Evidence-based quality care is essential for reducing the high burden of maternal and newborn mortality and morbidity in sub-Saharan Africa. Provision of quality care results from interaction between several components of the health system including competent midwifery care providers. We assessed midwifery care providers’ childbirth and immediate newborn competencies as part of the Action Leveraging Evidence to Reduce perinatal morTality and morbidity (ALERT) project in Benin, Malawi, Tanzania, and Uganda. We used a self-administered questionnaire assessing knowledge, and skills drills observations assessing skills and behaviours in the 16 ALERT maternity wards. A total of 302 participants took part in the knowledge assessment and 113 skills drills were conducted. The assessments revealed knowledge gaps in frequency of fetal heart rate monitoring and timing of umbilical cord clamping. More than half of the participants scored poorly on aspects related to routine admission tasks, clinical history-taking and rapid and initial assessment of the newborn in the skills drills assessment, while higher scores were achieved in active management of the third stage of labour. The assessment also suggested a lack of involvement of women in decision-making, illustrated by the failure to encourage women to ask questions and failing to report clinical findings back to them. Participants furthermore indicated a lack of support from their managers, supervision and access to education and training resources. Inadequate competency level of the midwifery care providers may be due to gaps in pre-service training but possibly furthermore related to the structural and operational facility characteristics including continuing professional development. Investment and actioning on these findings are needed when developing and designing pre-service and in-service training to ensure women, newborns and families have access to evidence-based and quality midwifery care when needed.

The authors have declared no competing interest.

PACTR202006793783148?June 17th, 2020.

https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-021-07155-z.

https://reproductive-health-journal.biomedcentral.com/articles/10.1186/s12978-021-01109-8

This study is part of the ALERT-project which is funded by the European Commission's Horizon 2020 (No. 847824) under a call for Implementation research for maternal and child health (CH). The contents of this article are solely the responsibility of the authors and do not reflect the views of the EU. Publication fees paid by University of Gothenburg, Sweden (ABM). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

This study is part of the Action Leveraging Evidence to Reduce perinatal morTality and morbidity in the sub-Saharan Africa project (ALERT). The project received ethical approval from the following institutions: Karolinska Institutet, Sweden (Etikprövningsmyndigheten—Dnr 2020–01587). School of Public Health research and ethics committee (HDREC 808) and Uganda National Council for Science and Technology (UNCST)— (HS1324ES). Muhimbili University of Health And Allied Sciences (MUHAS) Research and Ethics Committee, Tanzania (MUHAS-REC-04-2020-118) and The Aga Khan University Ethical Review Committee, Tanzania (AKU/2019/044/fb). College of Medicine Research and Ethics Committee (COMREC), Malawi—(COMREC P.04/20/3038). Comité National d’Ethique pour la Recherche en Santé, Cotonou, Bénin (83/MS/DC/SGM/CNERS/ST). The Institutional Review Board at the Institute of Tropical Medicine Antwerp and The Ethics Committee at the University Hospital Antwerp, Belgium—(ITG 1375/20. B3002020000116).

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.

Yes

All the results of the study are provided in the manuscript or in the supplementary files. As outlined in the ALERT consortium data management plan, all consortium level anonymized data will be made openly available through Zenodo (https://www.zenodo.org/) at the end of the project (2024).

https://www.zenodo.org