Knowledge and barriers on correct use of modified guidelines for active management of third stage of labour: a cross sectional survey of nurse-midwives at three referral hospitals in Dar es Salaam, Tanzania.

Fatina B Ramadhani,Yilan Liu,Melania Menrad Lembuka

doi:10.4314/ahs.v20i4.49

Abstract

Despite the fact that it is possibly preventable, postpartum haemorrhage (PPH) is the global most deadly form of obstetric bleeding, mainly sub-Saharan Africa with at least one-fourth of maternal deaths in East African regions. Active management of third stage of labour (AMTSL) is recommended to prevent PPH. However, AMTSL guidelines have been revised since 2006. To examine the current status of nurse-midwives' knowledge on modified AMTSL guidelines and highlight barriers to AMTSL correct use. Descriptive cross sectional survey was conducted to 160 nurse-midwives at three referral hospitals in Dar es Salaam, Tanzania. One-way, interactive modes ANOVA and Chi square (χ2) test were run in SPSS 21 version to compare the association of independent and dependent variables. Virtually all nurse-midwives knew the first recommended uterotonic (99.4%) and delayed cord clamping (98.8%) protocols as modified. Knowledge was significantly contributed by multiple factors; p=0.001. Reported correct AMTSL use was 46.8% which was significantly affected by AMTSL training (χ2 = 6.732, p = 0.009) and prioritizing atteding an asphyxiated baby (χ2 = 5.647, p = 0.017). Regardless of high nurse-midwives' AMTSL knowledge; it is imperative that responsible authorities plan appropriate strategies to solve reported barriers affecting correct AMTSL use.

Highlights

280,000 maternal deaths occur each year mainly in low and middle-income settings (LMICs)[1,2]
Regardless the reported fact that oxytocin was readily available in almost all child birth facilities in Tanzania[27,28], the current study reveals that nurse-midwives faced several barriers in the correct use of Active management of third stage of labour (AMTSL)
Their knowledge was associated with a combination of factors including demographics and the place of AMTSL training

Summary

Introduction

280,000 maternal deaths occur each year mainly in low and middle-income settings (LMICs)[1,2]. Despite the fact that it is possibly preventable, postpartum haemorrhage (PPH) is the global most deadly form of obstetric bleeding, mainly sub-Saharan Africa with at least one-fourth of maternal deaths in East African regions. Active management of third stage of labour (AMTSL) is recommended to prevent PPH. Objectives: To examine the current status of nurse-midwives’ knowledge on modified AMTSL guidelines and highlight barriers to AMTSL correct use. Conclusion: Regardless of high nurse-midwives’ AMTSL knowledge; it is imperative that responsible authorities plan appropriate strategies to solve reported barriers affecting correct AMTSL use. Knowledge and barriers on correct use of modified guidelines for active management of third stage of labour: a cross sectional survey of nurse-midwives at three referral hospitals in Dar es Salaam, Tanzania.

Objectives

Methods

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Discussion

Conclusion