20. Knowledge and practice of midwives on active management of third stage of labor in Dar es salaam, Tanzania

Abstract

Background: Postpartum Hemorrhage (PPH) is the major cause of maternal morbidity and mortality worldwide with the highest incidence in developing countries. In Tanzania Maternal mortality ratio (MMR) stands at 410 /100,000 live births where PPH alone accounts for 25-28% of all maternal deaths (8). Few studies done on this topic showed limited knowledge and practice on PPH prevention and management using AMTSL among midwives. There is no enough information on the current level of knowledge and practice of AMTSL among midwives in Tanzania. Objective: This study sought to know the knowledge and practice level of midwives on AMTSL in public hospitals namely Temeke, Amana and Mwananyamala in Dar es Salaam region. Methods: A descriptive cross- sectional study using quantitative research method was used in the assessment of knowledge and practice. Data was collected from April through May 2014. Additional data was collected in February 2015. A convenience sampling technique was used and a total of 105 midwives were recruited into the study. Knowledge among the 105 practicing registered midwives working in maternity wards was tested by using questionnaire with 15 questions. Practice was assessed only in the 35 midwives working in labor wards using an observational checklist with 19 items. Out of 122 total number of midwives who worked in maternity wards, 17 of them did not participate in this study as they were either on their annual leave, seminar or were not willing to participate. Knowledge and practice were expressed as percentages of correct responses obtained by the participants and categorized as adequate or inadequate respectively. Data were coded and entered into SPSS version 20 for descriptive and inferential statistics. Results: Of 105, midwives assessed, majority were female (90.5%); mean age was 33.8±6.9 (range 21-49 yrs); some (46.7%) of them were in the age group 31-40 yrs. In terms of professional training in midwifery, about half (49.9%) of them had attained a diploma level with work experience of mainly 1-5 yrs (56.2%). Generally knowledge and skills on prevention and management of PPH using AMTSL among midwives assessed was observed to be inadequate. A majority 94.3% of midwives demonstrated inadequate knowledge and 71.4% had inadequate skills on AMTSL. However, when considering the performance of participants on individual items of knowledge and skills, there were variable responses with some items getting better scores while others getting poor scores. Of the knowledge items, the proportional of participants who responded correctly were lowest in steps of managing a patient with PPH (8.6%) and harmful practices when performing AMTSL (36.2%) while among the skills items that were poorly done included not waiting for the gush of blood before performing CCT (45.7%), and need to reassess uterine contraction after every 15 minutes after delivery and then two hourly (45.7%). Regarding the three components of AMTSL according to FIGO/ICM most (more than 50%) participants got correct responses. The proportions of participants who had correct responses (in skills checklist) were; Oxytocin administration (85.7%), CCT (94.3%) and uterine massage (71.4%). Conclusion: Knowledge and skills of AMTSL among midwives in Dar es Salaam public hospitals were inadequate Recommendation: These findings indicate that there is a need for Policy makers to arrange periodic review of pre-service midwifery training curricula to assess whether its contents provide midwives with skills relevant to the obstetric care.