Current evidence on basic emergency obstetric and newborn care services in Addis Ababa, Ethiopia; a cross sectional study

Abstract

BackgroundEmergency obstetric and neonatal care (EmONC) is a high impact priority intervention highly recommended for improving maternal and neonatal health outcomes. In 2008, Ethiopia conducted a national EmONC survey that revealed implementation gaps, mainly due to resource constraints and poor competence among providers. As part of an ongoing project, this paper examined progress in the implementation of the basic EmONC (BEmONC) in Addis Ababa and compared with the 2008 survey.MethodsA facility based intervention project was conducted in 10 randomly selected public health centers (HCs) in Addis Ababa and baseline data collected on BEmONC status from January to March 2013. Retrospective routine record reviews and facility observations were done in 29 HCs in 2008 and in10 HCs in 2013. Twenty-five providers in 2008 and 24 in 2013 participated in BEmONC knowledge and skills assessment. All the data were collected using standard tools. Descriptive statistics and t-tests were used.ResultsIn 2013, all the surveyed HCs had continuous water supply, reliable access to telephone, logbooks & phartograph. Fifty precent of the HCs in 2013 and 34% in 2008 had access to 24 hours ambulance services. The ratio of midwives to 100 expected births were 0.26 in 2008 and 10.3 in 2013. In 2008, 67% of the HCs had a formal fee waiver system while all the surveyed HCs had it in 2013. HCs reporting a consistent supply of uterotonic drugs were 85% in 2008 and 100% in 2013. The majority of the providers who participated in both surveys reported to have insufficient knowledge in diagnosing postpartum haemorrhage (PPH) and birth asphyxia as well as poor skills in neonatal resuscitation. Comparing with the 2008 survey, no significant improvements were observed in providers’ knowledge and competence in 2013 on PPH management and essential newborn care (p > 0.05).ConclusionThere are advances in infrastructure, medical supplies and personnel for EmONC provision, yet poor providers’ competences have persisted contributing to the quality gaps on BEmONC in Addis Ababa. Considering short-term in-service trainings using novel approaches for ensuring desired competences for large number of providers in short time period is imperative.

Healthcare workers’ behaviors and personal determinants associated with providing adequate sexual and reproductive healthcare services in sub-Saharan Africa: a systematic review

“…Doctors, with a mean score of 76.1%, appear to satisfy more criteria than mid- wives at 67.4%, who in turn satisfy more criteria than assistant midwives, a non-professional grade of staff in private facilities in Ghana.Nyango et al (2010)/Nigeria [29]Nonphysician obstetric care workers ( n  = 54)Descriptive cross-sectional studyKnowledge and skills among birth attendantsA minority of the obstetric care workers routinely performed basic ANC services. EmOC services provided, including the use of partograph by the respondents were below optimal levels as prescribed by WHO.Mirkuzie et al (2014)/Ethiopia [30]Nonphysician obstetric care workers ( n  = 49)Health facility-based interventionKnowledge and skills of basic EmOCObstetric care workers’ knowledge on basic EmOC was poor both in 2008 respondents as well as in 2013 respondents.Ameh et al (2012)/ Somalia [31]Physician and nonphysician obstetric care workers ( n  = 222)Descriptive studyKnowledge and skills of life-saving EmOC, provision of EmOC Availability and quality of EmOCThere was a significant improvement in knowledge (50%) and skills (100%) among the obstetric care workers. Confidence in EmOC provision was improved.Haile-Mariam et al (2012)/Ethiopia [32]Nonphysician obstetric care workers ( n  = 711)Cross-sectional studyKnowledge of EmOC, resuscitationHalf of the midwives interviewed reported having performed neonatal resuscitation in the past three months compared to only 20% of the nurses.…”

“…A majority of the studies ( n  = 10) investigated knowledge of other components of basic EmOC and found: basic EmOC knowledge among the obstetric care workers was poor, EmOC knowledge and skills and confidence in providing the services was improved by training, higher knowledge scores of some life-saving techniques, such as neonatal resuscitation were associated with having performed the technique recently and with geographical location [30–39]. However, type of healthcare worker such as being a nurse or a midwife did not have any associations with higher knowledge scores among healthcare workers in Ethiopia [32].…”

Availability and Quality of Emergency Obstetric and Newborn Care in Bangladesh

“…[33][34][35] In our study, the difference between the higher prevalence of provision of signal functions and higher quality of services in EmOC compared with EmNC was due to the lack of two signal functions: KMC and provision of corticosteroids.…”

Assessment of the quality of neonatal care in the Solomon Islands

“…[14][15][16] Inadequate hygiene measures, documentation, staff knowledge and skills and insufficient essential equipment are common themes. [16][17][18][19] In other assessments where essential equipment is available, other systemic factors, such as hand hygiene, inadequately trained staff, poor routine care, documentation and prescribing practices, have an impact the quality of newborn care, 20,21 highlighting the need to focus beyond structural improvements.…”