Premium
Factors associated with the awareness and practice of evidence‐based obstetric care in an African setting
Author(s) -
Tita ATN,
Selwyn BJ,
Waller DK,
Kapadia AS,
Dongmo S
Publication year - 2006
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.2006.01042.x
Subject(s) - psychological intervention , medicine , family medicine , odds ratio , logistic regression , reproductive health , obstetrics and gynaecology , reproductive medicine , pregnancy , nursing , environmental health , population , pathology , biology , genetics
Objective To identify the factors associated with important (≥50%) variation in awareness and practice of evidence‐based obstetric interventions in an African setting where we have previously reported poor awareness and use of evidence‐based reproductive interventions. Design Cross‐sectional analysis of data from our Reproductive Health Interventions Study. Setting North‐west province, Cameroon, Africa. Population Health workers including obstetricians, other physicians, midwives, nurses and other staff providing reproductive care. Main outcome measures Prevalence ratios (PR) of uniform awareness and practice of four key evidence‐based obstetric interventions from the World Health Organization Reproductive Health Library (WHO RHL): antiretrovirals to prevent mother‐to‐child transmission of HIV/AIDS, antenatal corticosteroids for prematurity, uterotonics to prevent postpartum haemorrhage and magnesium sulphate for seizure prophylaxis. Methods Comparisons of descriptive covariates, applying logistic regression to estimate independent relationships with awareness and use of evidence‐based interventions. Results A total of 15.5% (50/322) of health workers were aware of all the four interventions while only 3.8% (12/312) reported optimal practice. Evidence‐based awareness was strongly associated with practice (PR = 15.4; 96% CI: 4.3–55.0). Factors significantly associated with awareness were: attending continuing education, access to the WHO RHL, employment as an obstetrician/gynaecologist and working in autonomous military or National Insurance Fund facilities. Controlling for potential confounding, working as an obstetrician was associated with increased awareness (adjusted prevalence odds ratio [aPOR] = 8.3; 95% CI: 1.3–53.8) as was median work experience of 5–15 years (aPOR = 2.0; 95% CI: 1.0–3.8). Internet access was associated with increased practice (aPOR = 3.4; 95% CI: 1.0–11.8). Other potentially important variations were observed, although they did not attain statistical significance. Conclusions Several factors including obstetric training and continuous education positively influence evidence‐based awareness and practice of key obstetric interventions. Confirmation and application of this information may enhance the effectiveness of programmes to improve maternal and perinatal outcomes.