Bulletin of the World Health Organization

Are skilled birth attendants really skilled? A measurement method, some disturbing results and a potential way forward

Steven A Harvey, Yudy Carla Wong Blandón, Affette McCaw-Binns, Ivette Sandino, Luis Urbina, César Rodríguez, Ivonne Gómez, Patricio Ayabaca, Sabou Djibrina, the Nicaraguan maternal and neonatal health quality improvement group

Volume 85, Number 10, October 2007, 783-790

Table 3. Mean Phase I competency scores (%) by country, provider cadre and topica

Topic Competency scores by country
Competency scores by provider cadre
Benin Ecuador Jamaica Rwanda Doctorsb Midwivesb All providersb
Knowledge test (n = 43) (n = 25) (n = 64) (n = 34) (n = 25) (n = 54) (n = 166)
Infection prevention 60.5% 41.1% 48.2% 34.9% 47.4% 54.5% 47.6%
Uncomplicated labour and delivery 52.6% 64.8% 59.5% 56.2% * 62.3% * 55.2% 57.9%
Immediate newborn care 49.1% 62.6% 65.8% 44.1% 57.8% 52.7% 56.5%
Postpartum haemorrhage 63.4% 68.0% 64.2% 54.2% * 72.7% * 63.1% 62.5%
Pregnancy-induced hypertension 54.8% 78.2% 68.9% 51.6% ** 74.7% ** 58.2% 63.1%
Sepsis 38.0% 53.3% 47.9% 39.2% * 56.7% * 42.0% 44.4%
Active management 3rd stage labour 10.5% 14.0% 39.1% 7.4% 24.0% 16.7% 21.4%
Total knowledge test score 52.5% 61.8% 59.8% 47.9% * 61.9% * 54.2% 55.8%
Partograph test (n = 42) (n = 24) (n = 27) (n = 20) (n = 45) (n = 93)
Written questions only 67.4% 54.5% NA 50.1% 67.2% 61.9% 59.0%
Graphing only 63.5% 33.0% NA 48.5% 59.6% 54.8% 51.3%
Total partograph test score 66.7% 50.7% NA 49.8% 65.9% 60.7% 57.7%
Skills evaluation (n = 42) (n = 25) (n = 62) (n = 19) (n = 22) (n = 49) (n = 148)
Manual removal of placenta 64.2% 46.8% 20.1% 51.1% 57.1% 56.8% 41.1%
Bimanual uterine compression 7.9% 28.6% 22.2% 40.2% ** 42.8% ** 12.4% 21.5%
Neonatal resuscitation with ambu bag 58.6% 39.5% 67.9% 43.3% 52.2% 59.0% 57.3%
Neonatal resuscitation mouth-to-mouth and nose 59.7% 26.0% 69.1% 44.7% * 45.0% * 57.5% 56.0%
Infection prevention 55.2% 38.0% 43.2% 53.7% 49.4% 52.0% 47.1%
IV insertion 79.4% 66.7% 60.2% 73.7% 74.5% 77.4% 68.5%
Total skills score 54.4% 41.8% 46.1% 50.2% 54.3% 52.7% 48.2%

IV, intravenous; NA, non-applicable.a Section totals do not represent cumulative mean scores from each section (knowledge test, partograph test, etc.) because their respective sub-sections contained different numbers of questions.b Scores for doctors and midwives are reported separately because these were the only two cadres present in all four Phase I countries. The mean scores for doctors, midwives and all providers represent pooled individual scores. Scores are not weighted by country. Statistical significance for the difference in scores between doctors and midwives established by t-test: * P < 0.05; ** P < 0.001.

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