Determinants of Nutrition Care Practice by Midwives and Nurses in the Antenatal and Postnatal Care Settings: A Multi-Site Cross-sectional Survey From Ghana

Abstract

Background: Midwives and nurses are in an opportune position to provide nutrition care to pregnant women and lactating mothers during routine antenatal and postnatal care. However, midwives and nurses may not have adequate competencies and confidence to provide effective nutrition care. We evaluated the adequacy of nutrition education received in nursing and midwifery school; nutrition care competencies; self – efficacy and the nutrition care practice of midwives and nurses during routine antenatal and postnatal care in Ghana. We also evaluated determinants of nutrition care practice among these participants.Methods: This was a multi-site cross- sectional study conducted among midwives and nurses working at antenatal and postnatal contact points in Sunyani Municipality, Ghana. Data was collected using a self-administered questionnaire. Descriptive statistics of mean, standard deviation and frequencies were used to describe the data. Results: Almost 90% (n=267) of the participants received nutrition education during training. More than half of the participants were either unsatisfied or uncertain with: the amount of time allocated for nutrition education during training in school (77.5%); the integration of nutrition content into the curriculum (82.6%); and how nutrition course content was presented (77.4%). Almost 40% of the participants felt inadequately prepared from school to provide nutrition care during routine antenatal and postnatal care. The mean (±SD) knowledge of the participants was 57.46 (8.12) %. Participants attitude towards nutrition care was positive. Self-efficacy level ranged from moderate to low. Factors that had a positive association with nutrition care practice were age of respondents (B = 0.04; p = 0.002), nutrition-related knowledge (B = 0.05; p = 0.016), adequacy of nutrition education in school (0.14; p = 0.006), receipt of nutrition training after school (B = 0.38; p = 0.010) and nutrition care self-efficacy (B = 0.03; p = 0.048). Conclusion: Nutrition education received during nursing/midwifery training was unsatisfying and inadequate, resulting in participants inadequate knowledge in basic nutrition issues, feeling ill prepared, less confident and lacking the key skills to provide nutrition care. Although participants recognised nutrition care to be important and as their responsibility to provide it, they could not provide nutrition care as may be needed by mothers during routine antenatal and postnatal care.

Barriers and Facilitators Influencing Midwives’ Implementation of South Africa’s Maternal Care Guidelines in Postnatal Health: A Scoping Review

“…Similarly, there is a need for increasing awareness of the fundamental information regarding maternal care guidelines, ensuring the evidenced-based practice of the guidelines in their roles during the postnatal periods, orientating and training midwives about the guidelines, scaling up midwives and midwifery education programs, motivating of midwives to take effective actions in the postnatal periods, building capacity and preparedness during emergencies to bridge gaps in the service delivery systems are some of these measures (Bingham et al, 2018;Walker et al, 2019;Ngunyulu et al, 2018) When competent midwives provide effective postnatal care services, there is a decrease in maternal and newborn mortality rates as well as positive health outcomes (Walker et al, 2019). Promoting midwives' roles in the provision of high-quality postnatal care thus depends on a supportive environment, the availability of resources and equipment, the expansion of human resources through hiring and retention of more midwives, the development of skills, ongoing education, effective leadership, enabling policies and collaboration with stakeholders, as well as effective referral system (Jordan et al, 2018;Kumbiley et al, 2021).…”