Knowledge and Skills of Healthcare Providers in Sub-Saharan Africa and Asia before and after Competency-Based Training in Emergency Obstetric and Early Newborn Care

Ameh, Charles A.; Kerr, Robert; Madaj, Barbara; Mdegela, Mselenge; Kana, Terry; Jones, Susan; Lambert, Jaki; Dickinson, Fiona; White, Sarah; van den Broek, Nynke

doi:10.1371/journal.pone.0167270

Cited by 110Global Maternal and Child HealthMaternal and fetal healthcareInnovations in Medical Education

Knowledge and Skills of Healthcare Providers in Sub-Saharan Africa and Asia before and after Competency-Based Training in Emergency Obstetric and Early Newborn Care

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Ameh, Charles A., Kerr, Robert, Madaj, Barbara, Mdegela, Mselenge, Kana, Terry, Jones, Susan, Lambert, Jaki, Dickinson, Fiona +2 more·2016·PLOS ONE

DOI 10.1371/journal.pone.0167270PMC PMC5179026

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Abstract

BACKGROUND: Healthcare provider training in Emergency Obstetric and Newborn Care (EmOC&NC) is a component of 65% of intervention programs aimed at reducing maternal and newborn mortality and morbidity. It is important to evaluate the effectiveness of this. METHODS: We evaluated knowledge and skills among 5,939 healthcare providers before and after 3-5 days 'skills and drills' training in emergency obstetric and newborn care (EmOC&NC) conducted in 7 sub-Saharan Africa countries (Ghana, Kenya, Malawi, Nigeria, Sierra Leone, Tanzania, Zimbabwe) and 2 Asian countries (Bangladesh, Pakistan). Standardised assessments using multiple choice questions and objective structured clinical examination (OSCE) were used to measure change in knowledge and skills and the Improvement Ratio (IR) by cadre and by country. Linear regression was performed to identify variables associated with pre-training score and IR. RESULTS: 99.7% of healthcare providers improved their overall score with a median (IQR) increase of 10.0% (5.0% - 15.0%) for knowledge and 28.8% (23.1% - 35.1%) for skill. There were significant improvements in knowledge and skills for each cadre of healthcare provider and for each country (p<0.05). The mean IR was 56% for doctors, 50% for mid-level staff and nurse-midwives and 38% for nursing-aides. A teaching job, previous in-service training, and higher percentage of work-time spent providing maternity care were each associated with a higher pre-training score. Those with more than 11 years of experience in obstetrics had the lowest scores prior to training, with mean IRs 1.4% lower than for those with no more than 2 years of experience. The largest IR was for recognition and management of obstetric haemorrhage (49-70%) and the smallest for recognition and management of obstructed labour and use of the partograph (6-15%). CONCLUSIONS: Short in-service EmOC&NC training was associated with improved knowledge and skills for all cadres of healthcare providers working in maternity wards in both sub-Saharan Africa and Asia. Additional support and training is needed for use of the partograph as a tool to monitor progress in labour. Further research is needed to assess if this is translated into improved service delivery.

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Competency-based training has been shown to work in various low-resource health care fields, such as surgery and obstetric care.
“Competency-based training approaches have already demonstrated success in diverse areas of health care in low resource settings, including surgery and obstetric care 5,6 .”
From Ensuring Quality in Psychological Support (WHO EQUIP): developing a competent global workforce (2020) · cites this paper as [6]

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Hekim Dışı Acil Sağlık Hizmetleri Çalışanlarına Verilen Acil Obstetrik Bakım Eğitiminin Etkinliğinin Değerlendirilmesi: Ön Test Son Test Araştırma
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Factors influencing healthcare providers’ knowledge and skills retention following helping mothers survive and helping babies survive training in Tanzania: A mixed methods cross-sectional studyPreprint
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Healthcare Providers’ Preconception Care Knowledge and Associated Factors in Ethiopia: A Systematic Review and Meta-Analysis
Zeleke, A. M., Tassew, W. C., Gonete, Y. A., & Ferede, Y. A. (2025) · SAGE Open · doi:10.1177/21582440251334881
“%) was also higher than that reported in a study conducted in sub-Saharan Africa (24.5%; Ameh et al., 2016) and studies among women in Ethiopia (35.7%; Ameh et al., 2016).”
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A co-designed conceptual educational framework for midwives to train Indigenous traditional birth attendants in low resource settings of remote Papua New Guinea
David, S. C. C., Kelly, M., Hauck, Y. L., & Bradfield, Z. (2025) · Midwifery · doi:10.1016/j.midw.2025.104547
Learning environment and simulation effectiveness in midwifery education: a Moroccan study
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Rugamba, G., Habyarimana, V. I., Ntiyamira, J. C., Mushimiyimana, F., Unyuzumutima, J., Agaba, F., Hitayezu, J., Habyarimana, O., & Bitzan, M. M. (2026) · BMC Pediatrics · doi:10.1186/s12887-026-06946-9
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Additional file 3 of Do in-service training materials for midwifery care providers in sub-Saharan Africa meet international competency standards? A scoping review 2000–2020
Welsh, J., Hounkpatin, H., Groß, M. M., Hanson, C., & Moller, A.-B. (2022) · Figshare · doi:10.6084/m9.figshare.21340399
Additional file 5 of Stakeholder opinions on perceived sub-standard emergency obstetric and newborn care in Ghana
Ayawine, A., Asaarik, M. J. A., & Atinga, R. A. (2024) · Figshare · doi:10.6084/m9.figshare.26705769
Additional file 1 of Effect of mentorship and a mHealth application in updating provider skills and knowledge in maternal and newborn care in two informal settlements of Nairobi
Ndwiga, C., Abuya, T., Okondo, C., Akinyi, S., Wickramanayake, A., & Warren, C. (2024) · Figshare · doi:10.6084/m9.figshare.26637501
Additional file 1 of Do in-service training materials for midwifery care providers in sub-Saharan Africa meet international competency standards? A scoping review 2000–2020
Welsh, J., Hounkpatin, H., Groß, M. M., Hanson, C., & Moller, A.-B. (2022) · Figshare · doi:10.6084/m9.figshare.21340393
Additional file 1 of Key components influencing the sustainability of a multi-professional obstetric emergencies training programme in a middle-income setting: a qualitative study
Ghag, K., Bahl, R., Winter, C., Mary, L., Bautista, N., Ilagan, R., Ellis, M., de Salis, I. O. C., & Draycott, T. J. (2021) · Figshare · doi:10.6084/m9.figshare.14489929
Additional file 4 of Stakeholder opinions on perceived sub-standard emergency obstetric and newborn care in Ghana
Ayawine, A., Asaarik, M. J. A., & Atinga, R. A. (2024) · Figshare · doi:10.6084/m9.figshare.26705766
Additional file 3 of Stakeholder opinions on perceived sub-standard emergency obstetric and newborn care in Ghana
Ayawine, A., Asaarik, M. J. A., & Atinga, R. A. (2024) · Figshare · doi:10.6084/m9.figshare.26705763
Additional file 2 of Stakeholder opinions on perceived sub-standard emergency obstetric and newborn care in Ghana
Ayawine, A., Asaarik, M. J. A., & Atinga, R. A. (2024) · Figshare · doi:10.6084/m9.figshare.25596558
Additional file 2 of Key components influencing the sustainability of a multi-professional obstetric emergencies training programme in a middle-income setting: a qualitative study
Ghag, K., Bahl, R., Winter, C., Mary, L., Bautista, N., Ilagan, R., Ellis, M., de Salis, I. O. C., & Draycott, T. J. (2021) · Figshare · doi:10.6084/m9.figshare.14489932
Additional file 1 of Stakeholder opinions on perceived sub-standard emergency obstetric and newborn care in Ghana
Ayawine, A., Asaarik, M. J. A., & Atinga, R. A. (2024) · Figshare · doi:10.6084/m9.figshare.25596405
Additional file 2 of Do in-service training materials for midwifery care providers in sub-Saharan Africa meet international competency standards? A scoping review 2000–2020
Welsh, J., Hounkpatin, H., Gross, M. M., Hanson, C., & Moller, A.-B. (2022) · London School of Hygiene & Tropical Medicine · doi:10.6084/m9.figshare.21340396

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Self-citation

Authors: Ameh, C. A., Kerr, R., Madaj, B., Mdegela, M., Kana, T., Jones, S., Lambert, J., Dickinson, F., White, S., & van den Broek, N.
Affiliations: Liverpool School of Tropical Medicine (GB)
Corresponding author: Madaj, Barbara
ORCID: Ameh, Charles A.
Kerr, Robert
Madaj, Barbara
Mdegela, Mselenge
Kana, Terry
Jones, Susan
Lambert, Jaki
Dickinson, Fiona
White, Sarah
Venue: PLOS ONE
Publisher: Public Library of Science (PLoS)
Published: 2016-12-22
Volume: 11
Issue: 12
Pages: e0167270
ISSN: 1932-6203 (ISSN-L)
DOI: 10.1371/journal.pone.0167270
PMC: PMC5179026
OpenAlex: W2569050240
Cited by: 109
References: 21
Citations by year: 2026: 9 · 2025: 9 · 2024: 13 · 2023: 13 · 2022: 13 · 2021: 16 · 2020: 16 · 2019: 12 · 2018: 5 · 2017: 3
FWCI: 7.75
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0/ (vor)
Locations: PLoS ONE (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
LSTM Online Archive (Liverpool School of Tropical Medicine) (acceptedVersion)
Sunderland Repository (University of Sunderland) (acceptedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders: Department for International Development (GB) (202945-101)
UNICEF (43144788)
Topics: Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
Keywords: emergency obstetric and newborn care, competency-based training, in-service training, obstetric hemorrhage management, obstructed labor, partograph, obstetric care, maternal mortality, neonatal mortality, sub-Saharan Africa, South Asia, mid-level health workers, nurses and midwives
MeSH terms: Asia, Emergency Treatment, Health Personnel, Humans, Infant Care, Infant, Newborn, Health Knowledge, Attitudes, Practice, Program Evaluation, Linear Models, Africa South of the Sahara, Delivery, Obstetric

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Knowledge and Skills of Healthcare Providers in Sub-Saharan Africa and Asia before and after Competency-Based Training in Emergency Obstetric and Early Newborn Care

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