Evidence-based reproductive health care in Cameroon: population-based study of awareness, use and barriers.
OBJECTIVE
To estimate the prevalence of awareness and use of evidence-based reproductive health interventions and to describe the barriers associated with the use of evidence-based interventions among health providers in north-west Cameroon.


METHODS
In February 2004, a population-based descriptive study of the awareness and use of 13 evidence-based interventions targeted health workers providing reproductive health care. Their awareness and use of a composite of four vital interventions was also evaluated. These were peripartum use of antiretrovirals to prevent transmission of HIV, antenatal corticosteroid administration, magnesium sulfate prophylaxis and active management of placental delivery with uterotonics. In-depth interviews with key informants were conducted as part of a qualitative substudy to discover the barriers to the use of evidence-based interventions.


RESULTS
Overall, 91.4% (328/359) of reproductive health workers were surveyed. Their awareness of evidence-based interventions varied from 29% for the use of antenatal corticosteroids to 97% for the use of iron and folic acid supplementation during pregnancy. Their use of these interventions ranged from 10.2% for antenatal corticosteroids to 94.8% for iron and folic acid supplementation. Only 50/322 (15.5%; 95% confidence interval (CI)=11.8-20.0) of health workers were aware of all four vital interventions, and only 12/312 (3.8%; 95% CI=2.0- 6.6) reported using all of them regularly. A total of 26 key informants participated in the qualitative substudy. A deficiency in the education and training of health workers, especially a lack of continuing education, was commonly identified as the most important barrier to their awareness of evidence-based practices. A lack of awareness and a lack of supplies and materials were the main barriers to practice.


CONCLUSIONS
The awareness and practice of important evidence-based reproductive health interventions were less than optimal. To improve maternal and perinatal outcomes both remedial programmes to enhance awareness, including continuing education for health workers, and the provision of necessary supplies are needed.
Tita
Alan T N
AT
MFM Division, Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL 35233, USA. alan.tita@obgyn.uab.edu
Selwyn
Beatrice J
BJ
Waller
D Kim
DK
Kapadia
Asha S
AS
Dongmo
Sylvestre
S
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D002163:Cameroon; D002983:Clinical Competence; D019587:Dietary Supplements / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use; D015658:HIV Infections / Q000517:prevention & control; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D058085:Iron Compounds / Q000627:therapeutic use; D011153:Population; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy / Q000517:prevention & control*; D011295:Prenatal Care / Q000592:standards*; D018456:Reproductive Medicine / Q000592:standards*; D011795:Surveys and Questionnaires
D000305:Adrenal Cortex Hormones; D058085:Iron Compounds; D005492:Folic Acid