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 5. Mean difference in score (%) by provider cadrea
| Topic | Doctor | Medical student | Professional nurse |
|---|---|---|---|
| Infection prevention |
|||
| Medical student | ** 9.2% | ||
| Professional nurse | * 5.2% | –4.1% | |
| Auxiliary nurse |
** 11.8% |
2.6% |
** 6.6% |
| Uncomplicated labour and delivery |
|||
| Medical student | 1.5% | ||
| Professional nurse | ** 20.5% | ** 19.1% | |
| Auxiliary nurse |
**25.6% |
** 24.2% |
* 5.1% |
| Immediate newborn care |
|||
| Medical student | 4.5% | ||
| Professional nurse | ** 20.6% | ** 16.1% | |
| Auxiliary nurse |
** 26.3% |
** 21.8% |
* 5.7% |
| Haemorrhage during pregnancy |
|||
| Medical student | 1.6% | ||
| Professional nurse | ** 12.5% | ** 10.9% | |
| Auxiliary nurse |
** 18.1% |
** 16.5% |
5.6% |
| Postpartum haemorrhage |
|||
| Medical student | 5.2% | ||
| Professional nurse | ** 20.7% | ** 15.5% | |
| Auxiliary nurse |
** 23.3% |
** 18.1% |
2.6% |
| Pregnancy-induced hypertension |
|||
| Medical student | 3.3% | ||
| Professional nurse | ** 15.0% | ** 11.7% | |
| Auxiliary nurse |
** 17.5% |
** 14.2% |
2.5% |
| Sepsis |
|||
| Medical student | 2.9% | ||
| Professional nurse | ** 14.8% | ** 11.8% | |
| Auxiliary nurse |
** 23.3% |
** 20.4% |
** 8.5% |
| Active management of third stage labour |
|||
| Medical student | 1.5% | ||
| Professional nurse | ** 16.3% | ** 14.8% | |
| Auxiliary nurse |
** 20.7% |
** 19.2% |
4.4% |
| Written questions |
|||
| Medical student | 1.2% | ||
| Professional nurse | ** 25.0% | ** 23.9% | |
| Auxiliary nurse |
** 34.1% |
** 32.9% |
* 9.0% |
| Graphing questions |
|||
| Medical student | –1.8% | ||
| Professional nurse | ** 48.0% | ** 49.8% | |
| Auxiliary nurse |
** 57.5% |
** 59.3% |
9.4% |
| Active management of third stage labour |
|||
| Medical student | 3.8% | ||
| Professional nurse | ** 11.6% | * 7.8% | |
| Auxiliary nurse |
** 16.1% |
* 12.3% |
4.5% |
| Manual extraction of the placentab |
|||
| Medical student | * 8.2% | ||
| Professional nurse | NA | NA | |
| Auxiliary nurse |
NA |
NA |
NA |
| Bimanual uterine compressionb |
|||
| Medical student | * 11.2% | ||
| Professional nurse | NA | NA | |
| Auxiliary nurse |
NA |
NA |
NA |
| Immediate newborn care |
|||
| Medical student | –0.3% | ||
| Professional nurse | * 9.0% | * 9.3% | |
| Auxiliary nurse |
** 12.8% |
* 13.1% |
3.8% |
| Neonatal resuscitation with ambu bag | |||
| Medical student | 3.9% | ||
| Professional nurse | ** 11.5% | 7.6% | |
| Auxiliary nurse | ** 16.5% | * 12.7% | 5.1% |
NA, non-applicable.a Statistical significance for the difference in scores by provider cadre (pair-wise comparison) determined by Bonferroni post hoc test: * P < 0.05; ** P < 0.001.b Skill in manual removal of placenta and bimanual uterine compression were evaluated for doctors and medical students only. Professional and auxiliary nurses are prohibited from carrying out these procedures in Nicaragua. Since only two categories of provider were compared, statistical significance was determined by t-test (instead of ANOVA) and post hoc pair-wise comparison was unnecessary.