A Delphi survey to determine midwifery research priorities among midwives in sub-Saharan Africa

Objective: In sub-Saharan Africa, midwifery input into the generation of important research questions is limited. The authors aimed to address this issue by enabling midwives to set their own research priorities with the intention of developing a research strategy to conduct studies relevant to clinical practice. Methods: A survey was carried out in six countries (Kenya, Malawi, Uganda, Zambia, Zimbabwe and Tanzania). The Delphi method was used with six panels of midwives (n=118) to attain a convergence of opinion on midwifery research priorities. Consensus-building was achieved by using a series of questionnaires delivered using multiple iterations to collect data. Data were analysed using ranked means and proportions. Findings: Consensus was reached on 11 research questions which were considered regional priorities. These covered three key areas: midwifery training, clinical care and organisational issues. Conclusions: Midwives prioritised areas of research that had direct applicability to their own practice. All questions were at the applied end of the research spectrum. Priorities tended to cover broad areas within reproductive health, as opposed to being disease-focused. This is likely to reflect the desire to provide quality care that embraces the social aspects of health. Some of these research priorities are being taken forward by midwives in the group. </jats:sec

The three pathways to becoming a midwife : self-assessed confidence in selected competencies in intrapartum care from seven African countries

Background/Aims Globally, there are three pathways to become a midwife: midwifery post nursing, direct entry midwifery and integrated nursing and midwifery. There is limited knowledge on the effectiveness of pre-service midwifery education. The aim of this study was to describe and compare midwifery students' confidence in intrapartum skills and associated factors such as type and level of education. Methods A multi-country cross-sectional study was conducted, where midwifery students were approached in the final months of their education programme. Data were collected using a questionnaire, based on the basic skills by the International Confederation of Midwives. Intrapartum care comprised 40 skills. Results In total, 1407 midwifery students from seven sub-Saharan countries responded. The 40 skills were grouped into six domains; three related to care during the first and second stage of labour and three related to care during the third stage of labour. Sex and age were significantly associated with confidence, with female students and those 26–35 years old having higher levels of confidence. Students enrolled in a direct entry programme were more confident than other students in all three domains of care related to the first and second stage of labour. Conclusions Direct entry was found to result in higher confidence for midwifery students than post nursing programmes or integrated programmes. Further research is needed for evaluation of competence

African midwifery students’ self-assessed confidence in antenatal care : a multi-country study

Background: Evidence-based antenatal care is one cornerstone in Safe Motherhood and educated and confident midwives remain to be optimal caregivers in Africa. Confidence in antenatal midwifery skills is important and could differ depending on the provision of education among the training institutions across Africa. Objective: The aim of the study was to describe and compare midwifery students’ confidence in basic antenatal skills, in relation to age, sex, program type and level of program. Methods: A survey in seven sub-Saharan African countries was conducted. Enrolled midwifery students from selected midwifery institutions in each country presented selfreported data on confidence to provide antenatal care. Data were collected using a selfadministered questionnaire. The questionnaire consisted of 22 antenatal skills based on the competency framework from the International Confederation of Midwives. The skills were grouped into three domains; Identify fetal and maternal risk factors and educate parents; Manage and document emergent complications and Physical assessment and nutrition. Results: In total, 1407 midwifery students from seven Sub-Saharan countries responded. Almost one third (25-32%) of the students reported high levels of confidence in all three domains. Direct entry programs were associated with higher levels of confidence in all three domains, compared to post-nursing and double degree programs. Students enrolled at education with diploma level presented with high levels of confidence in two out of three domains. Conclusions: A significant proportion of student midwives rated themselves low on confidence to provide ANC. Midwifery students enrolled in direct entry programs reported higher levels of confidence in all domains. It is important that local governments develop education standards, based on recommendations from the International Confederation of midwives. Further research is needed for the evaluation of actual competence