Percent of skilled health personnel knowledgeable in obstetric warning signs


The percentage of skilled health personnel who are considered knowledgeable as they can name at least three of the following warning signs of obstetric complications:

  •  bleeding
  •  labor lasting more than 12 hours
  •  placenta retained more than one hour
  •  convulsions or swelling of the hands or face (eclampsia)
  •  fever and vaginal discharge (puerperal sepsis)

Skilled health personnel include midwives, doctors, and nurses with midwifery and lifesaving skills. Traditional birth attendants (TBAs) are typically not included in this definition. For additional background on this indicator, see USAID/MEASURE Evaluation (2007).

This indicator is calculated as:

(Number of skilled health personnel who know at least three warning signs for obstetric complications / Total number of skilled health personnel interviewed) x 100

Surveys and interviews with facility staff provide the primary data used to calculate this indicator. Questions about the warning signs for obstetric complications need to be standardized in advance and used consistently over time in order to compare trends. The data can be disaggregated by the type of skilled worker, by the type of facility (public, private, non-governmental, community based) and by other relevant factors such as districts and urban/rural location. 

Health worker interviews and surveys

This indicator is used to assess the knowledge of skilled health personnel as the basis for their ability to make timely referrals to emergency obstetric care services (EmOC).

All pregnant women are at random risk for developing life-threatening complications and women with underlying health issues and lack of antenatal care are at increased risk. Evidence shows that about 15 percent of pregnancies result in complications  and the leading high-risk complications are hemorrhage, sepsis (infection), eclampsia, and obstructed labor (UNFPA, 2004). These four complications in conjunction with unsafe abortion account for more than two-thirds of maternal deaths. The presence of skilled health attendants knowledgeable about the warning signs for complications and able to make timely referrals to EmOC is vital to reducing maternal mortality and morbidity and directly relates to achieving Millennium Development Goals #5. improve maternal health #4. reduce child mortality.

The skilled attendants’ knowledge of obstetric warning signs does not indicate that they are knowledgeable about the severity of warning signs, that they know how to deal with the complications or will make timely referrals to EmOC.

training, postabortion care, knowledge, obstetric fistula (OF), safe motherhood (SM), access

UNFPA, 2004, Program Manager’s Planning Monitoring and Evaluation Toolkit, Part II: Indicators for Reducing Maternal Mortality, New York: UNFPA.  

USAID/MEASURE Evaluation, 2007, A Guide for Monitoring and Evaluating Population-Health-Environment Programs, Chapel Hill, NC: MEASURE Evaluation.

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