Knowledge, practice and associated factors of active management of third stage of labor among obstetric care providers at governmental health facilities in north wollo, amhara region, Ethiopia.

Abstract

Background: World health organization strongly recommend that, every obstetrical provider at birth needs to have knowledge, skills on active management of third stage of labour and use routinely for all women’s. However, implementation of this life saver intervention by skilled birth attendants is questionable because of 3% to 16.5% of women will still go on to experience postpartum hemorrhage and also 12.2% of maternal death in Ethiopia is due to postpartum hemorrhage. Objective: To assess knowledge, practice and associated factors of Active management of the third stage of labour among obstetric care providers at the governmental health facilities in North Wollo Zone, Amhara Region, Ethiopia, 2018. Methods: An institution based cross sectional study design was used among obstetric care providers from March 15 – April 15. Multi-stage sampling technique were used to get a total of 254 participants from their health facilities. Data was collected by using self-administered structured questionnaires and observation checklist. Then the data was coded, cleaned and entered into Epidemiological data version 3.1 and exported to statistical package for social science version 23.0 for analyses. Bivariate and multivariable logistic regression model was used to identifying statistically significant associations between dependent and independent variables. The odds ratio at 95% Confidence interval with P-Value 0.05% was computed. Result: A total of 232 obstetric care providers were participated in the study making the response rate of 91.3%. Out of 232 of obstetrical care providers, only 124(53.4%) and 75(32.3%) of respondent had good knowledge and good practice respectively. The knowledge of obstetrical care providers on AMTSL was significantly associated by training [AOR 7.122 (95%CI, (3.032-16.728)], profession [AOR 5.323 (95% CI, (1.479 to19.160)], Age [AOR 6.497(95% CI, 1.580 to 26.713)]and qualification [AOR 0.251 (95% CI, (0.108-0.584)]. Whereas the practice was associated by work experience [AOR 0.206 (95% CI, 0.067-0.635)], Knowledge [AOR (2.986(95% CI, 1.451-6.144)], the presence of assistance during third stage management [AOR 2.045 (95% CI, 1.062-3.936)]and time of uterotonic preparation [AOR 4.695(95% CI, 2.311-9.538)]. Conclusion and recommendation: More than half of obstetrical care providers had good knowledge. Whereas only one third of participants had good practice towards active management of third stage of labour. Zonal Health Bureau and health institutions focus on improving the knowledge and practice of obstetrical care providers by giving extensive training, conducting regular supportive supervision and monitoring. Furthermore, birth assistance should be avail with care providers and pre-loaded oxytocin before third stage of labour