Midwives’ adherence to guidelines on the management of birth asphyxia in Malawi


A study was conducted to determine midwives adherence to guidelines on management of birth asphyxia at Queen Elizabeth Central Hospital in Blantyre district, Malawi. The study design was descriptive cross sectional using quantitative data analysis method on 75 midwives that were working in the maternity unit of the hospital. A structured questionnaire was used to collect data on participant’s demographic characteristics and midwives’ comprehension of birth asphyxia and an observational check list was used to observe midwives’ adherence to WHO resuscitation guidelines. In addition midwives were observed on their adherence to the Integrated Maternal and Neonatal Health guidelines that were developed by the Malawi Ministry of Health. The findings indicate that the midwives had knowledge of birth asphyxia in general. However, there were gaps in their ability to identify warning signs of birth asphyxia through partograph use. In addition the midwives did not adhere to 9 out of the 21 steps of the resuscitation guideline. Generally there was substandard adherence to guidelines on identification of warning signs of birth asphyxia and neonatal resuscitation. On the other hand, the facility did not have adequate resuscitation equipment and supplies. The results are discussed in relation to the importance of adhering to resuscitation guidelines in the management of birth asphyxia for babies that do not breathe at birth. Training of the midwives on partograph use and resuscitation to improve neonatal outcomes is recommended. It is recommended further that the health facility should have adequate resuscitation equipment and supplies.

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Chikuse, B. , Chirwa, E. , Maluwa, A. , Malata, A. and Odland, J. (2012) Midwives’ adherence to guidelines on the management of birth asphyxia in Malawi. Open Journal of Nursing, 2, 351-357. doi: 10.4236/ojn.2012.24052.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Lawn, J.E., Cousens, S. and Zupan, J. (2009) Neonatal Survival Steering Team: 4 Million Neonatal Deaths: When? Where? Why? Lancet, 365, 891-900.
[2] Davis, P.G., O’Donnell, C.P.F., Tan, A. and Schulze, A. (2004) Air versus oxygen for resuscitation of infants at birth. The Cochrane Database of Systematic Reviews, 2, CD002273.
[3] National Statistics Office (NSO) and ICF Macro (2011) Malawi demographic and health survey. Calverton, Maryland.
[4] MICS (Malawi Multiple Indicator Cluster Survey) (2006) Preliminary report. National Statistical Office, Zomba.
[5] WHO (2009) Monitoring emergency obstetric care: A handbook: Averting maternal death and disability. World Health Organization, Geneva.
[6] Ministry of Health (2010) Malawi 2010 EMONC needs assessment final report. Malawi Ministry of Health, Lilongwe.
[7] World Health Organization (2005) Integrated management of pregnancy and childbirth: A guide for midwives and doctors. World Health Organization, Geneva.
[8] Kenzie, B. and Gomez, P. (2004) Basic maternal and neonatal care: A guide for skilled providers. The access program, USAID/JHPIEGO, Baltimore. http://www.BMNCrevmanEN.pdf
[9] Draycott, T., Sibanda, T., Owen, L., Akand, V., Winter, C. and Reading, S. (2006) Does training in obstetric emergencies improve neonatal outcome? BJOG: An International Journal of Obstetrics & Gynaecology, 113, 177- 182. doi:10.1111/j.1471-0528.2006.00800.x
[10] Bream, K.D., Gennero, S., Kafulafula, U. Mbweza, E. and David, H. (2005) Barriers to and facilitators for newborn resuscitation in Malawi, African. Journal of Midwifery and Women’s Health, 50, 329-334. doi:10.1016/j.jmwh.2005.04.006
[11] Christensson, K., Petterson, K.O., Bulgalho, A., Manuela, C.M., Dgedge, C., Johansson, E. and Belgstrom, S. (2006) The challenge of improving perinatal care with limited resources. Observations of midwifery practices in Mozambique. African Journal of Reproductive Health, 10, 47-61. doi:10.2307/30032443
[12] Berglund, S., Grunewald, C., Pettersson, H. and Cnattingius, S. (2010) Risk factors associated with substandard care during labour. Acta Obstetrica et Gynecological Scandinavia, 89, 39-48. doi:10.3109/00016340903418751
[13] Singhal, N. and Bhuttta, Z.A. (2008). Newborn resuscitation in resource-limited settings. Seminars in Fetal & Neonatal Medicine, 13, 432-439. doi:10.1016/j.siny.2008.04.013
[14] Lang, T.A., Hodge, M. and Olson, V. (2004) Nurse-patient ratios: A systematic review on the effects of nurse staffing on patient, nurse employee, and hospital outcomes. Journal of Nursing Administration, 34, 326-337. doi:10.1097/00005110-200407000-00005
[15] Stanton, M.W. and Rutherford, M.K. (2004) Hospital nurse staffing and quality care: Rockvilla, MD agency for health care research and quality; 2004. http://www.ahrq.gov/research/nursestaff/nursestaff.pdf
[16] Shrestha, M., Singh, R. and Upreti, D. (2009) Quality of care provided to newborns by nursing personnel at BP Koirala Institute of Health Sciences. Kathmandu University Medical Journal, 7, 231-237.
[17] Etsey, P.M. (2008) Towards the millennium development goal 5: Assessing the quality of supervised delivery in the G. A. West District, Ghana. M.Sc. Thesis, University of Ghana, Acra.
[18] Braner, D.A.V., Denson, S.E. and Ibsen, L.M. (2000) Textbook for neonatal resuscitation. 4th Edition, American Heart Association, Dallas.
[19] Ariff, S., Soofi, S., Sadik, K., Feroze, A., Khan, S. and Jafarey, S. (2010) Evaluation of health workforce competence in maternal and neonatal issues in public health sector of Pakistan: An assessment of their training needs. BMC Health Services Research, 10, 319. doi:10.1186/1472-6963-10-319
[20] Newton, O. and English, M. (2006) Newborn resuscitation: Defining best practice for low-income settings. Transactions of the Royal Society of Tropical Medicine and Hygiene, 100, 899-908. doi:10.1016/j.trstmh.2006.02.012
[21] Bhutta, Z.A., Ahmed, T., Black, R.E., Cousens, S., Dewey, K. and Giugliani, E. (2008) What works? Interventions for maternal and child undernutrition and survival. Lancet, 371, 417-440. doi:10.1016/S0140-6736(07)61693-6

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