Skilled Birth Attendant Competence and Facility Readiness For Managing Obstetric Emergencies in Eritrea

Abstract

Introduction: Skilled Care Attendance during pregnancy and child birth is crucial for the reduction of maternal
and neonatal mortality. Various studies have demonstrated the correlation between increase in skilled care attendance and reduction of maternal mortality globally.
Objective: The objective of the study was to asses the impact of life saving skills training in the improvement of
knowledge and skills of health workers and the quality of health services provided to mothers and newborns.
Methodology: The study was a cross sectional study on 137 Life Saving Skills trained health workers randomly
selected out of the total trained staff. The competence study measured knowledge with a 50-question knowledge
test that covered the topics of (1) aseptic technique, (2) uncomplicated labor and delivery, (3) immediate newborn
care, (4) postpartum hemorrhage, (5) sepsis and (6) pre-eclampsia, and eclampsia. Observation of competency of health workers was used to assess the competency of health workers. Results: The competency test scores appear that nurses and associate nurses are retaining their level of knowledge fairly well. Aseptic technique had the highest average score of any of competency tests. The assessment results showed that most nurses and associate nurses can perform the active management of labor skill relatively well, with an average score of 73% among those assessed. Five zones had average scores above 75%, which indicates the performance is consistently high in most areas. The average score for Manual Removal of placenta was quite high in most zones, with an average score of 66%. Four of the six zones received scores above 70%. The average score
for bimanual uterine compression (58%) was slightly lower than the other skills tests related to the prevention
and/or treatment of postpartum hemorrhage. After completing LSS training, the providers are expected to be
able to recognize the signs and symptoms of an infant who is having difficulty breathing and they should be able
to complete the five basic steps of immediate newborn care: DRY, WARM, POSITION, SUCTION (if necessary),
and STIMULATE. The scores for the skills of nurses and associate nurses in the five steps identified is an average
score of 65%. The study was designed to assess the impact of life saving skills training in the improvement of
knowledge and skills of health workers and quality of health services provided to mothers and newborns and
represents the first comprehensive assessment of the knowledge and skills of nurses and associate nurses in
emergency obstetric care.