New paradigm old thinking: the case for emergency obstetric care in the prevention of maternal mortality in Nigeria

Abstract

BackgroundThe continuing burden of maternal mortality, especially in developing countries has prompted a shift in paradigm from the traditional risk assessment approach to the provision of access to emergency obstetric care services for all women who are pregnant. This study assessed the knowledge of maternity unit operatives at the primary and secondary levels of care about the concept of emergency obstetric care (EmOC) and investigated the contents of antenatal care (ANC) counseling services they delivered to clients. It also described the operatives' preferred strategies and practices for promoting safe motherhood and averting maternal mortality in South-west Nigeria.MethodsThe study population included all the 152 health workers (doctors, midwives, nurses and community health extension workers) employed in the maternity units of all the public health facilities (n = 22) offering maternity care in five cities of 2 states. Data were collected with the aid of a self-administered, semi-structured questionnaire and non-participant observation checklist. Results were presented using descriptive statistics.ResultsNinety one percent of the maternity unit staff had poor knowledge concerning the concept of EmOC, with no difference in knowledge of respondents across age groups. While consistently more than 60% of staff reported the inclusion of specific client-centered messages such as birth preparedness and warning/danger signs of pregnancy and delivery in the (ANC) delivered to clients, structured observations revealed that less than a quarter of staff actually did this. Furthermore, only 40% of staff reported counseling clients on complication readiness, but structured observations revealed that no staff did. Only 9% of staff had ever been trained in lifesaving skills (LSS). Concerning strategies for averting maternal deaths, 70% of respondents still preferred the strengthening of routine ANC services in the health facilities to the provision of access to EmOC services for all pregnant women who need it.ConclusionWe concluded that maternity unit operatives at the primary and secondary care levels in South-west Nigeria were poorly knowledgeable about the concept of emergency obstetric care services and they still prioritized the strengthening of routine antenatal care services based on the risk approach over other interventions for promoting safe motherhood despite a global current shift in paradigm. There is an urgent need to reorientate/retrain the staff in line with global best practices.

Knowledge of Birth Preparedness and Complication Readiness and Associated Factors among Health Care Providers in Benin City, Edo State

“…This finding on good knowledge of BPACR among HCPs identified in this study is in contrast to findings reported from a study [9] in IleIfe South Western Nigeria which revealed a poor knowledge among health care providers on the concept of Emergency Obstetric Care. This finding is worrisome as majority of these health care providers reported in the study [9] to have conducted counselling and health education sessions for pregnant women on BPACR during ANC sessions and as such could have communicated wrong information to unsuspecting clients and these can negatively influence their knowledge base and their decision making ability in taking up appropriate health intervention and making informed decision under emergency situation.…”

“…This finding is worrisome as majority of these health care providers reported in the study [9] to have conducted counselling and health education sessions for pregnant women on BPACR during ANC sessions and as such could have communicated wrong information to unsuspecting clients and these can negatively influence their knowledge base and their decision making ability in taking up appropriate health intervention and making informed decision under emergency situation.…”

“…Sixty three percent of respondents in this study [9] admitted that they counselled clients on the fact that all pregnancy may have risk of developing complications which they should be aware of and be prepared appropriately for. Despite claims by 75% of HCPs studied that they counselled pregnant women on danger signs of pregnancy and delivery with 40% of them also reported to have counselled their clients on complication readiness; the nonparticipant observational checklist findings however did not confirm most of the claims by the health care providers, as a lesser proportion of health care providers studied counselled their clients with the counselling session being more general than specific [9]. This study was therefore carried out to assess knowledge of birth preparedness and complication readiness (BPACR) and associated factors among health care providers in Benin City, with a view to improving health care provider knowledge for enhanced obstetric service delivery.…”

“…Furthermore, a study [9] in South West Nigeria to assess the level of health care providers' knowledge in public Health facilities on the concept of emergency obstetric care and antenatal counselling services revealed that 91% of health care providers studied had poor knowledge of emergency obstetric care. Sixty three percent of respondents in this study [9] admitted that they counselled clients on the fact that all pregnancy may have risk of developing complications which they should be aware of and be prepared appropriately for.…”

Assessment of Critical Knowledge on Maternal and Newborn care Services among Primary Level Nurse Mid-wives in Kapilvastu District of Nepal

“…9 Nigerian studies identified reduced knowledge of active management of third stage of labor among maternity health care providors. 10,11 Despite safe motherhood and neonatal health programme is a focused health programmes of Nepal, this initiative yet to be evaluated. 12 So, this research was conducted to assess the critical knowledge of maternal and newborn care among nursing personnel working under primary level health care facilities in Kapilvastu District of Nepal.…”