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 4. Mean Phase II competency scores (%) by provider cadre and topica

Topic Doctors (n) Medical students (n) Professional nursesb (n) Auxiliary nurses (n) Total (n)
Knowledge test
Infection prevention 21.4% (506) 12.2% (148) 16.2% (339) 9.6% (365) ** 15.9% (1358)
Uncomplicated labour and delivery 73.1% (357) 71.7% (117) 52.6% (256) 47.5% (307) ** 60.3% (1037)
Immediate newborn care 65.3% (347) 60.8% (120) 44.8% (243) 39.0% (313) ** 51.9% (1023)
Haemorrhage during pregnancy 88.4% (357) 86.8% (117) 75.9% (256) 70.3% (307) ** 79.8% (1037)
Postpartum haemorrhage 81.1% (357) 75.9% (117) 60.4% (256) 57.8% (307) ** 68.5% (1037)
Pregnancy-induced hypertension 60.5% (357) 57.2% (117) 45.5% (256) 43.0% (307) ** 51.2% (1037)
Sepsis 76.3% (357) 73.4% (117) 61.5% (256) 53.0% (307) ** 65.4% (1037)
Active management of third stage labour 84.1% (357) 82.6% (117) 67.8% (256) 63.4% (307) ** 73.8% (1037)
Total knowledge score 71.5% (506) 67.5% (148) 56.7% (339) 51.4% (365) 62.0% (1358)
Partograph test
Written questions only 67.0% (343) 65.8% (116) 41.9% (118) 32.9% (89) ** 57.8% (666)
Graphing only 67.3% (343) 69.1% (116) 19.3% (118) 9.9% (89) ** 51.5% (666)
Total partograph test score 67.1% (343) 66.6% (116) 36.3% (118) 27.1% (89) 56.2% (666)
Skills evaluation
Active management of third stage labour 52.5% (170) 48.7% (41) 40.9% (93) 36.4% (81) ** 45.9% (385)
Manual extraction of the placenta 53.1% (170) 45.0% (41) ** 51.5% (211)
Bimanual uterine compression 48.4% (170) 37.2% (41) ** 46.2% (211)
Immediate newborn care 76.4% (159) 76.8% (40) 67.4% (86) 63.6% (84) ** 71.5% (369)
Neonatal resuscitation with ambu bag 61.6% (159) 57.7% (40) 50.1% (86) 45.0% (84) ** 54.7% (369)

a Statistical significance for the difference in scores between provider cadres determined by ANOVA: * P < 0.05; ** P < 0.001.b As in Table 2, five nurse-midwives who participated in Phase II were included in the category “professional nurses”.

[an error occurred while processing this directive]