Factors associated with the awareness and practice of evidence-based obstetric care in an African setting

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Study Justification:
The study aimed to identify the factors associated with the awareness and practice of evidence-based obstetric care in an African setting. This was important because previous reports indicated poor awareness and use of evidence-based reproductive interventions in the region. By understanding the factors influencing awareness and practice, interventions can be developed to improve maternal and perinatal outcomes.
Highlights:
– Only 15.5% of health workers were aware of all four evidence-based obstetric interventions studied.
– Only 3.8% reported optimal practice of these interventions.
– Evidence-based awareness was strongly associated with practice.
– Factors significantly associated with awareness included attending continuing education, access to the World Health Organization Reproductive Health Library (WHO RHL), employment as an obstetrician/gynecologist, and working in autonomous military or National Insurance Fund facilities.
– Working as an obstetrician and having 5-15 years of work experience were associated with increased awareness.
– Internet access was associated with increased practice.
Recommendations:
– Promote and provide continuing education opportunities for health workers to improve awareness of evidence-based obstetric interventions.
– Ensure access to the WHO RHL for health workers to facilitate evidence-based practice.
– Encourage obstetricians/gynecologists to play a key role in disseminating knowledge and promoting evidence-based care.
– Improve internet access for health workers to support evidence-based practice.
Key Role Players:
– Health workers including obstetricians, other physicians, midwives, nurses, and other staff providing reproductive care.
– Continuing education providers and institutions.
– World Health Organization (WHO) or other organizations responsible for providing access to the WHO RHL.
– Obstetrician/gynecologist associations or societies.
– Government or healthcare authorities responsible for improving internet access in healthcare facilities.
Cost Items for Planning Recommendations:
– Continuing education programs and resources.
– Access to the WHO RHL, including subscriptions or licensing fees.
– Training and support for obstetricians/gynecologists to disseminate knowledge.
– Investment in improving internet access in healthcare facilities, including infrastructure and equipment.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is rated 7 because it provides specific data and statistical analysis to support the findings. However, the study is limited to a specific region and may not be generalizable to other settings. To improve the evidence, the study could include a larger and more diverse sample size to increase the external validity of the findings.

Objective: To identify the factors associated with important (≥50%) variation in awareness and practice of evidence-based obstetric interventions in an African setting where we have previously reported poor awareness and use of evidence-based reproductive interventions. Design: Cross-sectional analysis of data from our Reproductive Health Interventions Study. Setting: North-west province, Cameroon, Africa. Population: Health workers including obstetricians, other physicians, midwives, nurses and other staff providing reproductive care. Main outcome measures: Prevalence ratios (PR) of uniform awareness and practice of four key evidence-based obstetric interventions from the World Health Organization Reproductive Health Library (WHO RHL): antiretrovirals to prevent mother-to-child transmission of HIV/AIDS, antenatal corticosteroids for prematurity, uterotonics to prevent postpartum haemorrhage and magnesium sulphate for seizure prophylaxis. Methods: Comparisons of descriptive covariates, applying logistic regression to estimate independent relationships with awareness and use of evidence-based interventions. Results: A total of 15.5% (50/322) of health workers were aware of all the four interventions while only 3.8% (12/312) reported optimal practice. Evidence-based awareness was strongly associated with practice (PR = 15.4; 96% CI: 4.3-55.0). Factors significantly associated with awareness were: attending continuing education, access to the WHO RHL, employment as an obstetrician/gynaecologist and working in autonomous military or National Insurance Fund facilities. Controlling for potential confounding, working as an obstetrician was associated with increased awareness (adjusted prevalence odds ratio [aPOR] = 8.3; 95% CI: 1.3-53.8) as was median work experience of 5-15 years (aPOR = 2.0; 95% CI: 1.0-3.8). Internet access was associated with increased practice (aPOR = 3.4; 95% CI: 1.0-11.8). Other potentially important variations were observed, although they did not attain statistical significance. Conclusions: Several factors including obstetric training and continuous education positively influence evidence-based awareness and practice of key obstetric interventions. Confirmation and application of this information may enhance the effectiveness of programmes to improve maternal and perinatal outcomes. © RCOG 2006.

Innovation 1: Develop a mobile application or online platform that provides easy access to evidence-based obstetric care guidelines and resources. This innovation would allow healthcare providers in African settings to access the latest information and recommendations on maternal health interventions, even in remote areas with limited internet connectivity.

Innovation 2: Establish a mentorship program where experienced obstetricians and midwives provide guidance and support to less experienced healthcare providers. This program would facilitate knowledge transfer and skill development, ensuring that evidence-based practices are effectively implemented in maternal health care.

Innovation 3: Introduce simulation-based training programs that allow healthcare providers to practice and refine their skills in a safe and controlled environment. These programs can simulate various obstetric scenarios, allowing providers to gain confidence and competence in evidence-based interventions before applying them in real-life situations.

Innovation 4: Implement a quality improvement program that focuses on monitoring and improving the adherence to evidence-based obstetric care practices. This program would involve regular audits, feedback sessions, and performance evaluations to identify areas for improvement and ensure consistent delivery of high-quality maternal health care.

Innovation 5: Develop partnerships with academic institutions and research organizations to conduct research and generate local evidence on the effectiveness of obstetric interventions in African settings. This would help bridge the gap between global evidence and local context, ensuring that maternal health practices are tailored to the specific needs and challenges of the region.
AI Innovations Description
Based on the research findings described in the publication “Factors associated with the awareness and practice of evidence-based obstetric care in an African setting,” the following recommendation can be developed into an innovation to improve access to maternal health:

Recommendation: Develop and implement a comprehensive training and continuous education program for health workers providing reproductive care in African settings, with a focus on obstetricians and midwives.

Explanation: The research findings indicate that attending continuing education and having access to the World Health Organization Reproductive Health Library (WHO RHL) were significantly associated with increased awareness and practice of evidence-based obstetric interventions. Therefore, it is crucial to provide ongoing training and education opportunities for health workers, particularly obstetricians and midwives, to improve their knowledge and skills in delivering evidence-based maternal health care.

The innovation should include the following components:

1. Training curriculum: Develop a comprehensive curriculum that covers the four key evidence-based obstetric interventions identified in the study: antiretrovirals for preventing mother-to-child transmission of HIV/AIDS, antenatal corticosteroids for prematurity, uterotonics for preventing postpartum hemorrhage, and magnesium sulfate for seizure prophylaxis. The curriculum should also address other important aspects of maternal health care.

2. Continuous education: Establish a system for providing ongoing education and updates to health workers to ensure they stay up-to-date with the latest evidence-based practices in maternal health care. This can include regular workshops, conferences, webinars, and online resources.

3. Access to resources: Ensure that health workers have easy access to the WHO RHL and other relevant resources. This can be achieved by providing internet access in healthcare facilities and promoting the use of digital platforms for accessing educational materials.

4. Collaboration and partnerships: Foster collaboration between healthcare institutions, professional associations, and international organizations to support the implementation of the training and continuous education program. This can involve sharing resources, expertise, and best practices.

5. Monitoring and evaluation: Establish a monitoring and evaluation framework to assess the impact of the training and continuous education program on the awareness and practice of evidence-based obstetric interventions. Regular assessments should be conducted to identify areas for improvement and measure the effectiveness of the program in improving maternal and perinatal outcomes.

By implementing this recommendation, healthcare providers in African settings can enhance their knowledge and skills in evidence-based obstetric care, leading to improved access to maternal health services and better outcomes for mothers and babies.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Study population: Select a representative sample of health workers providing reproductive care in African settings, including obstetricians, midwives, nurses, and other staff.

2. Baseline assessment: Conduct a baseline assessment to measure the current level of awareness and practice of evidence-based obstetric interventions among the selected health workers. This can be done through surveys, interviews, or observation of clinical practices.

3. Intervention implementation: Implement the comprehensive training and continuous education program based on the recommendations outlined in the publication. This includes developing the training curriculum, organizing workshops and conferences, providing access to resources such as the WHO RHL, and fostering collaboration and partnerships.

4. Monitoring and evaluation: Establish a monitoring and evaluation framework to assess the impact of the intervention. This can involve collecting data on the awareness and practice of evidence-based obstetric interventions before and after the intervention implementation.

5. Data analysis: Analyze the collected data to determine the changes in awareness and practice of evidence-based obstetric interventions following the intervention implementation. This can be done by comparing the baseline assessment results with the post-intervention assessment results.

6. Statistical analysis: Apply statistical methods, such as logistic regression, to estimate the impact of the intervention on improving access to maternal health. This can involve calculating prevalence ratios, odds ratios, and confidence intervals to measure the association between the intervention and the outcomes of interest.

7. Interpretation of results: Interpret the findings to determine the effectiveness of the intervention in improving access to maternal health. This can involve identifying any significant changes in awareness and practice of evidence-based obstetric interventions and assessing the overall impact on maternal and perinatal outcomes.

By following this methodology, researchers can simulate the impact of the main recommendations on improving access to maternal health and provide evidence-based insights for future interventions and programs in African settings.

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