title: Knowledge and perceptions of quality of obstetric and newborn care of local health providers: a cross-sectional study in three districts in Malawi.
abstract: OBJECTIVE
  Quality of service delivery for maternal and newborn health in Malawi is influenced by human resource shortages and knowledge and care practices of the existing service providers. We assessed Malawian healthcare providers' knowledge of management of routine labour, emergency obstetric care and emergency newborn care; correlated knowledge with reported confidence and previous study or training; and measured perception of the care they provided.
  
  
  METHODS
  This study formed part of a large-scale quality of care assessment in three districts (Kasungu, Lilongwe and Salima) of Malawi. Subjects were selected purposively by their role as providers of obstetric and newborn care during routine visits to health facilities by a research assistant. Research assistants introduced and supervised the self-completed questionnaire by the service providers. Respondents included 42 nurse midwives, 1 clinical officer, 4 medical assistants and 5 other staff. Of these, 37 were staff working in facilities providing Basic Emergency Obstetric Care (BEMoC) and 15 were from staff working in facilities providing Comprehensive Emergency Obstetric Care (CEMoC).
  
  
  RESULTS
  Knowledge regarding management of routine labour was good (80% correct responses), but knowledge of correct monitoring during routine labour (35% correct) was not in keeping with internationally recognized good practice. Questions regarding emergency obstetric care were answered correctly by 70% of respondents with significant variation depending on clinicians' place of work. Knowledge of emergency newborn care was poor across all groups surveyed with 58% correct responses and high rates of potentially life-threatening responses from BEmOC facilities. Reported confidence and training had little impact on levels of knowledge. Staff in general reported perception of poor quality of care.
  
  
  CONCLUSIONS
  Serious deficiencies in providers' knowledge regarding monitoring during routine labour and management of emergency newborn care were documented. These may contribute to maternal and neonatal deaths in Malawi. The knowledge gap cannot be overcome by simply providing more training.
authors.affiliation: UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH ; Parent and Child Health Initiative (PACHI).
authors.forename: O
authors.initials: O
authors.lastname: Bayley
authors.affiliation: UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH ; Parent and Child Health Initiative (PACHI).
authors.forename: T
authors.initials: T
authors.lastname: Colbourn
authors.affiliation: UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH ; Parent and Child Health Initiative (PACHI).
authors.forename: B
authors.initials: B
authors.lastname: Nambiar
authors.affiliation: UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH ; Parent and Child Health Initiative (PACHI).
authors.forename: A
authors.initials: A
authors.lastname: Costello
authors.affiliation: Reproductive Health Unit, Box 30377, Lilongwe, LL3, Malawi.
authors.forename: F
authors.initials: F
authors.lastname: Kachale
authors.affiliation: Department of Obstetrics & Gynaecology, University of Namibia, School of Medicine, Windhoek, Namibia.
authors.forename: T
authors.initials: T
authors.lastname: Meguid
authors.affiliation: Parent and Child Health Initiative (PACHI) ; Kamuzu Central Hospital, Namgwagwa, Lilongwe, Malawi.
authors.forename: C
authors.initials: C
authors.lastname: Mwansambo
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000592:standards*; D004638:Emergency Treatment / Q000592:standards; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D007231:Infant, Newborn; D008295:Malawi; D008427:Maternal Health Services / Q000458:organization & administration* / Q000592:standards; D007744:Obstetric Labor Complications; D010465:Perception; D011247:Pregnancy; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D019037:Urban Health Services / Q000458:organization & administration