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báo cáo khoa học: "Task shifting in maternal and newborn care: a non-inferiority study examining delegation of antenatal counseling to lay nurse aides supported by job aids in Benin"

Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Task shifting in maternal and newborn care: a non-inferiority study examining delegation of antenatal counseling to lay nurse aides supported by job aids in Benin | Jennings et al. Implementation Science 2011 6 2 http www.implementationscience.eom content 6 1 2 IMPLEMENTATION SCIENCE Implementation Science RESEARCH ARTICLE Open Access Task shifting in maternal and newborn care a non-inferiority study examining delegation of antenatal counseling to lay nurse aides supported by job aids in Benin 1.2 3 3 3 3 Larissa Jennings André Sourou Yebadokpo Jean Affo Marthe Agbogbe Aguima Tankoano Abstract Background Shifting the role of counseling to less skilled workers may improve efficiency and coverage of health services but evidence is needed on the impact of substitution on quality of care. This research explored the influence of delegating maternal and newborn counseling responsibilities to clinic-based lay nurse aides on the quality of counseling provided as part of a task shifting initiative to expand their role. Methods Nurse-midwives and lay nurse aides in seven public maternities were trained to use job aids to improve counseling in maternal and newborn care. Quality of counseling and maternal knowledge were assessed using direct observation of antenatal consultations and patient exit interviews. Both provider types were interviewed to examine perceptions regarding the task shift. To compare provider performance levels non-inferiority analyses were conducted where non-inferiority was demonstrated if the lower confidence limit of the performance difference did not exceed a margin of 10 percentage points. Results Mean percent of recommended messages provided by lay nurse aides was non-inferior to counseling by nurse-midwives in adjusted analyses for birth preparedness b -0.0 95 CI -9.0 9.1 danger sign recognition b 4.7 95 CI -5.1 14.6 and clean delivery b 1.4 95 CI -9.4 12.3 . Lay nurse aides demonstrated superior performance for communication on general prenatal care b 15.7 95 CI 7.0 24.4 although non-inferiority was not achieved for newborn care counseling b -7.3 95 CI -23.1 8.4 . The proportion of women with correct knowledge