Midwifery care providers childbirth and immediate newborn care competencies: a cross-sectional study in Benin, Malawi, Tanzania and Uganda

Evidence-based quality care is essential for reducing the high burden of maternal and newborn mortality and morbidity in sub-Saharan Africa. Provision of quality care results from interaction between several components of the health system including competent midwifery care providers. We assessed midwifery care providers childbirth and immediate newborn competencies as part of the Action Leveraging Evidence to Reduce perinatal morTality and morbidity (ALERT) project in Benin, Malawi, Tanzania, and Uganda. We used a self-administered questionnaire assessing knowledge, and skills drills observations assessing skills and behaviours in the 16 ALERT maternity wards. A total of 302 participants took part in the knowledge assessment and 113 skills drills were conducted. The assessments revealed knowledge gaps in frequency of fetal heart rate monitoring and timing of umbilical cord clamping. More than half of the participants scored poorly on aspects related to routine admission tasks, clinical history-taking and rapid and initial assessment of the newborn in the skills drills assessment, while higher scores were achieved in active management of the third stage of labour. The assessment also suggested a lack of involvement of women in decision-making, illustrated by the failure to encourage women to ask questions and failing to report clinical findings back to them. Participants furthermore indicated a lack of support from their managers, supervision and access to education and training resources. Inadequate competency level of the midwifery care providers may be due to gaps in pre-service training but possibly furthermore related to the structural and operational facility characteristics including continuing professional development. Investment and actioning on these findings are needed when developing and designing pre-service and in-service training to ensure women, newborns and families have access to evidence-based and quality midwifery care when needed. Trial registrationPACTR202006793783148--June 17th, 2020.