Determinants of knowledge of critical dangers signs, safe childbirth and immediate newborn care practices among auxiliary midwives in Myanmar: a cross-sectional survey in Myanmar.


The re-emergence of community-based health workers such as the auxiliary midwives (AMWs) in Myanmar, who are local female volunteers, has been an important strategy to address global health workforce shortages. The Myanmar government recommends one AMW for every village. The aim of this study is to investigate the current knowledge of critical danger signs and practices for safe childbirth and immediate newborn care of AMWs to inform potential task shifting of additional healthcare responsibilities.
A cross-sectional survey was conducted from July 2015 to June 2016 in three hard-to-reach areas in Myanmar. Face-to-face interviews were conducted using a pretested questionnaire.
Among 262 AMWs participating in the study, only 8% of AMWs were able to identify at least 80% of 20 critical danger signs. Factors associated with greater knowledge of critical danger signs included older age over 35 years (adjusted OR (AOR) 2.19, 95% CI 0.99 to 4.83), having received refresher training within the last year (AOR 2.20, 95% CI 1.21 to 4.01) and receiving adequate supervision (AOR 5.04, 95% CI 2.74 to 9.29). Those who employed all six safe childbirth and immediate newborn care practices were more likely to report greater knowledge of danger signs (AOR 2.81, 95% CI 1.50 to 5.26), adequate work supervision (AOR 3.18 95% CI 1.62 to 6.24) and less education (AOR 0.44, 95% CI 0.23 to 0.88).
The low level of knowledge of critical danger signs and reported practices for safe childbirth identified suggest that an evaluation of the current AMW training and supervision programme needs to be revisited to ensure that existing practices, including recognition of danger signs, meet quality care standards before new interventions are introduced or new responsibilities given to AMWs.

Authors & affiliation: 
Than KK1,2, Morgan A3, Pham MD1,4, Beeson JG1,2, Luchters S1,4,5. Author information 1 Burnet Institute, Melbourne, Australia. 2 Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia. 3 Nossal Institute for Global Health, Melbourne School of Population and Global Health, Victoria, Australia. 4 Department of Epidemiology and Preventive Medicine and Central Clinical School, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia. 5 Department of Obstetrics and Gynaecology, International Centre for Reproductive Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
Staff Members: 
Published In: 
BMJ Open. 2017 Jul 5;7(6):e017180
Publication date: 
Monday, January 22, 2018