Assessment of Midwife Knowledge, Practice, and Associated Factors towards Active Management of the Third Stage of Labor at Governmental Health Institutions in Tigray Region, Northern Ethiopia, 2018

  • BioMed Research International, Volume 2020, Year 2020

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Study Justification:
– Postpartum hemorrhage is a leading cause of maternal mortality and morbidity worldwide, accounting for over 25% of all maternal deaths.
– Uterine atony is the main cause of postpartum hemorrhage.
– Active management of the third stage of labor has been shown to reduce the occurrence of postpartum hemorrhage by 60% compared to expectant management.
– This study aimed to assess midwife knowledge, practice, and associated factors towards active management of the third stage of labor in governmental health institutions in the Tigray region of Northern Ethiopia.
Study Highlights:
– The study included 278 midwives from governmental health institutions in the Tigray region.
– 61.2% of the midwives had good knowledge, and 43.5% had good practice towards active management of the third stage of labor.
– Training related to active management of the third stage of labor and midwives’ practice level were significantly associated with their knowledge level.
– Midwives’ educational level, training related to active management of the third stage of labor, and knowledge level were significantly associated with their practice level.
– The study emphasized the need for midwives to update their academic level and knowledge and recommended that health institutions collaborate with the Tigray Regional Health Bureau to provide training for all midwives.
Recommendations for Lay Reader and Policy Maker:
– Midwives should receive training on active management of the third stage of labor to improve their knowledge and practice.
– Health institutions should collaborate with the Tigray Regional Health Bureau to arrange training programs for midwives.
– Midwives should update their academic level and knowledge to enhance their practice towards active management of the third stage of labor.
Key Role Players:
– Midwives: They need to update their academic level and knowledge and participate in training programs.
– Health Institutions: They should collaborate with the Tigray Regional Health Bureau to arrange training programs for midwives.
– Tigray Regional Health Bureau: They should provide support and resources for training programs and ensure their implementation.
Cost Items for Planning Recommendations:
– Training materials and resources
– Trainers’ fees and expenses
– Venue rental for training programs
– Transportation and accommodation for participants
– Administrative and logistical support for organizing training programs

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study design is clearly stated as an institutional-based cross-sectional study, which provides a snapshot of the situation at a specific point in time. The sample size calculation and data collection methods are described in detail, which adds to the credibility of the study. However, the abstract lacks information on the statistical analysis methods used and the specific results of the study. To improve the evidence, the abstract should include a summary of the statistical analysis performed and the key findings of the study, such as the prevalence of good knowledge and practice levels among midwives. Additionally, providing information on the limitations of the study would further enhance the strength of the evidence.

Introduction. Globally, postpartum hemorrhage is the most common cause of maternal mortality and morbidity, and it accounts for more than 25% of all maternal deaths. The majority of death due to postpartum hemorrhage is caused by uterine atony. Routine and correct usage of active management of the third stage of labor decreases the occurrence of postpartum hemorrhage by 60% when compared to expectant management of the third stage of labor. The purpose of this study was to assess midwife knowledge, practice, and associated factors towards active management of the third stage of labor at governmental health institutions in the Tigray region, 2018. Results. These study results showed that from the total study participants (N=278), 170 (61.2%) were good in knowledge and 121 (43.5%) were good in practice towards active management of the third stage of labor. Training related to active management of the third stage of labor (AOR=2.119, 95%CI=1.141, 3.3937) and practice level of midwives (AOR=8.089, 95%CI=4.103, 15.950) became significantly associated with the knowledge level. The educational level of midwives (AOR=3.811, 95%CI=2.015, 7.210), training related to active management of the third stage of labor (AOR=2.591, 95%CI=1.424, 4.714), and knowledge level of midwives towards active management of the third stage of labor (AOR=7.324, 95%CI=3.739, 14.393) were significantly associated with the practice level. This study showed that training related to active management of the third stage of labor was significantly associated with the knowledge and practice level of midwives. The educational level and knowledge level of midwives were significantly associated with the practice level of midwives towards active management of the third stage of labor. Therefore, midwives should update their academic level and knowledge. Health institutions in collaboration with the Tigray Regional Health Bureau should arrange training for all midwives to bring change.

Institutional-based cross-sectional study design was conducted from November 15/2017 to January 12/2018 to assess midwives’ knowledge, practice, and associated factors towards active management of the third stage of labor. The study was conducted at all governmental health institutions found in two zones of the Tigray region. The Tigray region is the northernmost of the nine regions of Ethiopia. It is also known as Region 1 according to the federal constitution. The state’s capital and largest city is Mekelle. Tigray is bordered by Eritrea to the north, Sudan to the west, Afar region to the east, and the Amhara region to the south and southwest [18]. Based on the projection made from the Ethiopian census of 2007, the region had a total population of 4,806,843 of whom 2,441,158 (50.8%) were female in 2015. The region is administratively divided into 7 zones including one special zone (Mekelle). The Tigray regional state has a total of 24 hospitals and 254 health centers, and the total number of midwives in the region is 918. The study was conducted in two zones of the Tigray region, the central zone and Mekelle specialized zone which contains 73 governmental health institutions (62 health centers and 11 hospitals), and the total number of midwives in the two zones was 304 [19]. So, all midwives who were working in the delivery room of selected governmental health institutions (62 health centers and 11 hospitals) in the Tigray region during data collection were included. The sample size was determined using a single population proportion formula at 95% confidence interval with the assumption of the prevalence of AMTSL knowledge in Ethiopia 37.7% [20]. With α = 0.05, marginal error d = 0.05. After using the correction formula, the final sample size became 285 midwives. Seven zones of the Tigray region were clustered, and two of them (30%) were taken by simple random sampling, and all midwives (285) working in the governmental health institutions (11 hospitals and 62 health centers) that are found in the two selected zones of the Tigray region who fulfilled the inclusion criteria were included in the study. Data was collected by face-to-face interview questionnaires and observation by using a semistructured questionnaire and observational checklist. Semistructured questionnaires were adapted and adopted from different literature, while the observational checklist was adopted from ICM and FIGO guidelines. The face-to-face interview using a questionnaire was used to assess study participant sociodemographic information and knowledge, and an observational checklist was used to assess midwife practice. Data was collected by 20 degree midwives who had experience in data collection and 3 supervisors. Questionnaires and checklist were prepared in the English language by the principal investigator and reviewed by the advisors. These questionnaires and checklist were pretested on 10% of the calculated sample size outside the selected study area (Machew Hospital, Adigudom Primary Hospital, and Hewane Health Center), and one-day training was given by the principal investigator for data collectors and supervisors concerning the research objective, data collection tools, procedures, and how to fill the questionnaire and checklist properly. Moreover, data quality was assured by designing a data collection instrument, and 10% of the collected data was checked by the supervisor daily for completeness, and finally, the principal investigator monitored the overall quality of data collection. The collected data was cleaned, coded, and entered into Epi Info version 3.5.1 and transported to SPSS (Statistical Package for the Social Sciences) version 20 for analysis. Descriptive statistical analysis was used to compute frequency, percentage, and others such as measures of central tendency. Binary logistic regression analysis was used to identify the association between dependent and independent variables. Variables with a significant association in the bivariate analysis were entered into multivariate analysis to determine the knowledge and practice of midwives towards AMTSL, and variables with p value less than 0.2 and 0.05 were considered statistically significant for bivariate and multivariate regression, respectively. The overall results were presented in texts, tables, and figures. These are sociodemographic characteristics such as religion, ethnicity, age, sex, and others such as year of experience, place of work, level of education, in-service training, access to reading material, and availability of uterotonic drugs. The dependent variables are knowledge and practice. Knowledge refers to the level of awareness and understanding of midwives regarding active management of the third stage of labor. Good in knowledge is defined as those who knew 5 and above from seven questions prepared to assess the knowledge level of midwives towards AMTSL. Poor in knowledge is defined as those who answered less than five questions from seven questions prepared to assess knowledge of midwives on AMTSL. Practice refers to the ability of midwives to carry out the management of the third stage of labor. Good in practice is defined as those who performed13 steps correctly in the proper sequence from 15 steps prepared to assess midwives’ skill. Poor in practice is defined as those who performed less than 13 steps correctly in the proper sequence from 15 steps prepared to assess midwife skill.

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Based on the provided information, here are some potential innovations that can be used to improve access to maternal health:

1. Training Programs: Develop comprehensive training programs for midwives on active management of the third stage of labor (AMTSL). These programs should focus on updating midwives’ knowledge and skills to ensure they are equipped to provide effective care during the third stage of labor.

2. Educational Initiatives: Implement educational initiatives to improve the academic level and knowledge of midwives. This can include providing access to updated reading materials, organizing workshops, and encouraging continuous learning and professional development.

3. Collaboration with Health Institutions: Establish partnerships between health institutions and the Tigray Regional Health Bureau to arrange training programs for midwives. This collaboration can help ensure that all midwives receive the necessary training and support to improve their practice in active management of the third stage of labor.

4. Quality Assurance Measures: Implement quality assurance measures to monitor and improve the practice of midwives. This can involve regular supervision, monitoring of adherence to guidelines, and providing feedback and support to midwives to enhance their skills and practice.

5. Access to Uterotonic Drugs: Ensure the availability of uterotonic drugs, which are essential for preventing postpartum hemorrhage. This can be achieved by strengthening the supply chain management system and ensuring that health institutions have an adequate stock of these drugs.

6. Technology Integration: Explore the use of technology, such as mobile applications or telemedicine, to provide remote support and guidance to midwives in rural or underserved areas. This can help overcome geographical barriers and improve access to maternal health services.

7. Community Engagement: Involve the community in promoting maternal health and raising awareness about the importance of active management of the third stage of labor. This can be done through community-based education programs, involving community leaders, and leveraging existing community networks.

These innovations can contribute to improving access to maternal health by enhancing midwives’ knowledge and practice, ensuring the availability of necessary resources, and engaging the community in promoting maternal health.
AI Innovations Description
Based on the study titled “Assessment of Midwife Knowledge, Practice, and Associated Factors towards Active Management of the Third Stage of Labor at Governmental Health Institutions in Tigray Region, Northern Ethiopia, 2018,” the following recommendation can be developed into an innovation to improve access to maternal health:

1. Training Programs: Health institutions in collaboration with the Tigray Regional Health Bureau should arrange training programs for all midwives to update their knowledge and skills related to active management of the third stage of labor. These programs should focus on providing comprehensive education on the proper techniques and practices to prevent postpartum hemorrhage.

2. Academic Upgrading: Midwives should be encouraged to upgrade their academic level to enhance their knowledge and understanding of maternal health. This can be achieved through providing opportunities for further education and professional development, such as advanced courses or degree programs in midwifery.

3. Access to Reading Material: Midwives should have access to relevant reading materials, guidelines, and resources that provide evidence-based information on active management of the third stage of labor. Health institutions should ensure that these materials are readily available and regularly updated.

4. Availability of Uterotonic Drugs: Health institutions should ensure the availability of uterotonic drugs, which are essential for preventing postpartum hemorrhage. This includes proper procurement, storage, and distribution of these drugs to ensure that they are accessible when needed.

5. Supervision and Monitoring: Regular supervision and monitoring of midwives’ practice towards active management of the third stage of labor should be implemented. This can help identify areas for improvement and provide feedback and support to midwives to ensure adherence to best practices.

6. Collaboration and Networking: Health institutions should foster collaboration and networking among midwives, healthcare providers, and relevant stakeholders involved in maternal health. This can facilitate knowledge sharing, exchange of best practices, and continuous learning.

By implementing these recommendations, there can be significant improvements in midwives’ knowledge, practice, and ultimately, access to maternal health services.
AI Innovations Methodology
Based on the provided information, here are some potential recommendations to improve access to maternal health:

1. Increase training and education: It is important to provide comprehensive and regular training programs for midwives on active management of the third stage of labor (AMTSL). This will help improve their knowledge and practice towards AMTSL, ultimately reducing the occurrence of postpartum hemorrhage.

2. Improve access to reading materials: Midwives should have easy access to up-to-date reading materials, guidelines, and resources related to AMTSL. This will enable them to stay updated with the latest evidence-based practices and enhance their knowledge and skills.

3. Strengthen supervision and mentorship: Regular supervision and mentorship programs should be implemented to support midwives in their practice of AMTSL. This will provide them with guidance, feedback, and opportunities for continuous learning and improvement.

4. Ensure availability of uterotonic drugs: Uterotonic drugs are essential for the prevention and management of postpartum hemorrhage. Health institutions should ensure a consistent supply of these drugs and promote their proper use during the third stage of labor.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Baseline assessment: Conduct a comprehensive assessment of midwives’ knowledge, practice, and associated factors towards AMTSL, similar to the study described in the provided information. This will establish a baseline understanding of the current situation.

2. Intervention implementation: Implement the recommended interventions, such as training programs, improved access to reading materials, supervision and mentorship programs, and ensuring availability of uterotonic drugs. These interventions should be implemented in a systematic and coordinated manner.

3. Monitoring and evaluation: Regularly monitor and evaluate the implementation of the interventions. This can be done through data collection, observation, and feedback from midwives and other stakeholders. Assess the extent to which the interventions are being implemented as planned.

4. Impact assessment: Measure the impact of the interventions on midwives’ knowledge, practice, and access to maternal health services. This can be done through follow-up assessments, comparing the post-intervention data with the baseline data. Analyze the data to determine if there have been improvements in midwives’ knowledge, practice, and access to maternal health services.

5. Continuous improvement: Based on the findings from the impact assessment, identify areas for further improvement and make necessary adjustments to the interventions. This could involve refining training programs, addressing any gaps in knowledge or practice, and ensuring ongoing support and resources for midwives.

By following this methodology, it will be possible to simulate the impact of the recommendations on improving access to maternal health and make evidence-based decisions for further interventions and improvements.


Statistics:
Citations: 3
Identifiers:
DOI: 10.1155/2020/8547040
ISSN: 23146133
Research Areas:
Disparities, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Social Determinants, Workforce
Study Countries:
Eritrea, Ethiopia, Multi-Countries, Sudan
Study Design:
Cross Sectional Study, Grounded Theory
Study Approach:
Quantitative
Participants Gender:
Female
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