ArticleBMJ open2016
Competence of health workers in emergency obstetric care: an assessment using clinical vignettes in Brong Ahafo region, Ghana.
Article in BMJ open, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00623337 (Cluster Randomised Trial to Evaluate the Impact of Routine Home Visits to Provide a Package of Essential Newborn Care Interventions in the Third Trimester of Pregnancy and the 1st Week of Life on Neonatal Mortality in Rural Ghana), which is not on this map. Cited by 16 papers.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Cluster Randomised Trial to Evaluate the Impact of Routine Home Visits to Provide a Package of Essential Newborn Care Interventions in the Third Trimester of Pregnancy and the 1st Week of Life on Neonatal Mortality in Rural Ghana
Who cites it
16 citing papers in PubMed.
- Did a quality improvement intervention improve quality of maternal health care? Implementation evaluation from a cluster-randomized controlled study.International journal for quality in health care : journal of the International Society for Quality in Health Care · 2020Trial
- The influence of distance and quality of care on place of delivery in rural Ghana.Scientific reports · 2016Trial
- Article
- Right-sizing Incentives.Journal of development economics · 2026Article
- Assessing the quality of care in low- and middle-income countries: a rapid review of the landscape of assessment tools.BMJ global health · 2026Review
- Maternal Health Nurse Competency in Addressing Emergency Obstetric Care: An Assessment in Southern Mozambique.Nursing reports (Pavia, Italy) · 2026Article
- Evaluating the implementation of the vignettes-based injury care process assessment tool in low- and middle-income countries settings.BMC health services research · 2026Article
- Association Between Emotional Intelligence and Work Outcomes Among Midwives in Northern Ghana: A Path Analysis Study.Journal of nursing management · 2026Article
- Stakeholder opinions on perceived sub-standard emergency obstetric and newborn care in Ghana.BMC health services research · 2024Article
- A scoping review of the residual barriers to skilled birth attendance in Ghana: A conceptual framework and a fish bone analysis.PLOS global public health · 2024Article
- Article
- When a Doctor Falls from the Sky: The Impact of Easing Doctor Supply Constraints on Mortality.The American economic review · 2023Article
- Characterizing health care provider knowledge: Evidence from HIV services in Kenya, Rwanda, South Africa, and Zambia.PloS one · 2021Article
- Article
- Does facility birth reduce maternal and perinatal mortality in Brong Ahafo, Ghana? A secondary analysis using data on 119 244 pregnancies from two cluster-randomised controlled trials.The Lancet. Global health · 2019Article
- Assessment Of Maternity Staff Training And Knowledge Of Obstetric Care In Burkina Faso: A Repeated Cross-Sectional Study.International journal of women's health · 2019Article
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
objectivesTo assess health worker competence in emergency obstetric care using clinical vignettes, to link competence to availability of infrastructure in facilities, and to average annual delivery workload in facilities.
designCross-sectional Health Facility Assessment linked to population-based surveillance data.
setting7 districts in Brong Ahafo region, Ghana.
participantsMost experienced delivery care providers in all 64 delivery facilities in the 7 districts. PRIMARY OUTCOME MEASURES: Health worker competence in clinical vignette actions by cadre of delivery care provider and by type of facility. Competence was also compared with availability of relevant drugs and equipment, and to average annual workload per skilled birth attendant.
resultsVignette scores were moderate overall, and differed significantly by respondent cadre ranging from a median of 70% correct among doctors, via 55% among midwives, to 25% among other cadres such as health assistants and health extension workers (p<0.001). Competence varied significantly by facility type: hospital respondents, who were mainly doctors and midwives, achieved highest scores (70% correct) and clinic respondents scored lowest (45% correct). There was a lack of inexpensive key drugs and equipment to carry out vignette actions, and more often, lack of competence to use available items in clinical situations. The average annual workload was very unevenly distributed among facilities, ranging from 0 to 184 deliveries per skilled birth attendant, with higher workload associated with higher vignette scores.
conclusionsLack of competence might limit clinical practice even more than lack of relevant drugs and equipment. Cadres other than midwives and doctors might not be able to diagnose and manage delivery complications. Checking clinical competence through vignettes in addition to checklist items could contribute to a more comprehensive approach to evaluate quality of care. TRIAL REGISTRATION NUMBER: NCT00623337.
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