Determinants of knowledge of critical danger signs, safe childbirth and immediate newborn care practices among auxiliary midwives: a cross sectional survey in Myanmar.
OBJECTIVES
The re-emergence of community-based health workers such as the auxiliary midwives (AMWs) in Myanmar, who are local female volunteers, has been an important strategy to address global health workforce shortages. The Myanmar government recommends one AMW for every village. The aim of this study is to investigate the current knowledge of critical danger signs and practices for safe childbirth and immediate newborn care of AMWs to inform potential task shifting of additional healthcare responsibilities.


METHODS
A cross-sectional survey was conducted from July 2015 to June 2016 in three hard-to-reach areas in Myanmar. Face-to-face interviews were conducted using a pretested questionnaire.


RESULTS
Among 262 AMWs participating in the study, only 8% of AMWs were able to identify at least 80% of 20 critical danger signs. Factors associated with greater knowledge of critical danger signs included older age over 35 years (adjusted OR (AOR) 2.19, 95% CI 0.99 to 4.83), having received refresher training within the last year (AOR 2.20, 95% CI 1.21 to 4.01) and receiving adequate supervision (AOR 5.04, 95% CI 2.74 to 9.29). Those who employed all six safe childbirth and immediate newborn care practices were more likely to report greater knowledge of danger signs (AOR 2.81, 95% CI 1.50 to 5.26), adequate work supervision (AOR 3.18 95% CI 1.62 to 6.24) and less education (AOR 0.44, 95% CI 0.23 to 0.88).


CONCLUSION
The low level of knowledge of critical danger signs and reported practices for safe childbirth identified suggest that an evaluation of the current AMW training and supervision programme needs to be revisited to ensure that existing practices, including recognition of danger signs, meet quality care standards before new interventions are introduced or new responsibilities given to AMWs.
['Than|Kyu Kyu|KK|', 'Morgan|Alison|A|', 'Pham|Minh Duc|MD|', 'Beeson|James G|JG|', 'Luchters|Stanley|S|']
D000328:Adult D003430:Cross-Sectional Studies D036861:Delivery, Obstetric D005260:Female D007722:Health Knowledge, Attitudes, Practice D006801:Humans D016015:Logistic Models D008875:Middle Aged D008880:Midwifery D002052:Myanmar D007744:Obstetric Labor Complications D011247:Pregnancy D011248:Pregnancy Complications D011295:Prenatal Care D057566:Self Report D012959:Socioeconomic Factors D055815:Young Adult
Danger signs Newborn care Auxiliary Midwives Myanmar cross-sectional survey Childbirth practices