Quality Of Maternal Services Research Articles

Improving Quality of Maternity Services in LMIC Settings: An Insight into Facility-based Quality Improvement Projects and Implications for Future Projects

Improving Quality of Maternity Services in LMIC Settings: An Insight into Facility-based Quality Improvement Projects and Implications for Future Projects

Strengthening caesarean birth: Sub-Saharan Africa health system evaluation: Scoping review.

Promoting safe caesarean birth (CB) is a challenge in sub-Saharan Africa (SSA) where maternal and neonatal mortality rates are high due to inadequate maternal health services. Although the CB rate in SSA is lower than the World Health Organization (WHO) recommendation, it is often associated with high maternal and neonatal mortality. The aim of this scoping review was to report on the extent to which SSA health systems deliver safe CB. A systematic search across various databases identified 53 relevant studies, comprising 30 quantitative, 10 qualitative and 16 mixed methods studies. These studies focused on clinical protocols, training, availability, accreditation, staff credentialing, hospital supervision, support infrastructure, risk factors, surgical interventions and complications related to maternal mortality and stillbirth. CB rates in SSA varied significantly, ranging from less than 1% to a high rate of 29.7%. Both very low as well as high rates contributed to significant maternal and neonatal morbidity. Factors influencing maternal and perinatal mortality include poor referral systems, inadequate healthcare facilities, poor quality of CBs, inequalities in access to maternity care and affordable CB intervention. The inadequate distribution of healthcare facilities, and limited access to emergency obstetric care impacted the quality of CBs. Early access to quality maternity services with skilled providers is recommended to improve CB safety.Contributions:This scoping review contributes to the body of knowledge motivating for the prioritization of maternal service across SSA.

Midwives' stress and burnout during the Omicron wave in Italy: An observational survey.

To evaluate midwives' level of stress and burnout during the COVID-19 Omicron phase in Italy. Secondary aims were to explore the impact of the pandemic on midwives' personal dimensions and professional activities and potential supporting strategies. A mixed-methods study was undertaken from July to December 2022. Data were collected using a national online observational survey. Descriptive and inferential analyses were performed to evaluate stress, burnout and the impact of the pandemic on personal and professional dimensions. A deductive qualitative approach was used to analyse open-ended responses, that were merged with quantitative data following a convergent mixed-methods approach. A total of 1944 midwives participated in the survey. The stress summary score mean was 10.34, and 562 midwives (28.91%) experienced burnout. The intention to reduce working hours was reported by 202 midwives (10.39%), with 60.40% (n = 122) of them experiencing burnout. The intention to leave clinical practice within the following 2 years was reported by 239 (12.29%), with 68.20% (n = 163) of them experiencing burnout. All the personal dimensions and professional activities considered were defined by more than half of midwives as being impacted 'Moderately' or 'To a great extent' by pandemic. Stress and burnout frequencies increased when the midwives' perception of the pandemic effects was higher. Potential supporting strategies described by midwives as the most important in increasing their ability to cope with the pandemic were 'Women's awareness of the midwives' role' (n = 1072; 55.14%) and 'Family and friends' emotional support' (n = 746; 38.38%). Our findings suggested strategies to support a positive and safe working environment for midwives during a pandemic emergency, with potential transferability to similar contexts when human resources are lacking. It is recommended that maternity services provide the necessary resources for a safe and supportive working environment to prevent high stress levels and chronic burnout. Studies conducted during the first COVID-19 pandemic wave showed an increased level of stress, anxiety, burnout, post-traumatic stress disorder and depression experienced by healthcare professionals; moreover, midwives experienced drastic changes in care pathways and policies with struggles identified when providing high-quality woman-centred care following pandemic restrictions. Although it is recommended, there is lack of knowledge about long-term psychological effects of COVID-19 for midwives. Our study highlights that during the Omicron wave midwives experienced a high level of stress and burnout with an impact on individual dimensions and professional activities. Their stress and burnout were influenced by several factors, including restrictions in place, lack of organizational acknowledgement, work overload and need for extra childcare cover. Maternity services should provide the necessary resources for a safe and supportive working environment to prevent high stress levels and chronic burnout. Recommendations on how to facilitate this are suggested. During the writing process, we referred to 'The Strengthening the Reporting of Observational Studies Epidemiology Statement', the guidelines for reporting observational studies from the Equator network. No patient or public contribution. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Work overload conditions negatively impacted on the quality of maternity services. Improving organizational aspects, reducing working hours, promoting family and friends' emotional support and improving women's awareness of midwife's role were the main strategies reported by midwives. These suggestions for ensuring a positive and safe working environment for midwives during a pandemic emergency could potentially be applied to similar situations where human resources are lacking.

Severe acute maternal morbidity reporting in Australia: Why is it so hard?

Adverse outcomes associated with pregnancy, including severe acute maternal morbidity (SAMM) and mortality, are internationally regarded as important indicators of quality of maternity services. Varied definitions and processes are barriers for SAMM recording, reporting and review. Identifying and documenting these cases of SAMM is a critical first step. Case reviews allow exploration of factors contributing to SAMM. Translation of the lessons learnt into practice improvement strategies and dissemination of this knowledge is essential for continual quality improvement. This review will outline the current status of SAMM review internationally and in Australia.

Health quality standards evaluation of quality indicators of maternity services

Indicators are used by health institutions to monitor the quality of maternity services and to determine the level of quality of care. The aim of this study was to examine the level of meeting the quality indicators of maternity services monitored in a training and research hospital and to analyze the results. This study was planned as a single-centre, retrospective, descriptive study The quality indicators of maternity services monitored by the quality unit of our hospital in 2021-2022 were included in the study. Primary cesarean section rate was 19.4% (2021), 21.3% (2022), cesarean section rate in women giving birth for the first time with low risk was 30.3% (2021), 32.5%, rate of venous thromboembolism prophylaxis after vaginal delivery according to risk level was 83.1% (2021), 92.5% (2022), rate of venous thromboembolism prophylaxis after vaginal delivery according to risk level was 8.9%, (2021), 7.2% (2022), the rate of use of safe birth control list was 12.6% (2021), 19.8% (2022), the rate of mother-infant pairs who had skin-to-skin contact within the first hour after birth was 88.6% (2021), 93.8% (2022), the rate of infants discharged with only breast milk was 85.7% (2021), 88.8% (2022), the rate of postnatal mothers being evaluated for depression risk was 95.7% (2021), 14.7% (2022). It has been determined that the quality indicators monitored within the scope of birth services in our hospital are monitored and necessary improvement activities are carried out in cases where target values aren’t reached. It is thought that indicator management is very important in increasing the quality of care of the complex birth process and preventing complications during the birth process.

Women’s Satisfaction with Hospital Based Intrapartum Care in a Medical College of Western Nepal

INTRODUCTION Birth satisfaction is a multi-dimensional concept comprising structure, process and outcome of care that influence postnatal adjustment. Mother’s satisfaction during the birthing process is an important indicator in evaluating quality of maternity services. The aim of the study is to find out the women’s satisfaction with hospital based intrapartum care in a medical college of western Nepal. MATERIAL AND METHODS Cross-sectional analytical study was conducted to find women’s satisfaction with hospital based intrapartum care in a medical college of western Nepal among 332 postpartum inpatient women delivered in Lumbini Medical College and Teaching Hospital, Pravas, Palpa, who were selected by using purposive sampling technique. A pretested interview schedule was used for data collection. Descriptive statistics and inferential statistics were used for data analysis. RESULTS The study findings revealed that about half of the respondents (50.9%) were satisfied with hospital based intrapartum care. The level of satisfaction was significantly associated with gravida (p=0.008), type of labor onset (p=0.007) and episiotomy status (p<0.001). CONCLUSION The study findings conclude that women attending teaching hospital for delivery tend to be somewhat satisfied with hospital based intra-partum care. Adequate counseling, reassurance and supportive care of women during intrapartum period might increase their satisfaction with intrapartum care.

Investment in the peace of mind? How private services change the landscape of maternity care in Poland

For over two decades midwifery research advocated for the continuity of care and the ability to establish a relationship between care providers and care users as an important features of quality maternity services. In many countries, while unavailable through public services, continuity of care became commercialized and can be access as a private service. In Poland, private prenatal consultations and dedicated midwifery care allow women to access continuity and establish personal relationships with care providers. In this study, we explore, how accessing these private services, impact the rates of medical interventions and type of care women receive during labour and birth. We analyse data collected through an online questionnaire from 4402 first-time mothers in healthy pregnancy who had given birth in Poland between 2020 and 2021. We show that while private consultation did not translate into any significant differences in care, women who accessed private dedicated midwifery services experienced more attentive and less medicalized care, namely were more likely to give birth in vertical position, move freely during labour and less likely to experience emergency caesarean section. However, private dedicated midwifery care did not shield them from negative experience. While private care offers benefits for women who can afford it, it also contributes to inequalities in access to quality care and puts women with less social and financial resources in a vulnerable position. Efforts should be made to develop a more universal and equitable model of care that allows for building personal relationships between maternity care providers and women.

UK maternity care experiences of ethnic minority and migrant women: Systematic review.

The increasing population of immigrant and migrant women in the United Kingdom has implications to the provision of healthcare and for healthcare experiences. Eliciting women's experiences and perceptions of maternity care received is an important way of monitoring and evaluating the quality of maternity services. This study was designed to explore the maternity care experiences of ethnic minority and migrant women in the United Kingdom. A literature search for relevant studies was carried across seven databases. We included nine studies carried out between 2015 and February 2022 that met the inclusion criteria. Data were analyzed using a thematic analysis approach. Findings showed that ethnic minority women and migrant women have had mixed experiences while utilizing maternity services in the United Kingdom. However, most of the experiences were negative and included issues related to communication, discrimination, culture, access to care, physical comfort, and continuity of care. Only one of the studies reported that the respondents had a wholly positive communication experience, one found that a few women felt the staff were respectful and one reported that the midwives gave the women treatment options that would respect their cultural and religious beliefs. This study has highlighted some important gaps in the maternity care experiences specific to ethnic minority and migrant women in the United Kingdom which provides useful insights to future policy and clinical practice.

Donna Ockenden: dedicated to improving UK maternity services

Donna Ockenden is a respected UK health-services leader. A Welsh native and nurse and midwife by training, she is Chair of the Independent Review of Maternity Services at the Nottingham University Hospitals NHS Trust, UK. Speaking about her priorities in the role, the straight-talking Ockenden says: “I’m absolutely clear that all voices that want to be heard, will be heard, and will be amplified. And what they tell us absolutely will be acted upon. We know that Nottingham has a diverse population and a community and from day one we are ensuring that we listen to and act upon the voices of all those women and families.” Noting that families campaigned for the review after the deaths of babies, she adds that “we need to make sure that families get the answers that they deserve, but also that they can see meaningful and sustainable change in the safety and quality of maternity services for their local communities…We will work with the trust to ensure that change happens in a timely way.”

An integrated care pathway for maternal and childcare: evidence from Ethiopia, Tanzania, and Uganda

Abstract Performance monitoring and evaluation are key to quality improvement in maternal and child healthcare in Sub-Saharan Africa. This study presents the experience of designing and implementing bottom-up and integrated performance evaluation tools for care pathway to monitor and manage maternity healthcare services. The research project involved four health districts and relative reference hospitals, supported by the NGO Doctors with Africa CUAMM in Ethiopia, Tanzania, and Uganda. The maternal and childcare pathway developed consists of 23 indicators, calculated at hospital and district level, relating to pregnancy, childbirth and first year of life phases. The authors developed staves and performance maps, as graphical representation tools, to display longitudinally integrated health services provision performance along the continuum of care. Substantial variation was observed between the phases of each maternal and childcare pathway and across the care pathways of the different analysed settings. The most impressive results across the four settings are: 1) regarding pregnancy phase, that women tend to attend more than four antenatal classes, still with a quite high drop-out rate, and are largely tested for syphilis, 2) with respect to childbirth, that there are varying percentage levels in terms of C-sections, episiotomies and peri/intra-partum asphyxia cases, and 3) as it regards first year of life, there emerges scope for improvement considering the vaccination coverages attained for pentavalent, measles and polio vaccinations. Thanks to the collaboration with local managers and health professionals, the maternal and childcare pathway allowed to monitor the changes in the quality of maternity services provided within the analysed contexts. The benchmarking approach encouraged local professionals to learn from other settings. The use of such tool allowed the development of targeted quality improvement actions, shared among all involved stakeholders. Key messages • In collaboration with local professionals, we designed and implemented an integrated pathway for maternal and childcare, covering the phases of pregnancy, childbirth and first year of life. • Benchmarking performance results encouraged collaboration among professionals and allowed the identification of actions to improve the provision of maternal and childcare services.

Patient Satisfaction and Characteristics of Maternity Room from April to June 2022 at Unggul Karsa Medika Hospital

Background Maternal Mortality Rate (MMR) is an indicator that reflects various aspects including the quality of healthcare from clinical standpoint, the quality of healthcare system, the quality of health insurance, the quality of referral systems and non-health aspects that related to healthcare such as economic, social, cultural, and education aspects. In order to reduce MMR, healthcare quality of maternity services should be increased. Patient satisfaction is one of indicators for healthcare quality. In this study, we aim to describe patient satisfaction in maternity room of Unggul Karsa Medika Hospital, Bandung, West Java, Indonesia. Methods This is a quantitative descriptive study conducted in Maternity Room, Unggul Karsa Medika Hospital, Bandung, West Java, Indonesia. The design of the study was cross-sectional. The research was conducted from April to June 2022. Minimal total sample of 97. Total sample that obtained in this study was 150 subjects. Sampling method used in this study was consecutive sampling. Results Percentage of total patient satisfaction of maternity room were slightly increasing from April to June 2022, with highest value was in June 2022 of 94,2%. Four out of six elements of patient satisfaction were increasing, which were speed of services, friendliness and responsiveness, clarity of information and instructions, and completeness of infrastructure and facilities. Conclusion Unggul Karsa Medika Hospital through its excellence service of maternity room has played a significant role to reduce maternal mortality rate in Indonesia, since good and increasing results in patient satisfaction of maternity room service from April to June 2022.

Mental health impact on Black, Asian and Minority Ethnic populations with preterm birth: A systematic review and meta-analysis.

BACKGROUNDPreterm birth (PTB) is one of the main causes of neonatal deaths globally, with approximately 15 million infants are born preterm. Women from the Black, Asian, and Minority Ethnic (BAME) populations maybe at higher risk of PTB, therefore, the mental health impact on mothers experiencing a PTB is particularly important, within the BAME populations.AIMTo determine the prevalence of mental health conditions among BAME women with PTB as well as the methods of mental health assessments used to characterise the mental health outcomes.METHODSA systematic methodology was developed and published as a protocol in PROSPERO (CRD42020210863). Multiple databases were used to extract relevant data. I2 and Egger’s tests were used to detect the heterogeneity and publication bias. A trim and fill method was used to demonstrate the influence of publication bias and the credibility of conclusions.RESULTSThirty-nine studies met the eligibility criteria from a possible 3526. The prevalence rates of depression among PTB-BAME mothers were significantly higher than full-term mothers with a standardized mean difference of 1.5 and a 95% confidence interval (CI) 29%-74%. The subgroup analysis indicated depressive symptoms to be time sensitive. Women within the very PTB category demonstrated a significantly higher prevalence of depression than those categorised as non-very PTB. The prevalence rates of anxiety and stress among PTB-BAME mothers were significantly higher than in full-term mothers (odds ratio of 88% and 60% with a CI of 42%-149% and 24%-106%, respectively).CONCLUSIONBAME women with PTB suffer with mental health conditions. Many studies did not report on specific mental health outcomes for BAME populations. Therefore, the impact of PTB is not accurately represented in this population, and thus could negatively influence the quality of maternity services they receive.

O26 - Barriers and enablers for midwives to use the Nursing and Midwifery Board of Australia’s Endorsement for scheduled medicines for midwives

In 2010, the Nursing and Midwifery Board of Australia introduced its registration standard: Endorsement for scheduled medicines for midwives. A midwife holding this endorsement can apply to Medicare Australia for both a Medicare provider number under the Medicare Benefits Schedule (MBS) and a prescriber number under the Pharmaceutical Benefits Scheme (PBS). Allocation of these numbers enables midwives to provide women with Medicare-rebatable episodes of care, prescribe relevant medications and order relevant Medicare-rebatable diagnostics. Uptake for the endorsement has been slow, indicating that potential barriers affect midwives’ ability to make use of the service provisions it enables. To discover the mechanisms that help and/or hinder midwives to work to their full scope of practice when they have completed a program of study leading to endorsement. An observational (non-experimental) design in the form of an online web-based survey was used. Most survey questions were quantitative, using closed questions with free text options to provide any additional responses. Descriptive statistics were used to analyse the survey results and content analysis was conducted on the qualitative data collected in the free text boxes. Results indicated that barriers—such as the limitations of MBS and PBS provisions for endorsed midwives and a general lack of support for the role—restrict endorsed midwives’ ability to provide quality maternity services. Support for the role may act as an enabler; however, midwives stated that personal determination and confidence in their ability also promoted endorsement use. Recommendations for practice to strengthen the endorsed midwife’s role include facilitating endorsement use in the public sector, relaxing MBS and PBS restrictions, raising awareness of the role and scope and improving midwives’ pre-endorsement preparation. This study has highlighted the need for a holistic approach to support and develop the role of the endorsed midwife.

Effectiveness Of Self-Instructional Module (Sim) On Paternal Attitude Of Expectant Fathers And Maternal Satisfaction On Perinatal Outcome

Introduction: Paternal involvement (PI) has been recognized to have an impact on pregnancy and infant outcomes. The mother’s satisfaction during the birthing process is the most frequently reported indicator in the evaluation of the quality of maternity services. Male involvement reduces maternal stress increases uptake of prenatal care leads to cessation of risk behaviours and ensures men’s involvement in their future parental roles from an early stage. The aim of the study is to assess the effectiveness of self instructional module paternal attitude towards perinatal outcome and maternal satisfaction on paternal attitude.
 Methodology: A cross-sectional study was conducted on 320 expectant fathers attending antenatal clinic. A five point rating scale was used to assess the attitude of paternal on pregnancy and labour outcome and Observational check list to assess the postnatal mother satisfaction.
 Results: The scores were significantly improved after intervention, in the experiment group, in pre-test, the mean score was 78.61 and the post-test mean score was 120.56, the mean difference is 41.95 whereas, in the control group, the mean score of 79.43 and the post-test mean score was 80.25, the mean difference is 0.82. After self instructional module intervention, in experimental group, 81.88% of them are having satisfied, 18.12% of them are having not satisfied. In control group, 48.75% of them are having satisfied level of score, 51.25% of them are having not satisfied level of score.
 Conclusion: Most fathers were very positive about their partner’s pregnancy. They, however, need to be motivated to use that knowledge into practice.

The association between institutional delivery and neonatal mortality based on the quality of maternal and newborn health system in India

Over 600,000 newborns in India died in their first month of life in 2017 despite large increases in access to maternal health services. We assess whether maternal and newborn health system quality in India is adequate for institutional delivery to reduce neonatal mortality. We identified recent births from the cross-sectional 2015–2016 National Family Health Survey and used reported content of antenatal care and immediate postpartum care averaged at the district level to characterize health system quality for maternity and newborn services. We used random effect logistic models to assess the relationship between institutional delivery and neonatal (death within the first 28 days of life) and early neonatal (death within 7 days of live births) mortality by quintile of district maternal and newborn health system quality. Three quarters of 191,963 births were in health facilities; 2% of newborns died within 28 days. District-level quality scores ranged from 40 to 90% of expected interventions. Institutional delivery was not protective against newborn mortality in the districts with poorest health system quality, but was associated with decreased mortality in districts with higher quality. Predicted neonatal mortality in the highest quintile of quality would be 0.018 (95% CI 0.010, 0.026) for home delivery and 0.010 (0.007, 0.013) for institutional delivery. Measurement of quality is limited by lack of data on quality of acute and referral care. Institutional delivery is associated with meaningful survival gains where quality of maternity services is higher. Addressing health system quality is an essential element of achieving the promise of increased access to maternal health services.

An analysis of the quality of maternity services in Nampula, Mozambique: implementation research.

Introductionthe quality of maternity services is an essential factor in reducing maternal and newborn morbidity and mortality, which remains extremely high in Africa. In Mozambique, maternal mortality rate is 451.6 deaths per 100,000 live births (2017). The reasons for this are complex, but one important factor to reduce this burden is to provide effective and efficient care, to improve institutional deliveries. To reduce maternal and newborn mortality rates in Nampula, researchers from Lúrio University and the University of Saskatchewan, carried out an implementation research program, including various interventions such as training activities for health professionals in maternal and child health care. We planned a mid-project evaluation, to assess the trainings´ impact on the quality of services at Marrere Hospital Maternity.Methodsquantitative pre-post study, carrying out two cross-sectional surveys about maternity service quality, one being conducted after five health professionals´ trainings and the other after six more trainings. The two surveys included samples of post-partum women in the maternity, calculated with a 10% margin error and 90% confidence interval for the first survey, and with a 7% margin error and 95% confidence interval for the second. The surveys were entered into REDCap and analysed to assess frequencies, percentages, mean and standard deviations. This research was approved by the Institutional Committees of Bioethics at Lúrio University and at the University of Saskatchewan.Resultsone hundred and sixteen post-partum women were surveyed at the maternity, assessing standards of patient centred care during delivery labour. Most areas showed no improvement. Some positive improvements were delivering women were given the option to have a person of their choice accompany them during labour (75%), notably a traditional birth attendant (34%), and they had continuous support from a health professional (68%). But many shortcomings persisted in areas of privacy (33%) and confidentiality (57%).Conclusionthe quality of patient centred care at Marrere Hospital Maternity did not improve much with health professionals´ trainings. Decreasing the large turnover rate of such staff, reviewing their learning styles, and promoting continuous professional capacity building would be the next steps to improve quality of care.

Knowledge, Attitudes, and Preparedness for Managing Pregnant and Postpartum Women with COVID-19 Among Nurse-Midwives in Kenya.

IntroductionGlobally, maternal morbidity and mortality have increased during the COVID-19 pandemic. Given the high burden of maternal and neonatal mortality in Kenya prior to COVID-19, front line health workers, including nurse-midwives, must be competent to ensure continued quality maternal services. Knowledge and awareness of COVID-19 transmission influence nurse-midwives risk perception and ability to implement prevention strategies.ObjectiveWe examined nurse-midwives’ knowledge, attitudes, and preparedness in managing pregnant and postpartum women with COVID-19 in Kenya.MethodsA cross-sectional online survey was conducted among 118 nurse-midwives between July 2020 and November 2020. A 31-item survey comprising 15 knowledge, 11 attitude, and five preparedness questions was administered using SurveyMonkey. A link to the survey was distributed among nurse-midwives via email. Multiple logistic regression analysis was used to assess associations between the variables. A p-value <.05 was considered statistically significant.ResultsEighty-five participants were included in the final analysis (response rate 72%). Most participants were female (n = 69, 81.2%), 52.9% (n = 45) worked in labor wards, and 57.6% (n = 49) worked in rural hospitals. Overall, 71% (n = 57) of participants had sufficient knowledge about managing COVID-19 in pregnant and postpartum women. However, only 63% were willing to receive COVID-19 vaccination. Nurse-midwives working in urban areas were 3.7 times more likely to have positive attitudes than those in rural areas (odds ratio 3.724, 95% confidence interval 1.042–13.31; p = .043).ConclusionNurse-midwives’ responses to the Kenyan government's COVID-19 guidelines for managing and caring for pregnant women were inconsistent. Continued professional development for nurse-midwives is important to ensure they stay abreast of evolving COVID-19 guidelines for maternal health. Our findings also suggest vaccine hesitancy may be a hurdle for ongoing COVID-19 vaccination.

Validation of the Arabic Childbirth Care Satisfaction Survey.

Measuring maternal satisfaction in Arab countries is an essential indicator of care quality. However, existing surveys have limited psychometric properties and inclusion criteria. To present the psychometric properties of the Arabic Childbirth Care Satisfaction Survey (CCSS). The Arabic CCSS was developed from 2 English surveys. In 2017, 13 mothers assessed survey items in terms of clarity, importance and acceptability. The CCSS was distributed to all mothers who delivered a live baby during the 4-week study period in 9 hospitals in Oman. A sample of 461 participants was used for principal component analysis (PCA) and another sample of 408 participants (after removing missing data) was used for confirmatory factor analysis (CFA). Two-sample independent t tests were conducted to establish discriminant validity. Stata software was used for the analysis. The survey demonstrated good face and content validity with all items rated above 3 out of 5. Out of the 3566 targeted population, 958 (26.9%) mothers participated. PCA identified 2 factors labelled as communication and control (Cronbach's α = 0.90) and care organization (Cronbach's α = 0.68) with good internal reliability. CFA demonstrated good model fit, confirming construct validity. Mothers who had vaginal delivery were more satisfied (P < 0.05) compared with those who underwent caesarean section, thus establishing good discriminant validity. A short Arabic CCSS tool was developed. This new 10-item tool had good face and content validity, good internal reliability, construct validity and discriminant validity. It can provide valuable information to clinicians and decision-makers about the quality of maternity services.

Knowledge on intrapartum care practices among skilled birth attendants in Cambodia\u2014a cross-sectional study

BackgroundDelivery is a critical moment for pregnant women and babies, and careful monitoring is essential throughout the delivery process. The partograph is a useful tool for monitoring and assessing labour progress as well as maternal and foetal conditions; however, it is often used inaccurately or inappropriately. A gap between practices and evidence-based guidelines has been reported in Cambodia, perhaps due to a lack of evidence-based knowledge in maternity care. This study aims to address to what extent skilled birth attendants in the first-line health services in Cambodia have knowledge on the management of normal delivery, and what factors are associated with their level of knowledge.MethodsMidwives and nurses were recruited working in maternity in first-line public health facilities in Phnom Penh municipality, Kampong Cham and Svay Rieng provinces. Two self-administered questionnaires were applied. The first consisted of three sections with questions on monitoring aspects of the partograph: progress of labour, foetal, and maternal conditions. The second consisted of questions on diagnostic criteria, normal ranges, and standard intervals of monitoring during labour. A multiple linear regression analysis was performed to identify relationships between characteristics of the participants and the questionnaire scores.ResultsOf 542 eligible midwives and nurses, 523 (96%) participated. The overall mean score was 58%. Only 3% got scores of more than 90%. Multivariate analysis revealed that ‘Kampong Cham province’, ‘younger age’, and ‘higher qualification’ were significantly associated with higher scores. Previous training experience was not associated with the score. Substantial proportions of misclassification of monitoring items during labour were found; for example, 61% answered uterine contraction as a foetal condition, and 44% answered foetal head descent and 26% answered foetal heart rate as a maternal condition.ConclusionThis study found that knowledge was low on delivery management among skilled birth attendants. Previous training experience did not influence the knowledge level. A lack of understanding of physiology and anatomy was implied. Further experimental approaches should be attempted to improve the knowledge and quality of maternity services in Cambodia.

Exclusive breastfeeding practice and associated factors among rural mothers with 6–12-month-old children in west Oromia, Ethiopia

Background/aims Despite the benefits of exclusive breastfeeding for children, the practice is not widespread in low-income countries, including Ethiopia, especially in rural settings. This study aimed to determine exclusive breastfeeding practice and associated factors among mothers with 6–12-month-old children in west Oromia, Ethiopia. Methods This cross-sectional study was conducted among 391 randomly selected mothers with 6–12-month-old children in Amuru, Ethiopia. Data on breastfeeding practice were collected using a structured questionnaire, adapted from the Ethiopian Health and Demographic Survey. Data were analysed using the Statistical Package for Social Sciences version 21. Factors that were significantly associated with exclusive breastfeeding at univariate analysis were then submitted to binary logistic regression, with P&lt;0.05 considered significant. Results Of the 391 respondents, 48.1% of the mothers reported exclusively breastfeeding their children. Factors associated with exclusive breastfeeding were: mother aged 21–25 years old (adjusted odds ratio=5.1, P&lt;0.0001), husband`s educational status (adjusted odds ratio=2.8, P&lt;0.0001), owning a radio (adjusted odds ratio=2.8, P&lt;0.0001), antenatal care attendance (adjusted odds ratio=9.2, P&lt;0.0001), delivery at a health institution (adjusted odds ratio=4.3, P&lt;0.0001) and initiating breastfeeding within an hour of birth (adjusted odds ratio=4.2, P&lt;0.0001). Conclusions The exclusive breastfeeding rate was low among mothers in this study. Health education should be provided to mothers at the community and health facility level. The quality of maternity services provided at health facilities or in the community needs improvement by providing pre-service and in-service training to health workers. Moreover, facility-based birth and respectful care needs promotion.