Factors Associated With Knowledge, Attitude And Practice Of Midwives On Active Management Of Third Stage Of Labour At Selected Health Centers Of Addis Ababa, Ethiopia

Abstract

Background: The third stage of labour includes the separation and detachment of the placenta from the uterine wall, and ends with complete expulsion of the placenta and membrane. This period is the most hazardous stage for the birthing woman due to the risk of profuse hemorrhage. Severe bleeding is the most important cause of maternal deaths. Active management of third stage of labour effectively reduces the occurrence of hemorrhage.

Objective: The objective of this study was to assess factors associated with Knowledge, Attitude, and Practice of Midwifes on active management of third stage of labour at selected health centers of Addis Ababa.

Methods: Institution based cross sectional study was conducted among Midwives in health center of Addis Ababa. Convenience sampling was carried out to select 136 Midwives who were working in the 26 health center of Addis Ababa. The questionnaires contained closed ended questions which covered socio demographic information, knowledge, attitude and practice of midwives on active management of third stage of labour. These were prepared in English. After checking for completeness and consistency, data was coded and entered into Epi-info program and transported to SPSS version 17 for analysis. Logistic regression was used to determine factors associated with knowledge, attitude and practices.  Data was presented by tables.

Result: In multivariate regression length of service and practice were significantly associated with level of knowledge. Those who have length of service greater than 11 years were 2.5 times more likely to be knowledgeable on Active Management of Third Stage of Labour than their counterparts (AOR= 2.49, 95% CI= 1.04, 5.95). Those who practice Active Management of Third Stage of Labour were almost 4 times more likely to be knowledgeable on Active Management of Third Stage of Labour than their counterparts (AOR = 3.57 (1.73, 7.39). Educational level of the midwives was significantly associated to attitude. Those who have high educational level (degree) were more likely to have positive attitude on Active Management of Third Stage of Labour than diploma holders (AOR= 0.67, 95% CI= 0.005, 0.89). Those who have additional on job training on Active Management of Third Stage of Labour were 3 times more likely to practice Active Management of Third Stage of Labour than their counterparts (AOR = 3.13, 95% CI= 1.0, 9.8). Those who have high educational level (degree) were nine times skillful than diploma holders (AOR= 8.51, 95% CI= 2.02, 35.92). Furthermore those who have good level of knowledge have four times higher odds to have better practice than their counterparts (AOR= 4.64, 95% CI= 1.96, 10.95).

Conclusion: Length of service was significantly associated with their knowledge towards AMTSL. Educational level was significantly associated with their attitude towards AMTSL.  Educational level, on job training and level of knowledge were significantly associated with their practice on AMTSL. Therefore concerned bodies should give emphasis on education and training of midwives to improve knowledge attitude and practice of AMTSL.

Keywords: Oxytocin, active management, Third stage of labor, Postpartum Haemorrhage.