Factors associated with health care provider knowledge on abortion care in Ethiopia, a further analysis on emergency obstetric and newborn care assessment 2016 data

listen audio

Study Justification:
– Abortion is a major cause of maternal death globally, accounting for 7.9% of deaths.
– In Africa, 5.5 million women have unsafe abortions annually.
– Although maternal deaths due to abortion complications have declined in Ethiopia, women still die from these complications.
– Few studies have focused on health care providers’ knowledge of abortion care in Ethiopia.
Study Highlights:
– Data from the national emergency obstetric and newborn care assessment in 2016 was used.
– A total of 3800 health care providers from 3804 facilities were included in the analysis.
– Providers’ knowledge of comprehensive abortion care was assessed through interviews.
– On average, providers identified approximately half or fewer of the expected responses.
– Factors associated with lower knowledge levels included being a midwife or nurse (compared to a health officer), being female, and lack of training or practice of manual vacuum aspiration.
– Facility-level factors protective against low knowledge levels included employment in Addis Ababa, being male, and having internet access in the facility.
Study Recommendations:
– Pre- and in-service training efforts should focus on increasing knowledge levels among health care providers.
– Special attention should be given to female providers who scored lower.
– Efforts should be made to ensure that more midlevel providers are capable of performing manual vacuum aspiration.
– Providers in the Gambella region should receive special attention.
Key Role Players:
– Ministry of Health: Responsible for implementing training programs and policies.
– Health care providers: Responsible for participating in training programs and updating their knowledge.
– Professional associations: Responsible for supporting and promoting continuous education for health care providers.
– Training institutions: Responsible for providing relevant and up-to-date training programs.
– Regional health bureaus: Responsible for coordinating and monitoring training activities at the regional level.
Cost Items for Planning Recommendations:
– Training materials: Development and distribution of training materials.
– Training sessions: Organizing and conducting training sessions for health care providers.
– Trainers: Hiring and compensating trainers to deliver the training sessions.
– Monitoring and evaluation: Establishing a system to monitor and evaluate the effectiveness of the training programs.
– Infrastructure and equipment: Ensuring facilities have the necessary infrastructure and equipment for training.
– Internet access: Providing internet access in facilities to support knowledge acquisition and updates.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a study using data from a national emergency obstetric and newborn care assessment. The study investigates the level of health workers’ knowledge of comprehensive abortion care in Ethiopia. The methods used in the study are described in detail, including the selection criteria for providers and the knowledge questions asked. The results show that providers identified approximately half or fewer of the expected responses, and the multivariate model identified factors associated with lower knowledge levels. The conclusion suggests actionable steps to improve knowledge levels among providers. However, the abstract does not provide information on the sample size or the statistical significance of the findings. Additionally, it does not mention any limitations of the study. To improve the evidence, the abstract could include these missing details and also provide more context on the importance and implications of the findings.

Background: Abortion is one of the major direct causes of maternal death, accounting for 7.9% globally. In Africa, 5.5 million women have unsafe abortions annually. Although maternal deaths due to complications of abortion have declined in Ethiopia, women still die from complications. Few studies have focused on providers’ clinical knowledge. This study investigates the level of health workers’ knowledge of comprehensive abortion care and its determinants in Ethiopia. Methods: Data from the national emergency obstetric and newborn care (EmONC) assessment was used. A total of 3804 facilities that provided institutional deliveries in the 12 months before the assessment were included. Provider knowledge was assessed by interviewing a single provider from each facility. Criteria for selection included: Having attended the largest number of deliveries in the last one or two months. A summary knowledge score was generated based on the responses to three knowledge questions related to immediate complications of unsafe abortion, how a woman should be clinically managed and what the counselling content should contain. The score was classified into two categories ( =50%). Logistic regression was used to determine individual and facility-level factors associated with the summary knowledge score. Result: A total of 3800 providers participated and the majority were midwives, nurses and health officers. On average, providers identified approximately half or fewer of the expected responses. The multivariate model showed that midwives and nurses (compared to health officers), being female, and absence of training or practice of manual vacuum aspiration were associated with lower knowledge levels. Important facility level factors protective against low knowledge levels included employment in Addis Ababa, being male and having internet access in the facility. Conclusion: To increase knowledge levels among providers, pre- A nd in-service training efforts should be particularly sensitive to female providers who scored lower, ensure that more midlevel providers are capable of performing manual vacuum aspiration as well as provide special attention to providers in the Gambella.

Data were used from the national 2016 emergency obstetric and neonatal care assessment. Detailed methods were presented in the assessment report [19]. Briefly, data were collected from May to October, 2016 at all facilities in all 9 regions and 2 city administrations in the country that had provided care for institutional deliveries in the 12 months preceding the assessment. The type of facilities included in this study were hospitals (referral, general and primary), health centres, Maternal Child Health (MCH) speciality centres, MCH speciality clinics and higher clinics. Rural and urban facilities were also included. From 3804 health facilities assessed, a total of 3800 health care providers were included in the analysis. Provider knowledge on abortion care was assessed by interviewing one provider from each facility. Selection criteria for the provider were: 1) the health worker who attended the largest number of deliveries in the last month or if no births had been reported in the facility in the previous 30 days, in the last two months,, and 2) was physically present when data collectors visited the facility. If the selected provider refused to provide consent, he or she was not replaced by another at that facility. The dummy variables entered in the regression were sex, qualification, MVA training and MVA service provision of health care providers were collected, the availability of internet, computers, safe abortion care, and family planning guidelines. Health care providers were asked a series of questions related to unsafe abortion: “What are the immediate complications of unsafe abortion?”; “What do you do for a woman with an unsafe or incomplete abortion?”; and, “What information do you give to clients after unsafe or incomplete abortion?” A summary knowledge score was generated based on these questions. Each knowledge question had multiple possible “correct” answers; that is, answers that respondents were expected to provide spontaneously. Respondents were scored on each question by calculating the number of correct responses provided out of the total possible, and standardizing this to a scale of 100. A one way ANOVA statistical test was used to compare the level of knowledge among different cadre of health care providers. The outcome variable was overall knowledge score, which was divided into two categories (> = 50 and < 50%). A score higher than 50% was considered acceptable [20]. The Medical Council of India recommends 50% as the minimum pass mark for all summative examinations in medical specialties. The National Board of Examination in India also accepts overall 50% marks as a minimum acceptable mark for passing in Objective Structure Clinical Examination (OSCE) [21]  and a score higher than 50% was also considered acceptable [22]. Accordingly, we operationally defined those scores 50% and above as a passing score. For the logistic regression, the overall abortion care knowledge score was based on the sum of all three questions and their 22 possible responses, and classified into two categories ( =50% labelled as 0). The dependent variable of interest was those providers who scored below 50%. We used in bivariate analysis a wider confidence interval (80% CI) in order not to miss potential factors that might affect provider low knowledge. Our main interest in the dependent variable category was those providers who scored below 50. Finally, a multivariable logistic regression model was used to determine independent individual and facility-level factors associated with the knowledge score at a 5% significance level. The analysis was done using STATA Version 14. Ethical clearance was obtained from the Ethiopian Public Health Institute (EPHI) scientific and ethical review board. Informed verbal consent was taken from all facilities and all selected health workers. No incentive was provided for participation. No personal identifier was used to maintain confidentiality and data were maintained on a password protected EPHI server.

N/A

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

1. Comprehensive training programs: Develop and implement comprehensive training programs for healthcare providers that focus on improving their knowledge and skills related to abortion care. These programs should cover topics such as immediate complications of unsafe abortion, clinical management of women with unsafe or incomplete abortions, and counseling content for clients after unsafe or incomplete abortions.

2. In-service training: Provide regular in-service training opportunities for healthcare providers to update their knowledge and skills in abortion care. This can help ensure that providers stay up-to-date with the latest evidence-based practices and guidelines.

3. Targeted training for midwives and nurses: Recognize that midwives and nurses play a crucial role in providing maternal health care, including abortion care. Develop targeted training programs specifically designed for midwives and nurses to improve their knowledge and skills in abortion care.

4. Increase access to manual vacuum aspiration (MVA) training: Ensure that more mid-level providers, such as midwives and nurses, are capable of performing manual vacuum aspiration (MVA). MVA is a safe and effective method for managing incomplete abortions and can help reduce maternal morbidity and mortality.

5. Improve access to information: Provide healthcare facilities with internet access and computers to improve access to information and resources related to abortion care. This can help healthcare providers stay informed about the latest guidelines, research, and best practices.

6. Address gender disparities: Recognize that female providers may have lower knowledge levels and provide special attention and support to ensure they receive the necessary training and resources to improve their knowledge and skills in abortion care.

7. Focus on underserved areas: Provide special attention and resources to healthcare providers in underserved areas, such as the Gambella region. This can help ensure that providers in these areas have the necessary knowledge and skills to provide quality abortion care.

These innovations can help improve access to maternal health by enhancing healthcare providers’ knowledge and skills in abortion care, particularly in areas where maternal deaths due to complications of abortion are still prevalent.
AI Innovations Description
Based on the provided information, the recommendation to improve access to maternal health would be to focus on enhancing the knowledge of healthcare providers regarding comprehensive abortion care. This can be achieved through the following strategies:

1. Pre- and in-service training: Implement targeted training programs for healthcare providers, particularly midwives, nurses, and health officers, to improve their knowledge and skills in providing comprehensive abortion care. These training programs should cover topics such as immediate complications of unsafe abortion, clinical management of women with unsafe or incomplete abortions, and appropriate counseling content.

2. Gender-sensitive approach: Pay special attention to female healthcare providers who scored lower in knowledge levels. Provide additional support, resources, and training opportunities to empower them and bridge the knowledge gap.

3. Expand access to manual vacuum aspiration (MVA) training: Ensure that more mid-level providers are capable of performing MVA, as it is a safe and effective method for managing incomplete abortions. This can be achieved by offering specialized training programs and incorporating MVA training into the curriculum of relevant healthcare education programs.

4. Improve facility-level factors: Focus on improving facility-level factors that are associated with higher knowledge levels among healthcare providers. This includes employment in urban areas like Addis Ababa, ensuring access to internet and computers in healthcare facilities, and promoting the availability of safe abortion care and family planning guidelines.

By implementing these recommendations, healthcare providers will be better equipped to provide comprehensive abortion care, leading to improved access to maternal health services and a reduction in maternal deaths due to complications of unsafe abortion.
AI Innovations Methodology
Based on the provided information, here are some potential recommendations to improve access to maternal health:

1. Increase training efforts: Provide pre- and in-service training programs that specifically focus on comprehensive abortion care for health care providers. These programs should address the knowledge gaps identified in the study and ensure that providers are equipped with the necessary skills and information to provide safe and effective care.

2. Target female providers: Pay special attention to female providers who scored lower in the knowledge assessment. Develop targeted training programs and resources that address their specific needs and challenges, aiming to improve their knowledge and confidence in providing abortion care.

3. Expand midlevel provider capacity: Ensure that more midwives and nurses are capable of performing manual vacuum aspiration (MVA), a safe and effective method for managing incomplete abortions. This can be achieved through training programs that focus on building the skills and competencies of midlevel providers in MVA.

4. Improve access to information: Increase access to internet and computers in health facilities, particularly in rural areas. This will enable providers to access up-to-date guidelines, research, and resources related to safe abortion care and family planning. Access to reliable information can help improve provider knowledge and ensure evidence-based practices.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Define the indicators: Identify key indicators that reflect access to maternal health, such as the number of safe abortions performed, the availability of trained providers, and the reduction in maternal mortality due to complications of abortion.

2. Collect baseline data: Gather data on the current status of these indicators before implementing the recommendations. This can be done through surveys, interviews, and data analysis from relevant sources such as health facilities, government reports, and population surveys.

3. Implement the recommendations: Roll out the recommended interventions, including training programs, capacity building initiatives, and improvements in information access. Ensure that these interventions are implemented consistently across different regions and health facilities.

4. Monitor and evaluate: Continuously monitor the progress and impact of the interventions. Collect data on the indicators identified in step 1 at regular intervals to assess the changes over time. This can involve conducting surveys, interviews, and data analysis to measure improvements in provider knowledge, the number of safe abortions performed, and maternal health outcomes.

5. Analyze the data: Use statistical analysis techniques to analyze the collected data and determine the impact of the recommendations on improving access to maternal health. This can involve comparing the baseline data with the data collected after implementing the interventions to identify any significant changes and trends.

6. Draw conclusions and make recommendations: Based on the analysis of the data, draw conclusions about the effectiveness of the recommendations in improving access to maternal health. Identify any challenges or areas for improvement and make recommendations for further interventions or adjustments to existing strategies.

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 future interventions.

Partilhar isto:
Facebook
Twitter
LinkedIn
WhatsApp
Email