Abstract
AimsTo assess the knowledge of nurses of national guidelines for emergency maternity, routine newborn and small and sick newborn care in Nairobi County, Kenya.BackgroundThe vast majority of women deliver in a health facility in Nairobi. Yet, maternal and neonatal mortality remain high. Ensuring competency of health workers, in providing essential maternal and newborn interventions in health facilities will be key if further progress is to be made in reducing maternal and neonatal mortality in low‐resource settings.DesignCross‐sectional survey.MethodsQuestionnaires comprised of clinical vignettes and direct questions and were administered in 2015–2016 to nurses (n = 125 in 31 facilities) on duty in maternity and newborn units in public and private facilities providing 24/7 inpatient neonatal services. Composite knowledge scores were calculated and presented as weighted means. Associations were explored using regression. STROBE guidelines were followed.ResultsNurses scored best for knowledge on active management of the mother after birth and immediate routine newborn care. Performance was worst for questions on infant resuscitation, checking signs and symptoms of sick newborns, and managing hypertension in pregnancy. Overall knowledge of care for sick newborns was particularly low (score 0.62 of 1). Across all areas assessed, nurses who had received training since qualifying performed better than those who had not. Poorly resourced and low case‐load facilities had lower average knowledge scores compared with better‐resourced and busier facilities.ConclusionOverall, we estimate that 31% of maternity patients, 3% of newborns and 39% of small and sick newborns are being cared for in an environment where nursing knowledge is very low (score <0.6).Relevance to clinical practiceFocus on periodic training, ensuring retention of knowledge and skills among health workers in low‐case load setting, and bridging the know‐do gap may help to improve the quality of care delivered to mothers and newborns in Kenya.
Highlights
International efforts to improve maternal and child health have led to significant reductions in mortality over the last three decades (Victora et al, 2016)
Assessments in low-resourced settings have shown that, in many cases, structures are in place to support delivery of emergency obstetric and neonatal care (EmONC), but staff
A questionnaire composed of vignettes and direct questions has been designed to evaluate nursing knowledge of maternal and neonatal care, including care for sick newborns
Summary
International efforts to improve maternal and child health have led to significant reductions in mortality over the last three decades (Victora et al, 2016). Neonatal mortality currently accounts for 45% of child deaths in Kenya, standing at 22 per 1000 live births (Kenya National Bureau of Statistics, 2015). Maternal mortality accounts for 14% of deaths among women aged 15–49, with a ratio of 362 per 100,000 live births (Kenya National Bureau of Statistics, 2015). It is estimated that increased coverage and quality of essential interventions, many delivered through inpatient facility-based care, could avert 71% of neonatal deaths, 33% of stillbirths, and 54% of maternal deaths by 2025 (Bhutta et al, 2014). The maximum effect on neonatal deaths would come from interventions delivered during labour and birth, such as emergency obstetric care and management of preterm labour, and care of small and ill newborns, such as resuscitation and management of neonatal infection (Bhutta et al, 2014). Where assessments have been conducted, these have mostly been for maternal and immediate newborn care in public sector facilities, with less reported on care of small and sick newborns and from private facilities
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