title: Knowledge and Skills of Healthcare Providers in Sub-Saharan Africa and Asia before and after Competency-Based Training in Emergency Obstetric and Early Newborn Care.
abstract: BACKGROUND
  Healthcare provider training in Emergency Obstetric and Newborn Care (EmOC&NC) is a component of 65% of intervention programs aimed at reducing maternal and newborn mortality and morbidity. It is important to evaluate the effectiveness of this.
  
  
  METHODS
  We evaluated knowledge and skills among 5,939 healthcare providers before and after 3-5 days 'skills and drills' training in emergency obstetric and newborn care (EmOC&NC) conducted in 7 sub-Saharan Africa countries (Ghana, Kenya, Malawi, Nigeria, Sierra Leone, Tanzania, Zimbabwe) and 2 Asian countries (Bangladesh, Pakistan). Standardised assessments using multiple choice questions and objective structured clinical examination (OSCE) were used to measure change in knowledge and skills and the Improvement Ratio (IR) by cadre and by country. Linear regression was performed to identify variables associated with pre-training score and IR.
  
  
  RESULTS
  99.7% of healthcare providers improved their overall score with a median (IQR) increase of 10.0% (5.0% - 15.0%) for knowledge and 28.8% (23.1% - 35.1%) for skill. There were significant improvements in knowledge and skills for each cadre of healthcare provider and for each country (p<0.05). The mean IR was 56% for doctors, 50% for mid-level staff and nurse-midwives and 38% for nursing-aides. A teaching job, previous in-service training, and higher percentage of work-time spent providing maternity care were each associated with a higher pre-training score. Those with more than 11 years of experience in obstetrics had the lowest scores prior to training, with mean IRs 1.4% lower than for those with no more than 2 years of experience. The largest IR was for recognition and management of obstetric haemorrhage (49-70%) and the smallest for recognition and management of obstructed labour and use of the partograph (6-15%).
  
  
  CONCLUSIONS
  Short in-service EmOC&NC training was associated with improved knowledge and skills for all cadres of healthcare providers working in maternity wards in both sub-Saharan Africa and Asia. Additional support and training is needed for use of the partograph as a tool to monitor progress in labour. Further research is needed to assess if this is translated into improved service delivery.
authors.affiliation: Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Ameh
authors.affiliation: Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors.forename: Robert
authors.initials: R
authors.lastname: Kerr
authors.affiliation: Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors.forename: Barbara
authors.initials: B
authors.lastname: Madaj
authors.affiliation: Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors.forename: Mselenge
authors.initials: M
authors.lastname: Mdegela
authors.affiliation: Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors.forename: Terry
authors.initials: T
authors.lastname: Kana
authors.affiliation: Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors.forename: Susan
authors.initials: S
authors.lastname: Jones
authors.affiliation: Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors.forename: Jaki
authors.initials: J
authors.lastname: Lambert
authors.affiliation: Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors.forename: Fiona
authors.initials: F
authors.lastname: Dickinson
authors.affiliation: Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors.forename: Sarah
authors.initials: S
authors.lastname: White
authors.affiliation: Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors.forename: Nynke
authors.initials: N
authors.lastname: van den Broek
mesh_terms: D017954:Africa South of the Sahara; D001208:Asia; D036861:Delivery, Obstetric / Q000193:education*; D004638:Emergency Treatment / Q000451:nursing*; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000193:education*; D006801:Humans; D007224:Infant Care; D007231:Infant, Newborn; D016014:Linear Models; D015397:Program Evaluation