools, seven Community Midwifery Education schools and 16 private midwifery schools was used. Participants were midwifery school staff, students and clinical preceptors. Results Libraries were available in 28/29 (97%) schools, active skills labs in 20/29 (69%), childbirth simulators in 17/29 (59%) and newborn resuscitation models in 28/29 (97%). School managers were midwives in 21/29 (72%) schools. Median numbers of students per teacher and students per preceptor were 8 (range 2–50) and 6 (range 2–20). There were insufficient numbers of teachers practicing midwifery (132/163; 81%), trained in teaching skills (113/163; 69%) and trained in emergency obstetric and newborn care (88/163; 54%). There was an average of 13 students at clinical sites in each shift. Students managed an average of 15 births independently during their training, while 40 births are required. Twenty-four percent (7/29) of schools used the national 2015 curriculum alone or combined with an older one. Ninety-one percent (633/697) of students reported access to clinical sites and skills labs. Students mentioned, however, insufficient clinical practice, lack of education materials, transport facilities and disrespect from school teachers, preceptors and clinical site providers as challenges. Conclusions Positive findings included availability of required infrastructure, amenities, approved curricula in 7 of the 29 midwifery schools, appropriate clinical sites and students’ commitment to work as midwives upon graduation. Gaps identified were use of different often outdated curricula, inadequate clinical practice, underqualified teachers and preceptors and failure to graduate all students with sufficient skills such as independently having supported 40 births.
Background The importance of healthcare seeking for women’s health is well documented. However, less is known how women’s knowledge of perceived severity of illness affects healthcare seeking behaviour. This study examined the associations of women’s knowledge of perceived severity of illness with healthcare seeking behaviour for maternal health services. Methods Data were used from the Afghanistan Health Survey 2018. Women’s knowledge in terms of knowing danger signs or symptoms related to maternal health was assessed. The signs or symptoms a woman was expected to name were bleeding, swelling of the body, headache, fever, or any other danger sign or symptom (e.g., high blood pressure). A categorical variable on knowledge was created. The outcome variables were defined as ≥ 4 ANC vs. 0–3 ANC; ≥ 4 PNC vs. 0–3 PNC visits; institutional vs. non-institutional deliveries. A multivariate regression model was applied. Results Data were used from 9,190 ever-married women, aged 13–49 years, who gave birth in the past two years. It was found that only 22% and 2% of women sought healthcare for ≥ 4 ANC, ≥ 4 PNC visits, respectively. Fifty six percent of women had institutional deliveries. Multivariate analysis showed that the odds ratios (ORs) for ANC visits were 1.76(95%CI;1.53–2.04), 2.25(95%CI;1.97–2.58), and 2.81 (95%CI:2.35–3.35) in women who knew 1, 2, and 3–5 signs or symptoms, respectively, compared to women who knew none. The ORs for PNC visits were 1.81(95%CI:1.12–2.93), 2.22(95%CI:1.42–3.48), and 3.37(95%CI:2.02–5.62) in women who knew 1, 2, and 3–5 signs or symptoms, respectively, compared to women who knew none. The ORs for institutional deliveries were 1.38(95%CI:1.22–1.56), 1.80(95%CI:1.59–2.04), and 1.97(95%CI:1.64–2.37) in women who knew 1, 2, and 3–5 signs or symptoms, respectively, compared to women who knew none. It was found that in women who did not use at least 4 ANC, 4 PNC visits, or institutional deliveries, 27%, 33%, and 23% of them, respectively, said that it was unnecessary to seek healthcare. Main perceived barriers mentioned, were distance to clinics, financial constraints, and lack of female staff. Conclusion Health interventions are needed to promote women’s knowledge of perceived severity of illness, and to address perceived barriers in accessing maternal health services.
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