Knowledge, practices and associated factors of knowledge on Preconception Care Package among public health midwives in Colombo District, Sri Lanka

Abstract

Background: Preconception care (PCC) is of paramount importance in reducing maternal and child morbidity and mortality. A new ‘Package of interventions for PCC’ has been introduced in 2012, which is delivered through the existing public health system. Objectives: To assess the knowledge, practices, associated factors and perceived barriers of public health midwives (PHMM) on implementing the PCC package in the Colombo district. Methods: Descriptive cross-sectional study was carried out using a pretested self-administered questionnaire among all PHMM in Colombo district (N=366). Identification and fine tuning of the perceived barriers was done through focus group discussions with PHMM outside the study setting. A checklist was used in four randomly selected MOH areas to assess the practices. Data was described using mean values and frequency. Chi-square test was used for associations (P<0.05). Results: Response rate is 97.3% (n=366). Overall knowledge of PHMM on the PCC package was high [mean total mark 89.7 (SD 9.1), Median was 92 (IQR 88-96)]. However, knowledge on some specific components was significantly low. Knowledge level was significantly associated with the age of the PHM (p=0.004), marital status (p=0.038), service experience (p=0.021), service experience as a field PHM (p=0.002) and time taken to travel for work (p=0.042). Majority of PHMM (95.4%) (n=349) conducts PCC clinics. But only 79.8% (n=292) conducts health education sessions. Only 3 (5.8%) PHMM had evaluated the screening tool. Nutritional assessment was done in all clinics (100%) but laboratory investigations were not done at any of the clinics neither couples were given the information booklet. Inadequate referral of couples to PHMM by marriage registrars was identified as a perceived barrier by 313 (85.5%) PHMM. 233 (63.7%) stated that couples don’t know the importance of attending PCC clinics while 229 (62.6%) stated couples don’t know about PCC clinics. Conclusions and recommendations: Although overall knowledge was high, knowledge on some aspects were not adequate. Most of the practices were poor and not in par with their high knowledge levels. No uniformity in the practices and procedures carried out indicating lack of proper guidance and deficiencies in training. Therefore, it is recommended to revise the national guidelines and the circular on PCC package and conduct refresher training on its implementation.

Keywords

• Preconception care
• Public health midwife
• Knowledge
• Practices
• Perceived barriers