Competency of health worker’s in emergency obstetric care: an assessment using clinical vignettes
Creators: name: Khan, Abdullah Nurus Salam
name: Karim, Farhana
name: Mohiuddin Ahsanul Kabir Chowdhury
name: Sk Masum Billah
name: Zaka, Nabila
name: Manu, Alexander
name: Shams El Arifeen
Publisher: name: Gates Open Research
Year: 2019

description: Background: Prompt identification and management of pre-eclampsia (PE) and antepartum haemorrhage (APH) depend on competency of the birth attendants. Clinical vignette based assessment could identify the extent of health worker’s competence in managing these infrequent conditions as part of emergency obstetric care (EmOC).<br><br>Method: During June-August 2016, competence of 39 Medical-Officers (MO) and 95 nurses working in obstetric-ward of 15 government health facilities (3 district hospitals, 12 sub-district hospital) was measured using clinical vignettes on PE and APH. The vignettes resulted in three outcome measures: i) total scores, ii) scores for diagnosis and iii) management component. Mean vignette scores were compared using T-tests and linear regression was performed to measure the association of vignette scores with cadres of health workers, facility readiness for EmOC and average annual utilization of normal deliveries after adjusting for type of facility, health workers’ work experience and training status on managing maternal complication. Cumulative EmOC readiness score (range: 0-7) was generated for each facility depending on provision of seven EmOC signal functions within last 6 months. Average of all normal deliveries conducted during three years (2013-2015) preceding the survey was calculated to estimate the annual utilization.<br><br>Result: About 80% of health workers received any training on managing maternal complication, however, only 7% received any refresher’s training within last 12 months. The overall vignette score was 8.8 (range: 0-19), which was significantly higher among MO than nurses (10.7 vs. 8.1, p&lt;0.001) and the score was not associated with health facility types, training status and years of experience of the providers. Vignette score for management component (range: 0-9) increased with higher annual average number of deliveries in their respective working facility (adjusted β-coefficient 0.16, CI 0.03-0.28, p=0.01) and increased with each unit increase in EmOC readiness score (adjusted β-coefficient 0.44, CI 0.04-0.8, p=0.03). The diagnosis component of vignette score was not associated with any of these factors except it was higher among MO than nurses (adjusted β-coefficient 1.2, CI 0.13-2.18, p=0.03).<br><br>Conclusion: In developing countries, nearly all normal deliveries are conducted by the nurses, hence, their lack of competence in diagnosing and managing obstetric complication is of concern. Better EmOC preparedness and higher utilization of normal deliveries resulted in higher vignette score for the management component, which might indicate the role of experiential learning through a higher number of case management in better-prepared facilities. Periodic refresher’s training should be arranged for retention of competency in obstetric case management.