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 5. Mean difference in score (%) by provider cadrea

Topic Doctor Medical student Professional nurse
Knowledge test
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%
Partograph test
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%
Skills evaluation
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.

[an error occurred while processing this directive]