Abstract
BackgroundGlobal neonatal mortality remains unacceptably high. Health workers who attend to prenatal and postnatal mothers need to be knowledgeable in preventive and curative care for pregnant women and their newborn babies. This study aimed to determine the level of knowledge related to prenatal and immediate newborn care among primary healthcare workers in Masindi, Uganda.MethodsA cross-sectional study was conducted. Interviews comprised of 25 multiple-choice questions were administered to health workers who were deployed to offer prenatal and postnatal care in Masindi in November 2011. Questions were related to four domains of knowledge: prenatal care, immediate newborn care, management of neonatal infections and identifying and stabilizing Low-Birth Weight (LBW) babies. Corresponding composite variables were derived; level of knowledge among health workers dichotomized as ‘adequate’ or ‘inadequate’. The chi-square statistic test was used to examine associations with independent variables including level of training (nursing assistant, general nurse or midwife), level of care (hospital/health centre level IV or health centre level III/II) and years of service (five years or less, six years or more).Results183 health workers were interviewed: general nurses (39.3%), midwives (21.9%) and nursing assistants (38.8%). Respectively, 53.6%, 46.5%, 7.1% and 56.3% were considered to have adequate knowledge in prenatal care, newborn care, management of neonatal infections and identifying/stabilizing LBW babies. Being a general nurse was significantly associated with having adequate knowledge in identifying and stabilizing LBW babies (p < 0.001) compared to being a nursing assistant. Level of care being hospital/health centre level IV was not significantly associated with having adequate knowledge in prenatal or newborn care with reference to health centres of level III/II.ConclusionKnowledge regarding prenatal and newborn care among primary healthcare workers in Masindi was very low. The highest deficit of knowledge was in management of neonatal infections. Efforts are needed to orientate health workers regarding prenatal and newborn care especially the offer of infection management among newborns. Similar levels of knowledge between health workers deployed to hospital/health centre level IV and health centres of level III/II raise important implementation questions for the referral system which is crucial for maternal and newborn survival.
Highlights
Sample characteristics We interviewed 183 health workers (Table 1): 72 general nurses (39.3%), 40 midwives (21.9%) and 71 nursing assistants (38.8%)
Knowledge on recommended prenatal care and newborn care practices About 70% of health workers correctly mentioned the expected observations and important health education messages routinely offered during prenatal consultations
Low level of knowledge especially regarding neonatal infection and caring for Low-Birth Weight (LBW) babies should be considered an important concern for the health system in Masindi, since this category of newborns are the most at risk
Summary
More recently the Global Newborn Action [8] advocates for acceleration and scale up of high-impact interventions to address major causes of newborn mortality [6] It underscores the importance of key interventions and quality care for women and their babies and calls for interventions days before, during and after birth. These interventions require deployment of health workers with adequate knowledge in maternal, child and newborn health [9]. In eastern Uganda, neonatal mortality autopsies demonstrated low levels of knowledge among health workers regarding prenatal and newborn care as a major cause of death [12]. Similar reasons have been highlighted in other disease conditions [13]
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