Evidence-Based Intrapartum Practice and Associated Factors Among Obstetric Care Providers Working in Public Hospitals of South Wollo Zone North-Central Ethiopia: An Institutional-Based Cross-Sectional Study

  • International Journal of Women's Health, Volume 14, Year 2022

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Study Justification:
– Maternal mortality is a significant issue in Ethiopia, and evidence-based intrapartum practices can improve maternal and neonatal health outcomes.
– The study aimed to assess the proportion of evidence-based intrapartum practice among obstetric care providers in public hospitals in South Wollo zone, North-central Ethiopia.
– Understanding the current practices and predictors can help identify areas for improvement and provide better-quality care to laboring mothers.
Highlights:
– The overall magnitude of evidence-based intrapartum care among obstetric care providers was found to be 54.7%.
– Factors such as knowledge, computer access, work experience, and training were statistically significant predictors of evidence-based intrapartum practice.
– Increasing knowledge of intrapartum care, providing continuous training, creating a safe working environment for experienced providers, and ensuring easy access to computers in the workplace are recommended to improve evidence-based intrapartum care and the quality of care.
Recommendations:
– Increase knowledge of intrapartum care among obstetric care providers through training programs and continuous education.
– Provide access to computers and the internet in the workplace to facilitate evidence-based practice.
– Create a safe working environment that supports experienced providers in delivering quality care.
– Strengthen the implementation of national protocols and guidelines for intrapartum care.
Key Role Players:
– Obstetric care providers (midwives, integrated emergency surgical officers, medical doctors)
– Hospital administrators and managers
– Training institutions and educators
– Health policymakers and government officials
– Professional associations and organizations
Cost Items for Planning Recommendations:
– Training programs and workshops for obstetric care providers
– Procurement and installation of computers and internet access in hospitals
– Infrastructure improvements to create a safe working environment
– Development and dissemination of educational materials and guidelines
– Monitoring and evaluation activities to assess the implementation of recommendations
Please note that the cost items provided are general categories and not actual cost estimates. The specific costs will depend on the context and resources available in South Wollo zone, North-central Ethiopia.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on an institutional-based cross-sectional study conducted in public hospitals of South Wollo Zone, North-central Ethiopia. The study employed a simple random sampling technique and collected data using a structured questionnaire and observational checklist. Bivariate and multivariable logistic regression analysis was conducted to determine predictors associated with evidence-based intrapartum practice. The overall magnitude of evidence-based intrapartum care was found to be 54.7%. The study provides specific factors that are statistically significant with evidence-based intrapartum practice, such as knowledge, computer access, work experience, and training. The study concludes that increasing knowledge, providing continuous training, creating a safe working environment, and ensuring easy access to computers in the workplace are needed to improve evidence-based intrapartum care. However, the abstract lacks information on the limitations of the study and the generalizability of the findings. To improve the evidence, future studies could consider a larger sample size and include a more diverse range of hospitals and healthcare providers.

Background: Even though recent progress, Ethiopia continues to be one of the most significant contributors to the worldwide burden of maternal mortality. Evidence-based intrapartum practices have significant value to improve the health outcome of the mother and the neonate. However, in Ethiopia, it is not exercised according to the standard. Assessing the proportion of evidence-based intrapartum practice and predictors is essential and vital to providing better-quality care to laboring mothers. Hence, this study was aimed to assess the magnitude of evidence-based intrapartum practice and predictors among obstetric care providers working in public hospitals in South Wollo zone, North-central Ethiopia. Patient and Methods: An institutional-based cross-sectional study was employed among 398 obstetric care providers from February 1 to April 30, 2021. Study participants were selected using a simple random sampling technique. Both a structured questionnaire and an observational checklist were used to collect the data. Bivariate and multivariable logistic regression was done to determine predictors associated with evidence-based intrapartum practice and P-value <0.05 at 95% CI was declared as statistically significant. Results: The overall magnitude of evidence-based intrapartum care was 54.7% [95% CI (49.6–59.7%)]. Knowledge [AOR = 2.1; 95% CI (1.30–3.38)], computer access [AOR = 2.04; 95% CI (1.27–3.27)], work experience [AOR= 2.13; 95% CI (1.21–3.73)] and training [AOR = 1.81; 95% CI (1.12–2.93)] were found to be statistically significant with evidence-based intrapartum practice. Conclusion: We found that only half of the obstetric care providers applied evidence-based intrapartum practice. Increasing knowledge of intrapartum care, providing continuous training, making the working environment safe to handle experienced providers, and easily access computers in the workplace will be needed to maximize the practice of evidence-based intrapartum care and scale up the quality of care.

An institutional-based cross-sectional study was performed in public hospitals of South Wollo Zone, North-central Ethiopia from February 1 to April 30/2021. South Wollo Zone is among the ten zones found in Amhara Regional State of Ethiopia. South Wollo has 16 hospitals (12 public and four private), 138 health centers, and many private clinics are placed. Out of the total 12 public hospitals, only one is a comprehensive specialized hospital, two are general hospitals and the rest nine were primary hospitals. The source populations were all obstetric care providers who were working in public hospitals of South Wollo zone, whereas the study populations comprise all obstetrics care providers who were working in selected public hospitals of South Wollo zone North-central Ethiopia during the study period. All obstetrics care providers who have a minimum of diploma qualifications in the health-care profession, and had provided obstetric care in the past 6 months in those selected public hospitals of South Wollo zone during the data period were included. Based on the zonal department health office information reports, an overall 950 obstetrics care providers were found in all twelve public hospitals of south Wollo zone North-central Ethiopia and 519 obstetric care providers were found in thus selected six public hospitals. A total of 398 respondents were identified by using single population proportion formula with the assumptions proportion of evidence based intrapartum practice among obstetrics care provider was 38.2% from a similar study,13 the margin of error 5%, confidence interval 95% and 10% non-response rate. Twelve public hospitals provide labor and delivery service in the study area. From the 12 hospitals, we selected six randomly by using lottery methods (Dessie, Akesta, Mekane Selam, Mekdela, Tenta, and Wegidi public hospitals). Samples were selected and proportionally allocated to each selected hospital based on the total number of obstetric care providers and study groups (Dessie = 178, Akesta = 72, Mekane selam=76, Mekdela = 70, Tenta = 65, and Wegidi = 58). Therefore, the calculated sample for each hospital was: Dessie = 136, Akesta = 55, Mekane selam = 58, Mekdela = 54, Tenta = 50, and Wegidi = 45. Evidence based intrapartum practice. Socio-demographic characteristics: age, sex, profession, qualification, income, marital status and experience. Managerial variable: managerial motivation, interactive EBP skill building workshops, in-service training, access to computer and internet, regular mentoring, role clarity. Individual variable: Searching up-to-date health information, participating on conference, training, seminar, and case-study over the last 6 months, Knowledge and Attitude. Evidence-based intrapartum practice: It is a set of standard activities recommended by WHO and national protocols that are expected to be performed by obstetric care providers during intrapartum care. Obstetrics care providers who scored greater than or equal to the median value of intrapartum-practice-related observational checklists.13,15 Obstetric care providers for this study includes: midwife, Integrated emergency surgical officers (IESO) and medical doctors who work in labour and delivery ward to give care and treatment for the women in childbirth and during the period before and after delivery. Knowledge: Obstetric care providers who scored greater than or equal to the median value of knowledge-related questions were considered as having a good knowledge while obstetric care providers who scored less than the median value were considered as having poor knowledge.13 Attitude: Those obstetric care providers who scored greater than or equal to the median value of attitude-related questions of intrapartum practice were labelled as having a positive attitude, whereas obstetric care providers who scored less than the median values were considered as negative attitude.13 Qualification: It is the obstetric care provider’s educational level. It includes: Diploma, BSc, MSc, General practitioners and specialist. Data were collected using a pretested and structured self-administered questionnaire supplemented with observational checklists adapted from a previous study,13 from WHO recommendations on intrapartum care for a positive childbirth experience.15 The questionnaire contains 36 questions arranged into four parts; socio-demographic factors, organizational and individual-related factors, knowledge, and attitude parts. The observational checklist also contains twenty-one items and the questionnaire was designed to elicit a “yes” or “no” response to gather the required information related to the utilization of evidence-based intrapartum care or practice-related questions. Pre-testing of both the questionnaire and observational checklist was conducted on 5% of the samples (20 obstetric care providers) in Haik primary public hospital which is not included in the study. Based on the pre-test modifications and corrections including wording, logical sequence, and skip patterns were immediately corrected before use. The data were collected by six BSc Midwives who had previous experience and were supervised by BSc Midwives. Two days of training were given for both data collectors and supervisors on the objective of the study, data collection techniques, items of the tool, and the privacy of the participants. The completeness and consistency of the collected data were cross-checked and compiled by supervisors and principal investigators on a daily basis. First, the data were collected by an observational checklist blindly and then by self-administered questionnaires. The collected data were entered into Epi Data version 4.2 and analyzed using SPSS Version 25 statistical software. Descriptive statistics such as frequencies and percentages were calculated. In addition, the cross-tabulation was computed using dependent and independent variables. To assess the effect of the independent variable on the dependent variable, bivariate and multivariable logistic regression analysis was carried out. Those variables in bivariate analysis whose p-value was less than 0.25 (p < 0.25) were fitted in multiple logistic regression by controlling confounding variables. Finally, a significant association was declared at a p-value of <0.05 with 95% CI and AOR, and the result was presented in the form of figures, tables, graphs, and charts. The ethical issue was considered in all stages of the research process, some of the most important are the following: Ethical clearance and approval were obtained from the Ethical Review Committee of college of medicine and health science coordination office under the delegation of the Institutional Review Board (IRB) of Wollo University. Then a letter of permission was secured from administrative bodies of the area to communicate with relevant bodies at the hospital. After explaining the objectives of the study in detail, informed written consent was taken from all study participants. All participants were reassured of the anonymity and personal identifiers were not used. Then, after obtaining informed consent from every participant, the data collectors continued the job by giving due respect to the norms, values, and beliefs of the study participant and ensure the confidentiality of the data.

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

1. Implementing a digital health system: This could involve providing obstetric care providers with access to computers and the internet, as mentioned in the study. By having access to digital resources, providers can easily access up-to-date health information, guidelines, and protocols, which can improve the quality of care they provide during intrapartum care.

2. Continuous training and skill-building workshops: The study found that training was a significant predictor of evidence-based intrapartum practice. Therefore, it is important to provide regular training and workshops for obstetric care providers to enhance their knowledge and skills in intrapartum care. This can help ensure that providers are up-to-date with the latest evidence-based practices and guidelines.

3. Creating a safe working environment: The study mentioned the need to make the working environment safe for experienced providers. This could involve implementing safety protocols and guidelines to prevent complications during childbirth. Additionally, ensuring that providers have access to necessary equipment and resources can contribute to a safer working environment.

4. Strengthening collaboration and communication: Improving communication and collaboration between obstetric care providers, such as midwives, integrated emergency surgical officers, and medical doctors, can enhance the coordination of care during intrapartum care. This can help ensure that all providers are working together effectively to provide the best possible care for laboring mothers.

5. Utilizing evidence-based guidelines and protocols: Implementing evidence-based guidelines and protocols for intrapartum care can help standardize practices and ensure that all providers are following best practices. This can improve the quality and consistency of care provided to laboring mothers.

Overall, these innovations aim to improve access to maternal health by enhancing the knowledge and skills of obstetric care providers, creating a safe working environment, promoting collaboration and communication, and implementing evidence-based practices and guidelines.
AI Innovations Description
The recommendation to improve access to maternal health based on the study findings is as follows:

1. Increase knowledge of intrapartum care: Providing continuous training and educational programs for obstetric care providers can help improve their knowledge and understanding of evidence-based intrapartum practices. This can be done through workshops, seminars, conferences, and case-study discussions.

2. Ensure access to computers and internet: Obstetric care providers should have easy access to computers and the internet in their workplace. This will enable them to access up-to-date health information and guidelines, which can support evidence-based intrapartum practice.

3. Create a safe working environment: It is important to create a safe and supportive working environment for experienced providers. This can be achieved by implementing proper mentoring programs, ensuring role clarity, and providing managerial motivation. A positive work environment can contribute to better-quality care for laboring mothers.

By implementing these recommendations, the practice of evidence-based intrapartum care can be maximized, leading to improved access to maternal health and better health outcomes for both mothers and neonates.
AI Innovations Methodology
Based on the provided description, here are some potential recommendations to improve access to maternal health:

1. Increase knowledge of evidence-based intrapartum practices: Develop and implement training programs for obstetric care providers to enhance their knowledge and understanding of evidence-based intrapartum practices. This can include workshops, seminars, and case-study discussions to ensure that providers are up-to-date with the latest guidelines and protocols.

2. Improve access to computers and internet: Provide obstetric care providers with easy access to computers and the internet in their workplace. This will enable them to access relevant research articles, guidelines, and resources to support evidence-based practice. Additionally, it can facilitate communication and collaboration with other healthcare professionals.

3. Create a safe working environment: Ensure that the working environment in public hospitals is safe and conducive to providing quality care. This can include implementing measures to prevent workplace violence, improving infection control practices, and providing necessary equipment and supplies.

4. Continuous training and professional development: Establish a system for continuous training and professional development for obstetric care providers. This can include regular workshops, conferences, and mentoring programs to enhance their skills and keep them updated on best practices in maternal health.

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

1. Define the indicators: Identify specific indicators that can measure the impact of the recommendations on access to maternal health. For example, indicators could include the proportion of obstetric care providers who apply evidence-based intrapartum practices, the availability of computers and internet access in hospitals, and the number of training programs conducted.

2. Collect baseline data: Gather baseline data on the current status of access to maternal health and the implementation of evidence-based intrapartum practices. This can be done through surveys, interviews, and observations in the selected public hospitals.

3. Implement the recommendations: Introduce the recommended interventions, such as training programs, improving access to computers, and creating a safe working environment. Ensure that these interventions are implemented consistently across the selected public hospitals.

4. Monitor and evaluate: Continuously monitor and evaluate the implementation of the recommendations. Collect data on the indicators identified in step 1 to assess the impact of the interventions on access to maternal health. This can be done through follow-up surveys, interviews, and observations.

5. Analyze the data: Analyze the collected data to determine the effectiveness of the recommendations in improving access to maternal health. Use statistical methods, such as bivariate and multivariable logistic regression, to identify predictors and assess the significance of the interventions.

6. Report and disseminate findings: Summarize the findings of the impact assessment and prepare a report. Share the findings with relevant stakeholders, including healthcare providers, policymakers, and researchers. Disseminate the findings through publications, presentations, and workshops to promote knowledge sharing and further improvements in access to maternal health.

By following this methodology, it will be possible to simulate the impact of the recommendations on improving access to maternal health and provide evidence-based insights for future interventions.

Statistics:
Citations: 1
Authors: 4
Identifiers:
DOI: 10.2147/IJWH.S351795
Research Areas:
Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Social Determinants, Workforce
Study Countries:
Ethiopia
Study Design:
Cross Sectional Study, Grounded Theory
Study Approach:
Quantitative
Participants Gender:
Female
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