title: Skilled birth attendant competence: an initial assessment in four countries, and implications for the Safe Motherhood movement.
abstract: OBJECTIVE
  Percentage of deliveries assisted by a skilled birth attendant (SBA) has become a proxy indicator for reducing maternal mortality in developing countries, but there is little data on SBA competence. Our objective was to evaluate the competence of health professionals who typically attend hospital and clinic-based births in Benin, Ecuador, Jamaica, and Rwanda.
  
  
  METHODS
  We measured competence against World Health Organization's (WHO) Integrated Management of Pregnancy and Childbirth guidelines. To evaluate knowledge, we used a 49-question multiple-choice test covering seven clinical areas. To evaluate skill, we had participants perform five different procedures on anatomical models. The 166 participants came from facilities at all levels of care in their respective countries.
  
  
  RESULTS
  On average, providers answered 55.8% of the knowledge questions correctly and performed 48.2% of the skills steps correctly. Scores differed somewhat by country, provider type, and subtopic.
  
  
  CONCLUSIONS
  A wide gap exists between current evidence-based standards and current levels of provider competence.
authors.affiliation: Quality Assurance Project, University Research Co., LLC, Bethesda, MD 20814, USA. sharvey@urc-chs.com
authors.forename: S A
authors.initials: SA
authors.lastname: Harvey
authors.forename: P
authors.initials: P
authors.lastname: Ayabaca
authors.forename: M
authors.initials: M
authors.lastname: Bucagu
authors.forename: S
authors.initials: S
authors.lastname: Djibrina
authors.forename: W N
authors.initials: WN
authors.lastname: Edson
authors.forename: S
authors.initials: S
authors.lastname: Gbangbade
authors.forename: A
authors.initials: A
authors.lastname: McCaw-Binns
authors.forename: B R
authors.initials: BR
authors.lastname: Burkhalter
mesh_terms: D001541:Benin / Q000453:epidemiology; D002983:Clinical Competence; D004484:Ecuador / Q000453:epidemiology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007563:Jamaica / Q000453:epidemiology; D008427:Maternal Health Services / Q000592:standards*; D008880:Midwifery / Q000592:standards* / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000401:mortality / Q000517:prevention & control; D012432:Rwanda / Q000453:epidemiology; D014944:World Health Organization