Knowledge, Attitudes and Practices of Obstetric Care Providers in Bugesera District, Rwanda

There is little information regarding the knowledge, attitudes and practices of obstetric care providers in Rwanda, who are a crucial component for providing quality Safe Motherhood care. Despite investments in the structural capacity needed to deliver these services, little has been directed towards understanding the current competency of skilled providers on the front lines of maternal mortality and morbidity prevention. This study surveyed 87% of all obstetric care providers in the Bugesera District of Rwanda to determine their demographic characteristics, competency in Safe Motherhood knowledge, obstetric practices, and attitudes towards patients and training approaches. The study identified the majority of providers to be A2 level nurses (82%) who have received one year of health education in secondary school. In addition, the majority of providers expressed that both their knowledge (60.6%) and skills confidence (72.2%) across fundamental topics of Safe Motherhood care need improvement. There was a low level of demonstrated knowledge in Safe Motherhood services with a mean of 46.4% of 50 questions answered correctly. Performance of knowledge in normal labor (39.3% correct) and obstetric complications (37.1% correct) were the weakest areas identified. A high percentage of providers (60.8%) engage in the potentially harmful practice of fundal pressure during vaginal delivery, while only 15.9% of providers practice steps of the active management of the third stage of labor in 100% of their deliveries. Providers view additional education and training in emergency obstetric care (EMOC) to be very useful, with 89.3% reporting an enthusiastic willingness for participation in a two-day workshop even if it was their day off. Improving knowledge, skills and practices of obstetric providers is an essential step in improving the quality of emergency obstetric care.