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 | ||
| (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% | |
| * |
* |
|||||||
| (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% | |
| (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% | |
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.