Knowledge and perceptions of quality of obstetric and newborn care of local health providers: a cross-sectional study in three districts in Malawi

Aim Quality of service delivery for maternal and newborn health in Malawi is influenced by human resource shortages and knowledge and care practices of the existing service providers. We assessed Malawian healthcare providers’ knowledge of management of routine labour, emergency obstetric care and emergency newborn care; correlated knowledge with reported confidence and previous study or training; and measured perception of the care they provided. Methods his study formed part of a large-scale quality of care assessment in three districts (Kasungu, Lilongwe and Salima) of Malawi. Subjects were selected purposively by their role as providers of obstetric and newborn care during routine visits to health facilities by a research assistant. Research assistants introduced and supervised the self-completed questionnaire by the service providers. Respondents included 42 nurse midwives, 1 clinical officer, 4 medical assistants and 5 other staff. Of these, 37 were staff working in facilities providing Basic Emergency Obstetric Care (BEMoC) and 15 were from staff working in facilities providing Comprehensive Emergency Obstetric Care (CEMoC). Results Knowledge regarding management of routine labour was good (80% correct responses), but knowledge of correct monitoring during routine labour (35% correct) was not in keeping with internationally recognized good practice. Questions regarding emergency obstetric care were answered correctly by 70% of respondents with significant variation depending on clinicians’ place of work. Knowledge of emergency newborn care was poor across all groups surveyed with 58% correct responses and high rates of potentially life-threatening responses from BEmOC facilities. Reported confidence and training had little impact on levels of knowledge. Staff in general reported perception of poor quality of care. Conclusion Serious deficiencies in providers’ knowledge regarding monitoring during routine labour and management of emergency newborn care were documented. These may contribute to maternal and neonatal deaths in Malawi. The knowledge gap cannot be overcome by simply providing more training.

Councellors' Experience During Training and Home Based HIV Councelling and Testing in Zomba District, Malawi

Introduction In 2007, St Luke’s Mission Hospital initiated a district-wide Door to Door HIV counselling and testing (HCT) programme in Zomba district. The intent of the programme was to provide quality HCT services to people in their homes and effectively those found to be HIV positive referred to appropriate services. Methodology This was a cross sectional study using a questionnaire consecutively administered to a sample of 105 counsellors who had resided in the community for a period of over one year. The questionnaire sought to establish, knowledge gained, experiences and recommendations on how the programme has been implemented and assist running of similar future programmes. Data analysis was done manually using both qualitative and quantitative methodologies. Results We report that nearly 23% of the counsellors thought that during their training as a door to door HTC councelor they had benefited in learning to working with communities; an aspect they found to be highly applicable in discharge of their duties. The major setbacks during the training were lack daily allowances, less amount of time spent on understanding child councelling and the manual used was diffucult to follow. Over 32% of the councellors were satisfied with the participation of their clients during pre-test counselling sessions, however, the major challenge they had was the misconception that they were blood suckers, a view reported by nearly 17% of the counsellors. Close to 72% reported not to have met any problems during post-test counselling compared to 24% who reported to have found challenges. Conclusion The study has revealed that there is a need to re-look child children counselling especially in training door to door HCT counsellors. It has also revealed the prevalent allowance culture despite the benefits of training. The common challenges were refusal of test Results and failure to understand discordance. Misconceptions may still exist in the community regarding anything dealing with removing blood. There is still need for more information regarding discordance especially among couples in the community.