Observational studyBMJ open2019
Where there is no nurse: an observational study of large-scale mentoring of auxiliary nurses to improve quality of care during childbirth at primary health centres in India.
Observational study in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
20 citing papers in PubMed, 30 citations in OpenAlex.
- Costs and Cost-Effectiveness of mCME Version 2.0: An SMS-Based Continuing Medical Education Program for HIV Clinicians in Vietnam.Global health, science and practice · 2022Trial
- Trial
- Transitioning to midwifery models of care: lessons from case studies in India.Global health action · 2025Article
- Preclinical usability evaluation of the Liveborn app: A mobile health application that provides feedback for neonatal resuscitation.PLOS digital health · 2025Article
- Traumatic perinatal events and educational needs of labor and delivery room nurses in Korea: a cross-sectional survey.Women's health nursing (Seoul, Korea) · 2024Article
- Strengthening quality in sexual, reproductive, maternal, and newborn health systems in low- and middle-income countries through midwives and facility mentoring: an integrative review.BMC pregnancy and childbirth · 2023Review
- mHealth learning tool for skilled birth attendants: scaling the Safe Delivery App in India.BMJ open quality · 2022Article
- The impact of institutional delivery on neonatal and maternal health outcomes: evidence from a road upgrade programme in India.BMJ global health · 2022Article
- Safe Delivery application with facilitation increases knowledge and confidence of obstetric and neonatal care among frontline health workers in India.Journal of family medicine and primary care · 2022Article
- Super Divya, an Interactive Digital Storytelling Instructional Comic Series to Sustain Facilitation Skills of Labor and Delivery Nurse Mentors in Bihar, India-A Pilot Study.International journal of environmental research and public health · 2022Article
- Improving Newborn Resuscitation by Making Every Birth a Learning Event.Children (Basel, Switzerland) · 2021Review
- Does engagement with frontline health workers improve maternal and child healthcare utilisation and outcomes in India?Human resources for health · 2021Article
- Building a Sustainable Comprehensive Multiple Myeloma Program in Western Kenya.JCO global oncology · 2021Article
- In-service nurse mentoring in 2020, the year of the nurse and the midwife: learning from Bihar, India.Global health action · 2020Article
- Using a mobile nurse mentoring and training program to address a health workforce capacity crisis in Bihar, India: Impact on essential intrapartum and newborn care practices.Journal of global health · 2020Article
- Mentoring the working nurse: a scoping review.Human resources for health · 2020Article
- Barriers to home-based palliative care in people with cancer: A qualitative study of the perspective of caregivers.Nursing open · 2020Article
- Building capacities of Auxiliary Nurse Midwives (ANMs) through a complementary mix of directed and self-directed skill-based learning-A case study in Pune District, Western India.Human resources for health · 2020Article
- Enabling change in public health services: Insights from the implementation of nurse mentoring interventions to improve quality of obstetric and newborn care in two North Indian states.Gates open research · 2020Article
- The impact of a nurse mentoring program on the quality of labour and delivery care at primary health care facilities in Bihar, India.BMJ global health · 2019Article
Corrections and comments
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Authors and funding
7 authors at 2 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveClinician scarcity in Low and Middle-Income Countries (LMIC) often results in de facto task shifting; this raises concerns about the quality of care. This study examines if a long-term mentoring programme improved the ability of auxiliary nurse-midwives (ANMs), who function as paramedical community health workers, to provide quality care during childbirth, and how they compared with staff nurses.
designQuasi-experimental post-test with matched comparison group.
settingPrimary health centres (PHC) in the state of Bihar, India; a total of 239 PHCs surveyed and matched analysis based on 190 (134 intervention and 56 comparison) facilities.
participantsAnalysis based on 335 ANMs (237 mentored and 98 comparison) and 42 staff nurses (28 mentored and 14 comparison).
interventionMentoring for a duration of 6-9 months focused on nurses at PHCs to improve the quality of basic emergency obstetric and newborn care. PRIMARY OUTCOME MEASURES: Nurse ability to provide correct actions in managing cases of normal delivery, postpartum haemorrhage and neonatal resuscitation assessed using a combination of clinical vignettes and Objective Structured Clinical Examinations.
resultsMentoring increased correct actions taken by ANMs to manage normal deliveries by 17.5 (95% CI 14.8 to 20.2), postpartum haemorrhage by 25.9 (95% CI 22.4 to 29.4) and neonatal resuscitation 28.4 (95% CI 23.2 to 33.7) percentage points. There was no significant difference between the average ability of mentored ANMs and staff nurses. However, they provided only half the required correct actions. There was substantial variation in ability; 41% of nurses for normal delivery, 60% for postpartum haemorrhage and 45% for neonatal resuscitation provided less than half the correct actions. Ability declined with time after mentoring was completed. DISCUSSION: Mentoring improved the ability of ANMs to levels comparable with trained nurses. However, only some mentored nurses have the ability to conduct quality deliveries. Continuing education programmes are critical to sustain quality gains.
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