Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2024 Dec 31;24(1):1562.
doi: 10.1186/s12909-024-06581-x.

An evaluation of the effectiveness of an updated pre-service midwifery curriculum integrated with emergency obstetric and newborn care in Kenya: a cluster randomised controlled trial

Duncan N Shikuku  1   2 , Catherine Mwaura  3 , Peter Nandikove  4 , Alphonce Uyara  5 , Helen Allott  6 , Lucy Waweru  3 , Lucy Nyaga  7 , Edna Tallam  8 , Issak Bashir  9 , Eunice Ndirangu  10 , Carol Bedwell  6 , Sarah Bar-Zeev  11 , Charles Ameh  6   12   13
Affiliations
Randomized Controlled Trial

An evaluation of the effectiveness of an updated pre-service midwifery curriculum integrated with emergency obstetric and newborn care in Kenya: a cluster randomised controlled trial

Duncan N Shikuku et al. BMC Med Educ. .

Abstract

Introduction: Quality midwifery education is central to improving midwifery service delivery and maternal and newborn health outcomes. In many settings, midwifery educators insufficiently prepared for their teaching role and deficient curriculum compared to international standards affect the quality of healthcare provided by the midwifery graduates. This study assessed the effectiveness of an EmONC enhanced midwifery curriculum delivered by trained and mentored midwifery educators on the quality of education and student performance in Kenya.

Methods: A cluster randomised controlled trial in 20 midwifery colleges (12 intervention, 8 control colleges). Educators in both arms received training in teaching/EmONC skills to deliver the updated national midwifery curriculum. The intervention arm received additional 3-monthly post-training mentoring for 12 months. Educators' knowledge and confidence in EmONC/teaching skills was assessed before and after training and at 3, 6, 9 and 12 months. Teaching skills observations at baseline and endline in both study arms were also assessed. Knowledge, self-rated confidence and three OSCE in EmONC practical skills among final year midwifery students were assessed. Linear mixed effects models were used to evaluate the effect of intervention on educators and students.

Results: Seventy four educators and 146 students participated. Training significantly improved educators' mean knowledge (61.3%-73.3%) and confidence to teach EmONC (3.1-4.2 out of 5). Observed teaching skills mean scores of educators in the intervention arm were significantly higher compared to those of controls at endline (89.4%-vs-72.2%, mean difference 17.2 [95%CI, 3.2-29.8]). Mean scores for students in the intervention arm were significantly higher than those in controls for knowledge (59.6%-vs-51.3%, mean difference 8.3 [95%CI, 1.6-15.0]) and the three skills assessed (means; mean difference (95%CI): shoulder dystocia (64.5%-vs-42.7%; 21.8 (10.8-33.9); newborn resuscitation (43.9% vs 26.1%; 17.8 (2.0-33.9); and maternal shock resuscitation (56.5%-vs-39.2%; 17.3 (8.0-26.0) and combined average skills scores (55.0%-vs-36.0; 19.0 (8.7-29.5).

Conclusion: Training and supportive mentoring improved the quality of educators' teaching pedagogy and EmONC skills and enhanced students' learning. Overall performance in EmONC knowledge and skills was significantly higher for students who were taught by trained and mentored educators compared to those who received training alone. Thus, a local mentoring system is effective to enhance learning and effectiveness of an EmONC-updated midwifery curriculum.

Keywords: Curriculum; Education; Emergency obstetrics and newborn care; Kenya; Midwifery.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was reviewed and approved by Liverpool School of Tropical Medicine’s Research and Ethics Committee (REC 20–050), Moi University/Moi Teaching and Referral Hospital Institutional Research and Ethics Committee (IREC) (IREC FAN: 0003764), Kenya Medical Training College (KMTC/ADM/74/Vol VI) and the National Commission for Science, Technology and Innovation (License No: NACOSTI/P/21/8931). Consent was received at various levels. Details about the study were communicated by the KMTC Headquarters to all the participating colleges’ administration for institutional entry and required support. Study participants (educators) received an electronic detailed study information booklet containing all information about the study (including recording of teaching sessions as appropriate) and consent form two weeks before the commencement of the study. Secondly, a print copy of the same participant information sheet was issued to each participant and a written informed consent was obtained at the start of the face-to-face training sessions. A written informed consent was obtained from the students who participated in the study. Participation was strictly voluntary with an explicit option to withdraw at any time with no consequences. Those who opted not to participate in the study were not denied the training. Confidentiality was maintained throughout the study using the anonymous identity codes assigned to the study participants (educators and students). The study carried no risk to the participants as their identity was concealed throughout, study results (knowledge or skills scores) were not shared with the administration and participation in the study did not form part of their performance appraisal. Assessments, interview discussions and debrief meetings were conducted in a designated private space within the colleges. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
CONSORT diagram showing the flow of participants through each stage of a randomized trial
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. WHO. Every Newborn: An Action Plan to End Preventable Deaths. Geneva: WHO; 2014. Available from: https://apps.who.int/iris/bitstream/handle/10665/127938/9789241507448_en....
    1. WHO. Strategies towards ending preventable maternal mortality (EPMM) 2015 2nd March 2021]. Available from: https://apps.who.int/iris/handle/10665/153544.
    1. United Nations Population Fund, International Confederation of Midwives, World Health Organization. The State of the World’s Midwifery 2021: Building a health workforce to meet the needs of women, newborns and adolescents everywhere 2021. Available from: https://www.unfpa.org/publications/sowmy-2021.
    1. Nove A, Friberg IK, de Bernis L, McConville F, Moran AC, Najjemba M, et al. Potential impact of midwives in preventing and reducing maternal and neonatal mortality and stillbirths: a lives saved tool modelling study. Lancet Glob Health. 2021;9:e24–32. - PMC - PubMed
    1. Chou VB, Walker N, Kanyangarara M. Estimating the global impact of poor quality of care on maternal and neonatal outcomes in 81 low-and middle-income countries: a modeling study. PLoS Med. 2019;16(12): e1002990. - PMC - PubMed

Publication types

LinkOut - more resources