what are midwives in ethiopia doing to reduce pph complications
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Obstetric care providers' noesis, practice and associated factors towards active management of third phase of labor in Sidama Zone, South Ethiopia
BMC Pregnancy and Childbirth volume 17, Commodity number:292 (2017) Cite this article
Abstract
Background
Agile management of tertiary stage of labor played a smashing part to prevent kid birth related hemorrhage. Notwithstanding, maternal morbidity and mortality related to hemorrhage is high due to lack of knowledge and skill of obstetric intendance providers 'on agile management of third stage of labor.
Our study was aimed to assess cognition, practice and associated factors of obstetric intendance providers (Midwives, Nurses and Health officers) on active direction of tertiary stage of labor in Sidama Zone, South Ethiopia.
Methods
An institution based cross sectional study design was conducted from December one–30 /2015 among midwives, nurses and health officers. Simple random sampling technique was used to go the full of 528 participants. Data entry was done using EPI Info 3.5.1 and exported to SPSS version twenty.0 software package for analysis. The presence of association between independent and dependent variables was assessed using odds ratio with 97% confidence interval by applying logistic regression model.
Results
Of the 528 obstetric care providers 37.7% and 32.8% were knowledgeable and skilled to manage 3rd stage of labor respectively. Later on controlling for possible confounding factors, the result showed that pre/in service training, being midwife and graduation twelvemonth were found to be the major predictors of proper agile management of third stage of labor.
Determination
The knowledge and practice of obstetric care providers towards active direction of third phase of labor tin be improved with appropriate interventions like in-service trainings. This study also clearly showed that the level of cognition and practice of obstetric care providers to wards active management of tertiary stage of labor needs immediate attention of Universities and wellness science colleges better to revise their obstetrics class contents, health institutions and zonal wellness bureau should arrange trainings for their obstetrics intendance providers to enhance skill.
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Background
Active direction of 3rd phase of labor played a great role to prevent childbirth related hemorrhage. Proper practise of active management of third stage of labor is a novel method to convalesce postpartum hemorrhage [i, two].
Hemorrhage is the leading crusade of maternal death, particularly in developing countries including Ethiopia. Maternal bloodshed ratio in Ethiopia per 100,000 alive births were 676 in 2012 and 420 in 2014. A 2015 estimate puts the maternal mortality ratio in Ethiopia 353 /100,000.
Worldwide, maternal morbidity and mortality is alarmingly decrease, withal in developing countries, peculiarly sub-Saharan Africa frontline maternal expiry is acquired by hemorrhage due to infrastructure limitation, lack of skill birth attendants, inappropriate management of active third stage of labor, [2].
Tertiary stage of labor is the menses later the fetus is delivered until the placenta completely removed. It is the easiest and shortest fourth dimension, but unsafe as most maternal deaths were occurred [three].
Active management of third phase of labor involves the obstetric intendance providers to carry out three interrelated simply independent processes: - Safe assistants of an uterotonic agent, Controlled cord traction and uterine massage. Active management of tertiary stage of labor is an interventions needed to reduce maternal decease due to PPH [4].
FIGO–ICM Recommends to employ uterotonic drugs immediately following delivery of the fetus, controlled cord traction and uterine massage immediately after delivery of the placenta, followed by massage of the uterus every fifteen min for 2 h to assess the continued need for massage [5].
Active management of third stage of labor is a proven solution to prevent unnecessary procedures and complications, such every bit transmission removal of the placenta and postpartum hemorrhage [6].
Since all parturient women are at risk for PPH, obstetric care providers need to possess the necessary knowledge and skills of active management of the third stage of labor properly to foreclose PPH [seven].
The WHO technical update, assures that now a days the nigh effective arroyo to prevent PPH is active direction of the third phase of labor (AMTSL) [8].
Effective use of AMTSL in reducing PPH and the need for PPH handling has been investigated by a number of large trials. The Hinchinbrook 12 randomized command trials provided evidence that AMTSL significantly reduces postpartum hemorrhage, decreases claret loss and decreases the demand for claret transfusions [2].
The AMTSL exercise of obstetric care providers in developing countries is not in line with what is recommended past FIGO because of sure factors like cognition, qualification, training, and other demographic factors. The practice of AMTSL according to the FIGO/ICM recommendations in Ethiopia was just 5% of all observed deliveries [5].
The aimed of this study is to assess knowledge, practise and associated factors of obstetric care providers (amongst midwives, nurses and wellness officers) on active management of 3rd stage of labor in Sidama Zone, South Ethiopia.
Methods
An Institution based cross-sectional study was conducted among obstetric care providers in Sidama Zone from December 1–xxx, 2015. Sidama zone is one of the zone found in southern nation'southward nationalities and peoples region (SNNPR) of Ethiopia.
According to Sidama zone health department, the total population in 2014/2015 is expected to be 3,676,576. The health institutions which are found in the zone include 3 governmental hospitals, 130 governmental wellness centers, 524 posts. Regarding man resource for health, the zone has 1857 obstetrics care providers.
Out of 19 Woredas (districts), from the Zone vii were selected by simple random sampling techniques [9]. The written report population was randomly selected obstetric care providers. The sample size was determined using unmarried population proportion formula at 95% of confidence interval with supposition of prevalence of AMTSL practice in Ethiopia 5% [5] with (α = 0.05), three% marginal error (d = 0.03).
Multistage phase sampling method was employed by using design consequence of 2 and 10% non-response response. The concluding sample size was 528 obstetric care providers. To collect the data, initially all public health institution in Sidama zone from selected Districts were listed and identified. The participants were allocated proportionally to each public health institution and were selected by using simple random sampling technique from each public health institution. Obstetric care providers who had service greater than half dozen month were participated in the written report.
The structured interviewer administered questionnaires were included sociodemographic characteristics, personal characteristics and noesis while observational checklist for skill part assessment were used equally data collection instruments.
Obstetric intendance provider who knew all AMTSL components, right time of oxytocin administration and string clamping were considered equally knowledgeable and the obstetric care provider who administered oxytocin with in i min, apply CCT and perform uterine massage considered as skilled.
Pretest was washed on 5% obstetric care providers working out of the selected wellness to check clarity, length and abyss of the questionnaires and ascertainment bank check listing. Based on this necessary correction was washed appropriately.
Data was collected past face to face interview using a structured and pre-tested questionnaire to assess knowledge and ascertainment check lists for practice assessment.
Both interview and observation were used for the same participant, interview was administered to assess the sociodemographic characteristics and knowledge of the participant. Later on interview, exact consent was obtained from the parturient mothers, and the participant was observed while managing third phase of labor.
Interview and ascertainment were performed by obstetric care provider data collectors. Both sexes were participated in data collection. 7 (07) obstetric intendance providers who have BEmONC preparation were recruited and training was given for 01 days on the objective, relevance of the study, confidentiality of information, respondent rights, informed consent, and technique of interview, 02 Wellness professional person who have 1st degree (BSC nurse, midwife or HO) were trained and supervise the data drove. Data entry was done by using EPI Info 3.5.1 and exported to SPSS version twenty.0 software package for analysis. The presence of association between independent and dependent variables was assessed using odds ratio with 97% confidence interval by applying logistic regression model.
Ethical clearance was obtained from Higher of Medicine and Health Sciences ethical review committee, Hawassa University. Formal letter of cooperation was written for Sidama Zone Health Department and Sidama zone selected Commune Health Offices. Subsequently informing the objective of the report, consent was obtained voluntarily from each written report subject.
Results
Socio-demographic characteristic and experiences of obstetric care providers
A total of 528 obstetric care providers were participated in the study, with 96.four% response rate. Out of the total respondents, 75.4% (n = 398) were females and the age of participants were from 22 to 45 years old. The hateful historic period of the study population was 26.4 with SD iii.05 years. Sidama was a dominant ethnic group, which accounted for 49.6% (n = 262) (Table 1).
Cognition of obstetrics intendance providers on active management of tertiary stage of labor
The knowledge of the obstetrics care providers towards active management of 3rd stage of labor were 37.7%(n = 199) (Table 2).
Practice of obstetrics intendance providers on active managements of 3rd phase of labor
The exercise of the obstetrics care providers towards agile management of 3rd stage of labor were 32.8%(northward = 173) (Table 3).
Factors associated with obstetric care provider's knowledge to wards AMTSL
Profession and year of graduation were factors which associate with knowledge of obstetric care provider'southward towards active management of tertiary stage of labor (Table 4).
Factors associated with obstetric care provider's practice to wards AMTSL
Pre/in service training was associated with the practice of obstetric intendance providers to wards agile management of third phase of labor (Table 5).
In this study 11.4% (north = 60) of the obstetric intendance providers were clamp the cord within the recommended fourth dimension which is within 2–3 min (Fig. 1).
Exercise of string clamping time of obstetrics care providers (Due north = 528)
Lxxx 8 betoken 4 % (n = 467) of the commitment rooms were conducive to utilize active third stage management (Fig. 2).
Conduciveness of delivery room
Discussion
The available reports and this study showed that in Ethiopia the knowledge and do of obstetric intendance providers towards active management of third stage of labor is unsatisfactory. Among the participants 37.seven% (n = 199) of the obstetric care providers were knowledgeable on managing of third stage of labor actively. This finding is higher than the study conducted in south Nigeria and Tanzania 28.3% and ix% respectively [10, xi]. Profession and year of graduation were the factors which associate with obstetric care provider'due south noesis towards active management of third stage of labor. Even observational studies are exposed to observational bias, utilization of both structured interviewer administered questionaries and observation check listing is considered as force of this study. This study is the first of its kind in southern Ethiopia which includes observational check listing to assess the actual practice of obstetric care providers towards agile management of third stage of labor. Based on the observation the practice of obstetric care providers were not satisfactory in this written report even information technology is better from the previous findings in Ethiopia and Nigeria [5, 9]. Almost all the obstetric care providers were rid of the placenta after administration of uterotonic drugs, like that of Australia, Holland and United Kingdom practice, but different from some United States and Canada which advocates withholding uterotonic administration until the placenta is delivered [12]. All obstetric acre providers were used oxytocin as an uterotonic drug for AMTSL which is slightly different from a report conducted in Istanbul, Turkey [6]. Most of the obstetric care providers check presence of 2d twine before administration of oxytocin which is amend than Istanbul Turkey do [vi]. Majority of the participants were observed while correctly apply counter cord traction practice only half of them were not wait uterine contraction like that of Nepal [13] Practice. Participants who got pre/in service preparation were observed while correctly practicing AMTSL than who did not have training which indicates AMTSL related training is needed.
In this report bulk of the obstetric care providers were midwives which is totally different from a study conducted in Federal democratic republic of ethiopia, which concludes nurses performed well-nigh (61%) in Ethiopia [5]. Physicians were not observed during active management of third phase of labor, this might exist due to Physicians tend to manage more complicated third stages. Almost of our participants were not clamp the cord with the recommended time which is within ii–three min. In Albanian maternity hospital the practice is within xx south [14]. In that location was no problem on delivery room conduciveness and availanlity of oxytocic drugs to practice AMTSL in our study area.
Conclusion and recommendation
The knowledge and exercise of obstetric care providers towards active management of tertiary phase of labor can be improved with appropriate interventions like in-service trainings. This report also clearly showed that the knowledge and practice of obstetric care providers to wards AMTSL which needs immediate attending of Universities and health science colleges improve to revise their obstetrics course contents, health institutions and zonal health function demand to conform trainings for their obstetrics care providers to heighten skill.
Abbreviations
- AMTSL:
-
Active management of tertiary phase of labor
- AOR:
-
Adjusted odds ratio
- BEmONC:
-
Bones emergency obstetrics and newborn care
- E.C:
-
Eastward Ethiopian agenda
- FIGO:
-
Federation of international gynecology and obstetrics
- ICM:
-
International cooperation of midwifery
- PPH:
-
Postpartum hemorrhage
- SNNPRS:
-
Southern nation nationalities people regional land
- WHO:
-
World health arrangement
References
-
Organization WH, UNICEF. Trends in maternal bloodshed: 1990–2015: estimates from WHO, UNICEF, UNFPA, Globe Bank Group and the United nations Population Partition. 2015.
-
Organization WH. Maternal bloodshed in 2005. Estimates adult by WHO, UNICEF, UNFPA, and The World Depository financial institution. 2010.
-
Deepak NN, Mirzabagi Eastward, Koski A, Tripathi V. Knowledge, Attitudes, and Practices Related to Uterotonic Drugs during Childbirth in Karnataka, India: A Qualitative Research Written report. PLoS One. 2013;8(four):e62801.
-
Ramadhani F. Midwives' competency for implementation of active management of 3rd stage of labor in Dar es salaam municipal hospitals. Tanzania: Muhimbili University of Wellness and Allied Sciences; 2011.
-
Taylor U, Delorme P, Miller Southward. FIGO Guidelines: Prevention and Handling of Postpartum Hemorrhage in Low-Resource Settings.
-
Stanton C, Armbruster D, Knight R, Ariawan I, Gbangbade S, Getachew A, et al. Employ of active management of the third stage of labour in seven developing countries. Bull World Health Organ. 2009;87(3):207–15.
-
Tan WM, Klein MC, Saxell Fifty, Shirkoohy SE, Asrat G. How practice physicians and midwives manage the third phase of labor? Nascency. 2008;35(iii):220–nine.
-
Leduc D, Senikas V, Lalonde AB, Ballerman C, Biringer A, Delaney M, et al. Active management of the third stage of labour: prevention and handling of postpartum hemorrhage. JOGC. 2009;31(x):980–93.
-
Salvador East. Agile Management of the 3rd State of Labor Is Rare in Some Developing Countries. Balderdash World Wellness Organ. 2009;87(3):207–xv.
-
Maughan KL, Heim SW, Galazka SS. Preventing postpartum hemorrhage: managing the tertiary stage of labor. Am Fam Physician. 2006;73(6):1025–8.
-
Oladapo OT, Fawole AO, Loto OM, Adegbola O, Akinola OI, Alao MO, et al. Active direction of third stage of labour: a survey of providers' knowledge in southwest Nigeria. Curvation Gynecol Obstet. 2009;280(six):945–52.
-
Bimbashi A, Ndoni Eastward, Dokle A, Duley Fifty. Care during the third stage of labour: obstetricians views and practise in an Albanian motherhood hospital. BMC Pregnancy Childb. 2010;ten(1):4.
-
Prick BW, Vos AA, Hop WC, Bremer HA, Steegers EA, Duvekot JJ. The current state of active tertiary stage direction to forestall postpartum hemorrhage: a cross-sectional study. Acta Obstet Gynecol Scand. 2013 November;92(11):1277–83.
-
Oladapo OT, Akinola OI, Fawole AO, Adeyemi AS, Adegbola O, Loto OM, et al. Active management of tertiary stage of labor: evidence versus practice. Acta Obstet Gynecol Scand. 2009;88(11):1252–threescore.
Acknowledgements
Nosotros are very grateful to Hawassa University for approval of ethical clearance, technical and financial support of this report. And then, we would similar to thank all obstetrics care providers who participated in this study for their commitment in responding to our interviews and consent for observations. Finally, we are too grateful to the Sidama zone wellness department and Sidama zone selected District health offices for their assistance and permission to undertake the research.
Competent interests
The authors declare that they have no competing interests.
Funding
This research were funded by Hawassa University for academic staff.
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We send all which is available equally, there is not remaining information and materials.
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ZT wrote the proposal, participated in information drove, analyzed the information and drafted the paper. ZY and AA canonical the proposal with some revisions, participated in data assay and revised subsequent drafts of the newspaper. All authors read and approved the last manuscript.
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Ethical clearance was obtained from the Institutional Review Board of the Hawassa Academy. Communication with the dissimilar District health office administrators were made through formal letter obtained from the Hawassa University. After the purpose and objective of the written report accept been informed, written and verbal consent was obtained from each study participant. Participants were also be informed that participation was on voluntary footing and they tin can withdraw from the study at any time if they were not comfortable about the questionnaire. In order to keep confidentiality the information was maintained throughout by excluding names as identification in the questionnaire and kept their privacy during the observation by observing them lone.
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Tenaw, Z., Yohannes, Z. & Amano, A. Obstetric care providers' noesis, practice and associated factors towards active direction of third stage of labor in Sidama Zone, South Ethiopia. BMC Pregnancy Childbirth 17, 292 (2017). https://doi.org/10.1186/s12884-017-1480-8
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DOI : https://doi.org/10.1186/s12884-017-1480-8
Keywords
- Active management of third phase of labor
- Ethiopia
- Knowledge
- Practice
- Third stage
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