title: Obstetric competence among referral healthcare providers in Mali.
abstract: OBJECTIVE
  To determine the factors associated with obstetric competency and clinical practice among obstetric care providers in referral health centers in Mali.
  
  
  METHODS
  The present cross-sectional study was conducted between March and May 2012 among 140 obstetric care providers (obstetric nurses, midwives, and physicians) working in referral health centers in Mali. Emergency obstetric care knowledge and skills were evaluated with clinical vignettes developed using national Malian guidelines. The vignettes covered 5 areas of emergency obstetric care, and the results were used to generate a competency score. A backward stepwise random-effects model using a maximum likelihood estimator was applied to evaluate variables independently associated with competency score.
  
  
  RESULTS
  Out of 100, the mean±SD score was 57.8±11.2 for obstetric nurses, 66.4±14.7 for midwifes, and 78.6±13.4 for physicians (P<0.001). Three variables were significantly associated with a higher competency score: professional qualification, working in an urban setting, and working in a health center with a smaller number of obstetric care providers.
  
  
  CONCLUSIONS
  Increasing the in-service training of both rural staff and lower-level healthcare workers working in larger health centers via facility-based maternal death reviews might help to improve clinical practice and maternal health outcomes.
authors.affiliation: Centre de recherche du CHU Sainte Justine, Montréal, Canada; Axe de Santé Mondiale, CRCHUM, Université de Montréal, Montréal, Canada.
authors.forename: Cyrille
authors.initials: C
authors.lastname: Huchon
authors.affiliation: Axe de Santé Mondiale, CRCHUM, Université de Montréal, Montréal, Canada.
authors.forename: Catherine
authors.initials: C
authors.lastname: Arsenault
authors.affiliation: Axe de Santé Mondiale, CRCHUM, Université de Montréal, Montréal, Canada.
authors.forename: Caroline
authors.initials: C
authors.lastname: Tourigny
authors.affiliation: Axe de Santé Mondiale, CRCHUM, Université de Montréal, Montréal, Canada.
authors.forename: Aliou
authors.initials: A
authors.lastname: Coulibaly
authors.affiliation: URFOSAME, Faculté de Médecine, Université de Bamako, Bamako, Mali.
authors.forename: Mamadou
authors.initials: M
authors.lastname: Traore
authors.affiliation: Unité 216, Institut de recherche pour le développement, Paris, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Dumont
authors.affiliation: Axe de Santé Mondiale, CRCHUM, Université de Montréal, Montréal, Canada. Electronic address: pierre.fournier@umontreal.ca.
authors.forename: Pierre
authors.initials: P
authors.lastname: Fournier
mesh_terms: D002983:Clinical Competence / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006282:Health Personnel / Q000706:statistics & numerical data*; D006801:Humans; D008302:Mali; D009774:Obstetrics / Q000592:standards* / Q000706:statistics & numerical data; D011247:Pregnancy; D012017:Referral and Consultation / Q000592:standards*
keywords: Clinical vignette; Emergency obstetric care; Obstetric knowledge; Referral care; Sub-Saharan Africa