Adherence to evidence-based intrapartum care practices and influencing factors among obstetric care providers in Ethiopia: A systematic review and meta-analysis

BackgroundEven though Evidence-Based Practice (EBP) is a key component of quality of Intrapartum care and links to improved health care outcomes, consistent application of EBP in patient care remains a challenge for health care providers. In the study area, there are no previous studies conducted on evidence-based Intrapartum care practice among obstetric care providers. Therefore, this study was aimed to assess the magnitude of evidence based intra-partum care practice and its associated factors among obstetric care providers working in hospitals of Wollega zones, Oromia Region, West Ethiopia, 2022.MethodAn institution-based cross-sectional study using quantitative method was conducted from January to April/2022 in 11 hospitals of the four Wollega zones. All obstetric care providers (278) who were practicing intrapartum care in the selected hospitals were included. The data was collected using structured self-administered questionnaire and observational checklist. Data was entered via Epi-Data version 3.1 and analyzed by SPSS version 25 statistical software. To see the association between the independent variables and evidence based Intrapartum care practice, multivariable logistic regression analysis was done. The statistical significance of association was declared at p-value ≤ 0.05. Tables, figures and charts were also used in descriptive statistics.ResultThe overall magnitude of evidence-based Intrapartum care practice was found to be 63.7% [95% CI (59.7, 67.7)]. There was a statistically significant association between evidence-based Intrapartum care practice and having good knowledge about Intrapartum care practice [AOR = 2.95; 95% CI (1.52,5.73)], positive attitude towards Intrapartum care practice [AOR = 3.13; 95% CI (1.59,6.16)], availability of updated Intrapartum care guideline [AOR = 2.88; 95% CI (1.46,5.70)], number of obstetric care providers per a shift (≥5 care providers) [AOR = 2.31; 95% CI (1.01,5.29)], number of deliveries within a day (<10 deliveries) [AOR = 4.61; 95% CI (2.28,9.31)], educational level (MSc and above) [AOR = 5.75; 95% CI (2.23,14.84)] at p-value ≤ 0.05.ConclusionOur study revealed that, magnitude of evidence-based Intrapartum care practice was found to be low according to the WHO recommendation. These findings indicate that additional attention and monitoring is required to implement current Intrapartum care practices with the WHO guidelines.

Even though Evidence-Based Practice (EBP) is a key component of quality of Intrapartum care and links to improved health care outcomes, consistent application of EBP in patient care remains a challenge for health care providers. In the study area, there are no previous studies conducted on evidence-based Intrapartum care practice among obstetric care providers. Therefore, this study was aimed to assess the magnitude of evidence based intra-partum care practice and its associated factors among obstetric care providers working in hospitals of Wollega zones, Oromia Region, West Ethiopia, 2022. An institution-based cross-sectional study using quantitative method was conducted from January to April/2022 in 11 hospitals of the four Wollega zones. All obstetric care providers (278) who were practicing intrapartum care in the selected hospitals were included. The data was collected using structured self-administered questionnaire and observational checklist. Data was entered via Epi-Data version 3.1 and analyzed by SPSS version 25 statistical software. To see the association between the independent variables and evidence based Intrapartum care practice, multivariable logistic regression analysis was done. The statistical significance of association was declared at p-value ≤ 0.05. Tables, figures and charts were also used in descriptive statistics. The overall magnitude of evidence-based Intrapartum care practice was found to be 63.7% [95% CI (59.7, 67.7)]. There was a statistically significant association between evidence-based Intrapartum care practice and having good knowledge about Intrapartum care practice [AOR = 2.95; 95% CI (1.52,5.73)], positive attitude towards Intrapartum care practice [AOR = 3.13; 95% CI (1.59,6.16)], availability of updated Intrapartum care guideline [AOR = 2.88; 95% CI (1.46,5.70)], number of obstetric care providers per a shift (≥5 care providers) [AOR = 2.31; 95% CI (1.01,5.29)], number of deliveries within a day (<10 deliveries) [AOR = 4.61; 95% CI (2.28,9.31)], educational level (MSc and above) [AOR = 5.75; 95% CI (2.23,14.84)] at p-value ≤ 0.05. Our study revealed that, magnitude of evidence-based Intrapartum care practice was found to be low according to the WHO recommendation. These findings indicate that additional attention and monitoring is required to implement current Intrapartum care practices with the WHO guidelines.

BackgroundDespite the availability of clear guidelines, evidence from low- and middle-income countries, including Ethiopia, shows persistent gaps in implementing evidence-based intrapartum practices, contributing to high maternal and neonatal morbidity and mortality. In southern Ethiopia, including the Wolaita Zone, where resource constraints are common, the extent of adherence to these practices and factors influencing their implementation is not well understood. Therefore, this study aimed to assess the implementation level of evidence-based intrapartum care practice and its associated factors among obstetric care providers working in hospitals in Wolaita Zone in 2022.MethodsA facility-based cross-sectional study was conducted from August 1–31, 2022, among 332 obstetric care providers in the hospitals of the Wolaita Zone. The data were collected using structured interviewer-administered questionnaires and non-participatory observation with a standard checklist supplemented with record review. Data were entered into EpiData version 4.6.0.2 and then exported to Stata Version 15 for analysis. Binary logistic regression analyses were conducted to identify factors associated with evidence-based intrapartum care among obstetric care providers. An adjusted odds ratio (AOR) with a 95% confidence interval was reported.ResultsThe implementation of evidence-based intrapartum practice was 52.5% [95% CI (47.1%-57.9%)]. Work experience >5 years [AOR:1.74;95%CI (1.04,2.91)], knowledge [AOR:1.77; 95% CI (1.06,2.95)], in-service training [AOR = 1.83; 95% CI (1.05,3.17)], access to EBP guidelines [AOR:1.70; 95% CI (1.01,2.85)], and managerial support [AOR:3.1; 95% CI (1.11,8.67)] were associated with the implementation of evidence-based intrapartum care.ConclusionEvidence-based intrapartum care practice implementation was low in the study area. Years of work experience, knowledge, in-service training, availability of EBP guidelines, and support from managers were the factors with a significant association with evidence-based intrapartum care practice. Strengthening these enabling factors may help creating an environment that facilitates greater adherence to recommended intrapartum care practices, thereby improving maternal and newborn outcomes.

Background:Evidence-based practice in intrapartum care is critical for lowering maternal and neonatal mortality and morbidity. Evidence-based practice, according to the World Health Organization Quality of Care Framework for Maternal and Newborn Health, is an important component of intrapartum care. However, little is understood about evidence-based intrapartum care practice in Ethiopia, particularly in the study setting.Objective:To assess evidence-based intrapartum care practice and associated factors among obstetric care professionals in Jimma Zone public hospitals in Southwest Ethiopia.Methods:A facility-based cross-sectional study was carried out on 217 obstetric care providers in Jimma Zone public hospitals in southwest Ethiopia. The study used a census approach to include all eligible participants within the specified population. Data were collected from June 1 to 30, 2023, using semistructured self-administered questionnaires. The collected data were entered into EpiData version 4.6 and exported to Statistical Packages for Social Sciences version 25 for analysis. Multivariable logistic regression was run to see the association between evidence-based intrapartum care practice and predictor variables. Statistical significance was set at p-values less than 0.05 in the multivariable logistic regression.Results:Overall, 41.2% (95% CI: 40.8–42.3) of obstetric care providers in Jimma Zone public hospitals used evidence-based practices for intrapartum care. Attending in-service training (AOR (95% CI): 3.5 (1.61–9.71)), accessibility of obstetric care guidelines (AOR (95% CI): 2.082 (1.222–3.547)), having regular case presentation (AOR (95% CI): 2.5 (1.234–6.743)), having knowledge (AOR (95% CI): 2.3 (1.222–3.547)), attitude of obstetric care providers (AOR (95% CI): 1.847 (1.065–3.204)), having less than 2 years of work experience (AOR (95% CI): 1.32 (1.012–3.56)), and having 2–5 years of work experience (AOR (95% CI): 3.49 (1.23–6.312)) were among factors significantly associated with evidence-based intra-partum care practice of obstetric care providers in Jimma Zone public hospitals.Conclusions:This study indicated that the majority of obstetric care providers did not practice evidence-based intrapartum care, which requires attention from all stakeholders. It is recommended for hospitals in the Jimma Zone to make guidelines available, provide in-service trainings, and identify systematic strategies to improve the knowledge and attitude of obstetric care providers.

BackgroundEven though recent progress, Ethiopia continues to be one of the most significant contributors to the worldwide burden of maternal mortality. Evidence-based intrapartum practices have significant value to improve the health outcome of the mother and the neonate. However, in Ethiopia, it is not exercised according to the standard. Assessing the proportion of evidence-based intrapartum practice and predictors is essential and vital to providing better-quality care to laboring mothers. Hence, this study was aimed to assess the magnitude of evidence-based intrapartum practice and predictors among obstetric care providers working in public hospitals in South Wollo zone, North-central Ethiopia.Patient and MethodsAn institutional-based cross-sectional study was employed among 398 obstetric care providers from February 1 to April 30, 2021. Study participants were selected using a simple random sampling technique. Both a structured questionnaire and an observational checklist were used to collect the data. Bivariate and multivariable logistic regression was done to determine predictors associated with evidence-based intrapartum practice and P-value <0.05 at 95% CI was declared as statistically significant.ResultsThe overall magnitude of evidence-based intrapartum care was 54.7% [95% CI (49.6–59.7%)]. Knowledge [AOR = 2.1; 95% CI (1.30–3.38)], computer access [AOR = 2.04; 95% CI (1.27–3.27)], work experience [AOR= 2.13; 95% CI (1.21–3.73)] and training [AOR = 1.81; 95% CI (1.12–2.93)] were found to be statistically significant with evidence-based intrapartum practice.ConclusionWe found that only half of the obstetric care providers applied evidence-based intrapartum practice. Increasing knowledge of intrapartum care, providing continuous training, making the working environment safe to handle experienced providers, and easily access computers in the workplace will be needed to maximize the practice of evidence-based intrapartum care and scale up the quality of care.

Evidence-based practice is defined as using the best available research and clinical evidence by incorporating patients' values and preferences for their health needs. The use of evidence-based intrapartum care practices is an essential tool to improve the quality of obstetrics care. The primary objective of this study was to determine the prevalence of evidence-based intrapartum care and associated factors among obstetrics care providers in Ethiopia. Important articles were retrieved from universally accepted and used databases, including Cochran, PubMed, HINARI, Google Scholar, Web of Science, African OnLine, and repositories of Ethiopian Universities. We extracted articles by using a standard JOANNA Briggs Institute data extraction sheet. To determine the existence of heterogeneity in studies, I 2 statistics and Cochran Q tests were used. The publication bias of the included studies was checked using Egger's test and a Funnel plot. A total of 2035 obstetrics care providers were involved in this systematic review and meta-analysis. The estimated overall rate of evidence-based intrapartum care practice in Ethiopia was 54.45% (95% CI: 43.06, 65.83); I 2 = 96.6%, p < 0.001). The studies with a sample size greater than 300 count for 47.25% (95% CI: 36.14, 65.83). Whereas obstetrics care providers have a decent knowledge of intrapartum care evidence 3.31 times, a positive attitude toward evidence 3.34 times, training 2.21 times, and work experience ⩾5 years 3.31 times associated with the practice of evidence-based intrapartum care. The overall practice of evidence-based intrapartum care among obstetrics workers in Ethiopia is estimated to be low. Therefore, there should be a focused effort on training and disseminating protocols and guidelines to enhance knowledge and foster a positive attitude among obstetrics care providers. Additionally, the Ethiopian government should prioritize the implementation of the 2021 to 2025 National Health Equity Strategic Plan to achieve its objective of improving the quality of health services.

The majority of developing countries do not follow the WHO's emphasis on replacing harmful and ineffective traditional practices with evidence-based clinical treatment. In these countries, harmful or ineffective practices are routinely used as part of routine care during labor and delivery, while beneficial procedures are not used for the majority of laboring mothers. However, it is critical to use evidence-based practices while giving therapy since they improve care quality, save costs, increase patient and family happiness, and promote professional progress. To assess the magnitude of non-recommended (harmful) intrapartum practices among obstetric care providers in public hospitals in southern Ethiopia, 2023. An institution-based cross-sectional study was conducted from January 30, 2023, to February 30, 2023, in public hospitals in the Gamo and Gofa zones. An observational checklist and a self-administered questionnaire were used to gather data. Using odds ratio of 95% C, bivariate and multivariable logistic regression was used to discover factors related with the outcome variable during data analysis using SPSS version 27. A P-value of less than 0.05 and I were regarded as statistically significant. The magnitude of harmful intrapartum practice was 60.6% (95% CI: 53.25-68.5). Lack of internet access (AOR = 10.1, 95% CI: 4.93-21.1), a few years of work experience (AOR = 6.21, 95% CI: 3.1-12.5), and not being trained on evidence-based intrapartum practices (AOR = 4.01, 95% CI: 1.94-7.95) were statistically significant with harmful intrapartum practices. Evidence-based practice can be improved by promptly providing obstetric care providers with ongoing training and standards for intrapartum care.

Introduction: Evidence-based intrapartum care uses the best available research on safety and effectiveness of specific practices to guide labor and delivery practice with the least harm intervention. Therefore this study was aimed to assess proportion of evidence-based intrapartum care and associated factors among obstetric care providers in Northwest Ethiopia, 2015. Methods: An institution based cross-sectional study was conducted. The data was collected using self-administered questionnaire from April to May 2015. The study sites were five referral hospitals in Northwest Ethiopia. All obstetric care providers registered in each referral hospitals were participated. Results: In adequate evidence is available towards intrapartum care, where the proportions of obstetric care providers practicing evidences during intrapartum phase were 38.3%. While using health information seldom for teaching (AOR=3.50, 95% CI=1.30, 9.40), providing in-service training for obstetric health care providers (AOR=4.52, 95% CI=1.61, 12.71), adequate knowledge (AOR=5.30, 95% CI=2.01, 13.90) and favorable attitude (AOR=3.34, 95% CI=1.30, 8.60). Conclusion: Obstetric care providers in Northwest Ethiopia were giving intrapartum care not guided by best evidence available. Further investigation is needed to stipulate on current Intrapartum care among obstetric care providers in northwest Ethiopia.

ABSTRACTBackground: The collaborative quality improvement approach proposed by the Institute for Healthcare Improvement has the potential to improve coverage of evidence-based maternal and newborn health practices. The Safe Care, Saving Lives initiative supported the implementation of 20 evidence-based maternal and newborn care practices, targeting labour wards and neonatal care units in 85 public and private hospitals in Telangana and Andhra Pradesh, India.Objective: We present a protocol for the evaluation of this programme which aims to (a) estimate the effect of the initiative on evidence-based care practices and mortality; (b) evaluate the mechanisms leading to changes in adherence to evidence-based practices, and their relationship with contextual factors; (c) explore the feasibility of scaling-up the approach.Methods: The mixed-method evaluation is based on a plausibility design nested within a phased implementation. The 29 non-randomly selected hospitals comprising wave II of the programme were compared to the 31 remaining hospitals where the quality improvement approach started later. We assessed mortality and adherence to evidence-based practices at baseline and endline using abstraction of registers, checklists, observations and interviews in intervention and comparison hospitals. We also explored the mechanisms and drivers of change in adherence to evidence-based practices. Qualitative methods investigated the mechanisms of change in purposefully selected case study hospitals. A readiness assessment complemented the analysis of what works and why. We used a difference-in-difference approach to estimate the effects of the intervention on mortality and coverage. Thematic analysis was used for the qualitative data.Discussion: This is the first quality improvement collaborative targeting neonatal health in secondary and tertiary hospitals in a middle-income country linked to a government health insurance scheme. Our process evaluation is theory driven and will refine hypotheses about how this quality improvement approach contributes to institutionalization of evidence-based practices.

To use direct observations of first prenatal visits to describe obstetric providers' adherence to the evidence-based clinical practice guideline for smoking cessation counseling recommended by the American College of Obstetricians and Gynecologists, the 5 A's (Ask, Advice, Assess, Assist, and Arrange). Observational study using audio recordings of first obstetric visits. An urban academic hospital-based clinic. Obstetric care providers and pregnant women attending their first obstetric visit. First obstetric visits were audio recorded. Visits were identified in which patients reported smoking, and discussions were analyzed for obstetric providers' use of the 5 A's in smoking cessation counseling. Obstetric providers asked about smoking in 98% of the 116 visits analyzed, but used 3 or more of the 5 A's in only 21% (24) of visits. In no visits did providers use all 5 A's. In 54% of the visits, providers gave patients information about smoking, most commonly about risks associated with perinatal smoking. Few obstetric care providers performed the recommended 5 A's smoking cessation counseling with their pregnant smokers. Effective and innovative methods are needed to improve obstetric providers' use of the 5 A's.

The purpose of this study was to determine whether there was a change in the oral care practices of intensive care unit (ICU) nurses for ventilated patients after a national effort to increase evidence-based oral care practices. Descriptive comparison of ICU nurses in 2004-2005 and 2012. Two convenience national surveys of ICU nurses were collected in 2004-2005 (n = 218) and 2012 (n = 233). After the results of the initial survey were reported, a national effort to increase awareness of evidence-based oral care practices was conducted that included in-service presentations; publication of an evidence-based protocol in a national nursing journal; publication of the survey findings in an international nursing journal; and reports to the local press. A repeat survey was conducted 7 to 8 years later. The same survey instrument was used for both periods of data collection. This questionnaire included questions about demographic and personal characteristics and a checklist of oral care practices. Nurses rated their perceived priority level concerning oral care on a scale from 0 to 100. An evidence-based practice (EBP)[O4] score was computed representing the sum of 14 items related to equipment, solutions, assessments, and techniques associated with the evidence. The EBP score, priority score, and oral care practices were compared between the two samples. A regression model was built based on those variables that were associated with the EBP score in 2012. There was a statistically significant increase in the use of EBPs as shown by the EBP score and in the perceived priority level of oral care. Increased EBPs were found in the areas of teeth brushing and oral assessment. Decreases were found in the use of non-evidence-based practices, such as the use of gauze pads, tongue depressors, lemon water, and sodium bicarbonate. No differences were found in the use of chlorhexidine, toothpaste, or the nursing documentation of oral care practices. A multiple regression model was found to be significant with the time of participation (2004-2005 vs. 2012) and priority level of oral care significantly contributing to the regression model. The national effort was partially successful in improving evidence-based oral care practices; however, increased awareness to EBP also might have come from other sources. Other strategies related to knowledge translation need to be attempted and researched in this clinical setting such as the use of opinion leaders, audits and feedback, small group consensus, provider reminder systems, incentives, clinical information systems, and computer decision support systems. This national effort to improve EBP did reap some rewards; however, other knowledge translation strategies should be used to further improve clinical practice.

BackgroundDelays in care have been recognized as a significant contributor to maternal mortality in low-resource settings. The non-pneumatic antishock garment is a low-cost first-aid device that can help women with obstetric haemorrhage survive these delays without long-term adverse effects. Extending professionals skills and the establishment of new technologies in basic healthcare facilities could harvest the enhancements in maternal outcomes necessary to meet the sustainable development goals. Thus, this study aims to assess utilization of non-pneumatic anti-shock garment to control complications of post-partum hemorrhage and associated factors among obstetric care providers in public health institutions of Southern Ethiopia, 2020.MethodsA facility-based cross-sectional study was conducted among 412 obstetric health care providers from March 15 –June 30, 2020. A simple random sampling method was used to select the study participants. The data were collected through a pre-tested interviewer-administered questionnaire. A binary logistic regression model was used to identify determinants for the utilization of non-pneumatic antishock garment. STATA version 16 was used for data analysis. A P-value of < 0.05 was used to declare statistical significance.ResultsOverall, 48.5% (95%CI: 43.73, 53.48%) of the obstetric care providers had utilized Non pneumatic antishock garment for management of complications from postpartum hemorrhage. Training on Non pneumatic antishock garment (AOR = 2.92; 95% CI: 1.74, 4.92), working at hospital (AOR = 1.81; 95% CI: 1.04, 3.16), good knowledge about NASG (AOR = 1.997; 95%CI: 1.16, 3.42) and disagreed and neutral attitude on Non pneumatic antishock garment (AOR = 0.41; 95%CI: 0.24, 0.68), and (AOR = 0.39; 95% CI: 0.21, 0.73), respectively were significantly associated with obstetric care provider’s utilization of Non-pneumatic antishock garment.ConclusionsIn the current study, roughly half of the providers are using Non-pneumatic antishock garment for preventing complications from postpartum hemorrhage. Strategies and program initiatives should focus on strengthening in-service and continuous professional development training, thereby filling the knowledge and attitude gap among obstetric care providers. Health centers should be targeted in future programs for accessibility and utilization of non-pneumatic antishock garment.

Delays in care have been recognized as a significant contributor to maternal mortality in low-resource settings. The non-pneumatic antishock garment is a low-cost first-aid device that can help women with obstetric haemorrhage survive these delays without long-term adverse effects. Extending professionals skills and the establishment of new technologies in basic healthcare facilities could harvest the enhancements in maternal outcomes necessary to meet the sustainable development goals. Thus, this study aims to assess utilization of non-pneumatic anti-shock garment to control complications of post-partum hemorrhage and associated factors among obstetric care providers in public health institutions of Southern Ethiopia, 2020. A facility-based cross-sectional study was conducted among 412 obstetric health care providers from March 15 -June 30, 2020. A simple random sampling method was used to select the study participants. The data were collected through a pre-tested interviewer-administered questionnaire. A binary logistic regression model was used to identify determinants for the utilization of non-pneumatic antishock garment. STATA version 16 was used for data analysis. A P-value of < 0.05 was used to declare statistical significance. Overall, 48.5% (95%CI: 43.73, 53.48%) of the obstetric care providers had utilized Non pneumatic antishock garment for management of complications from postpartum hemorrhage. Training on Non pneumatic antishock garment (AOR = 2.92; 95% CI: 1.74, 4.92), working at hospital (AOR = 1.81; 95% CI: 1.04, 3.16), good knowledge about NASG (AOR = 1.997; 95%CI: 1.16, 3.42) and disagreed and neutral attitude on Non pneumatic antishock garment (AOR = 0.41; 95%CI: 0.24, 0.68), and (AOR = 0.39; 95% CI: 0.21, 0.73), respectively were significantly associated with obstetric care provider's utilization of Non-pneumatic antishock garment. In the current study, roughly half of the providers are using Non-pneumatic antishock garment for preventing complications from postpartum hemorrhage. Strategies and program initiatives should focus on strengthening in-service and continuous professional development training, thereby filling the knowledge and attitude gap among obstetric care providers. Health centers should be targeted in future programs for accessibility and utilization of non-pneumatic antishock garment.

To evaluate the evidence for implementation strategies for evidence-based diabetic foot ulcer care in healthcare settings. Evidence-based practice in diabetic foot ulcer care improves healing rates and reduces complications. However, facilitating the uptake of evidence-based practice is challenging. To overcome this, a number of different strategies are used. However, there is little literature to support which strategies are effective in implementing evidence-based practice in diabetic foot ulcer care in healthcare settings. A systematic search was undertaken of Medline, PubMed, CINAHL, Cochrane Library databases, APA Psych INFO, Health & Medical Collection, India Database, Nursing & Allied Health Database and Google Scholar from 24 March 2010 to 01 May 2023. Original, English language, peer-reviewed research articles and systematic reviews that relate to the implementation of diabetic foot ulcer care in any healthcare settings with healthcare professionals were included in the review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-P) 2015 guided the reporting of this review. A total of 42 articles were included in the final analysis. Implementation strategies such as educational workshops, educational resources, creating champions, audit and feedback, reminders, creating networks and tools were determined to support the implementation of evidence-based strategies for diabetic foot ulcer care. The use of multiple implementation strategies aids in the successful implementation of evidence-based diabetic foot ulcer care in healthcare settings.

This study examined the efforts of states' mental health authorities to promote the use of evidence-based practices through policy. Data were drawn from three components of a national study, including a survey of state children's mental health directors (N=53), which was developed using a three-step process that involved stakeholders. Data from the directors' survey revealed that over 90% of states are implementing strategies to support the use of evidence-based practices. The scope of these efforts varies, with 36% reporting statewide reach. Further, states' strategies for implementing evidence-based practices are often not accompanied by comparable efforts to enhance information systems, even though enhancing such systems can bolster opportunities for successful implementation. Variability in the adoption of evidence-based practices, poor attention to information systems, and inconsistent fiscal policies threaten states' efforts to improve the quality of children's mental health services.