The knowledge and practice of nurse midwives concerning the provision of postnatal care at primary health care facilities in Lilongwe District, Malawi

Abstract

Malawi continues to struggle with high maternal mortality rates, with most occurring during the postnatal period. Skilled care given during the provision  of postnatal care (PNC) is reported to improve the health outcomes of the mother and baby. However, despite having skilled providers, maternal deaths  remain high, particularly during the first six weeks of delivery. This study aimed to assess the knowledge and practice of nurse midwives in the provision  of PNC at primary health care facilities in Lilongwe District, Malawi. Data were collected with questionnaires and observations from nurse midwives (n=38  for questionnaires, 20 for observations) across 11 primary healthcare centers in the district. Nurse midwives trained in emergency obstetric and neonatal  care (EmONC) were more knowledgeable than those that did not. Registered nurse midwives had more knowledge scores compared to nurse midwife  technicians and community midwife assistants. Despite being more knowledgeable, their practice was below the standards stipulated in the Malawi Ministry of Health Maternal and Neonatal care guidelines. Lack of clear staffing norms which contribute to the maldistribution of staff led to shortages;  among several other factors affecting the practice of nurse midwives in the provision of PNC in the study area. For instance, the literature notes that the  lack of prioritising the allocation of skilled midwives following uncomplicated birth in the rural areas affects the provision of PNC. This study recommends  balanced distribution of skilled midwives, the development of a deployment policy to mitigate the challenge of staff maldistribution, and the expansion of  EmONC training to address challenges affecting the quality of care at primary healthcare facilities, particularly in rural areas of the country.