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Health services research
Research
Competence of healthcare professionals in diagnosing and managing obstetric complications and conducting neonatal care: a clinical vignette-based assessment in district and subdistrict hospitals in northern Bangladesh
  1. Abdullah Nurus Salam Khan1,2,
  2. Farhana Karim2,
  3. Mohiuddin Ahsanul Kabir Chowdhury2,3,
  4. Nabila Zaka4,
  5. Alexander Manu5,
  6. Shams El Arifeen2,
  7. Sk Masum Billah2
  1. 1 Health Promotion, Education and Behavior, University of South Carolina, Columbia, South Carolina, USA
  2. 2 Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
  3. 3 Epidemiology, University of South Carolina, Columbia, South Carolina, USA
  4. 4 Health Section, Maternal and Newborn Health, UNICEF USA, New York, New York, USA
  5. 5 Department of Population Health, Liverpool School of Tropical Medicine, Liverpool, Liverpool, UK
  1. Correspondence to Mr Sk Masum Billah; billah{at}icddrb.org

Abstract

Background This study assesses the competency of maternal and neonatal health (MNH) professionals at district-level and subdistrict-level health facilities in northern Bangladesh in managing maternal and newborn complications using clinical vignettes. The study also examines whether the professional’s characteristics and provision of MNH services in health facilities influence their competencies.

Methods 134 MNH professionals in 15 government hospitals were interviewed during August and September 2016 using structured questionnaire with clinical vignettes on obstetric complications (antepartum haemorrhage and pre-eclampsia) and neonatal care (low birthweight and immediate newborn care). Summative scores were calculated for each vignette and median scores were compared across different individual-level and health facility-level attributes to examine their association with competency score. Kruskal-Wallis test was performed to identify the significance of association considering a p value<0.05 as statistically significant.

Results The competency of MNH professionals was low. About 10% and 24% of the health professionals received ‘high’ scores (>75% of total) in maternal and neonatal vignettes, respectively. Medical doctors had higher competency than nurses and midwives (score=11 vs 8 out of 19, respectively; p=0.0002) for maternal vignettes, but similar competency for neonatal vignettes (score=30.3 vs 30.9 out of 50, respectively). Professionals working in health facilities with higher use of normal deliveries had better competency than their counterparts. Professionals had higher competency in newborn vignettes (significant) and maternal vignettes (statistically not significant) if they worked in health facilities that provided more specialised newborn care services and emergency obstetric care, respectively, in the last 6 months.

Conclusions Despite the overall low competency of MNH professionals, exposure to a higher number of obstetric cases at the workplace was associated with their competency. Arrangement of periodic skill-based and drill-based in-service training for MNH professionals in high-use neighbouring health facilities could be a feasible intervention to improve their knowledge and skill in obstetric and neonatal care.

  • human resource management
  • quality in healthcare
  • organisation of health services
  • obstetrics
  • perinatology
  • public health

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjopen-2018-028670

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    Footnotes

    • Contributors SEA, SMB, NZ and MAKC designed the study, and SMB, MAKC and ANSK conceptualised the paper. ANSK, FK and MAKC were involved in data acquisition and literature review. ANSK and FK conducted the analysis of the paper, and NZ, AM and SEA guided the additional analysis. ANSK and FK prepared the first draft. MAKC, NZ, AM, SEA and SMB contributed to the revision and preparation of the final draft. All authors have reviewed and approved the final manuscript.

    • Funding The study was conducted with funding support from Bill and Melinda Gates Foundation (BMGF) for Every Mother Every Newborn Quality Improvement initiative to UNICEF Headquarter (BMGF grant number OPP1112117, UNICEF and BMGF partnership grant).

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The ethical review committee of ICDDR,B approved the study (protocol number PR-16024). Informed written consent was sought from the healthcare professionals and health facility managers before conducting the interviews.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request.