Obstetrics knowledge and skills training as a catalyst for change

  • RC Pattinson
  • A-M Bergh
  • J Makin
  • Y Pillay
  • J Moodley
  • B Madaj
  • C Ameh
  • N van den Broek

Abstract

Background. Poor emergency obstetric care has been shown by national confidential enquiries into maternal deaths to contribute to a number of maternal deaths in South Africa. Objectives. To assess whether a structured training course can improve knowledge and skills and whether this can influence the capacity of a healthcare facility to provide basic and comprehensive emergency obstetric care signal functions. Methods. A baseline survey was conducted to assess the seven basic emergency obstetric and neonatal care signal functions in 51 community health centres (CHCs) and the nine comprehensive emergency care signal functions in 62 district hospitals (DHs). A reassessment was conducted 1 year after saturation training had been provided in each district. The delegates were trained using a structured training programme (Essential Steps in Managing Obstetric Emergencies, ESMOE) and their knowledge and skills were tested before and after the training. Saturation training was considered to have been achieved once 80% of the healthcare professionals involved in maternity care had been trained. Results. There was a significant improvement in the knowledge and skills of doctors, namely by 16.8% and 32.8%, respectively, of advanced midwives by 13.7% and 29.0%, and of professional nurses with midwifery by 16.1% and 31.2%. The seven basic emergency care functions improved from 60.8% to 67.8% in the CHCs and from 90.7% to 92.5% in the DHs before and after training. If the two signal functions that are not within the scope of practice of professional nurses with midwifery are excluded (viz. assisted delivery and manual vacuum aspiration), the functionality of CHCs increased from 85.1% to 94.9%. Conclusions. The ESMOE training programme improved knowledge and skills, but there was a modest improvement in the functionality of the facilities. Improvement in functionality requires changes in the structure of the health system, including changing the scope of practice of professional nurses with midwifery and employing more advanced midwives in CHCs.

S Afr Med J 2018;108(9):748-755

Author Biographies

RC Pattinson
South African Medical Research Council Maternal and Infant Health Care Strategies Unit, Faculty of Health Sciences, University of Pretoria, South Africa; Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Pretoria, South Africa
A-M Bergh
South African Medical Research Council Maternal and Infant Health Care Strategies Unit, Faculty of Health Sciences, University of Pretoria, South Africa
J Makin
South African Medical Research Council Maternal and Infant Health Care Strategies Unit, Faculty of Health Sciences, University of Pretoria, South Africa; Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Pretoria, South Africa
Y Pillay
Deputy Director-General: Programmes, National Department of Health, South Africa
J Moodley
Chairman: Emergency Obstetric Simulation Training Board, South Africa; Chairman: National Committee for Confidential Enquiries into Maternal Deaths in South Africa
B Madaj
Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
C Ameh
Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
N van den Broek
Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK
Published
2018-10-14
Section
Articles

Journal Identifiers


eISSN: 0256-95749
print ISSN: 2078-5135