The maternal mortality ratio (MMR) is not merely an indicator of maternal health but is also considered to be an important indicator of the health status and wellbeing of a nation. Bangladesh has made a significant improvement in several health indicators. There has been a substantial decline in the infant mortality rate from 87 per 1000 live births in the 1990 to 43 per 1000 live births in 2011.1 The neonatal mortality rate too declined from 52 in 1993 to 28 in 2015, which is largely attributed to the success of the vaccination program.2 As a matter of fact, more than two-thirds of children were receiving all recommended vaccinations before their first birthday. In addition, the total fertility rate declined from more than six in 1975 to three in 2004 [3,19]. 

Nurses in Bangladesh have traditionally been poorly-trained, underpaid, and disrespected as professionals [3,24]. The better hospitals hire nurses from out of country. Nurse educators – those providing the training –lack basic educational resources and are often out-of-touch with the skills necessary to provide even basic patient care. A major shift is needed, and indeed is taking place. Nurses need consistent, ongoing education based on international evidence-based practice [4]. When education improves, practice standards are raised, the credibility and contribution of nurses is recognized, better wages are demanded, more nurses are attracted to the profession – and patient care improves [5,10].    

A training needs assessment survey conducted by Research Training and Management International (RTM International) revealed that many service providers require training to improve their knowledge and skills in maternal health services including their counseling skills [4,6,22]. Poor quality of services precludes optimal utilization of services. Lack of skilled health care providers is a major problem both at facility and community level [7,21,23]. Referral services are not always accessible or simply available. Provision of health services is unequal according to the regions and coordination between child and maternal health programmes are often missing. In addition, in the past, neonatal health has had little attention in policy and strategy documents of the Health sector [8, 11, 18].

The knowledge of caregivers plays a crucial role in avoiding the unnecessary maternal and newborn death [9,13,14]. There is a great need for better understanding of essential newborn care practices such as clean and safe    delivery,   drying    and   wrapping  for   thermal protection, early initiation of exclusive breastfeeding, tactile stimulation and resuscitation, care of eyes, skin and cordfor infection prevention [10,15].

Bangladesh has a high maternal mortality ratio, with 320 deaths per 100,000 births. This means there are about 11,000 to 12,000 women dying from pregnancy or childbirth complications every year in Bangladesh. And because maternal and newborn health is inextricably linked, of those women who die, only one in four of their babies will survive their first week of life. Moreover, a malnourished mother is very likely to give birth to a low birth weight baby. Bangladesh has one of the world’s highest rates of adolescent motherhood, based on the proportion of women younger than 20 giving birth every year. 

One in three teenage girls in Bangladesh is already a mother. Another 5 per cent are pregnant with their first child. Maternal mortality for adolescents is double the national figure. These high mortality rates are underpinned by the fact that nine out of every 10 deliveries take place at home, most with unskilled attendants or relatives assisting. The low status of women, poor quality and low uptake of services all add to this problem. Service providers including nurses are not well trained and motivated to provide maternal services. They usually ignore to counsel the mothers to seek services from qualified providers. In addition the nurses do not have enough knowledge on maternal health. Several studies show that mother of Bangladesh does not utilize institution based maternal service due to low quality services. Service providers are not available at the facility and when they are available, not motivated to provide quality care. On the other hand lack of logistics also an obstacle for low utilization of care. Negative attitude service providers towards poor mothers also a factor of poor access to health services from public facility. 

The study is aiming to explore the knowledge and attitude towards providing maternal health services to develop a strategy for training for nurses in public hospitals for achieving MDG 5 by 2015. It also will influence policy makers for making available all materials at the facility for increase knowledge which are new.

Objectives

General objective of the study is to know the Knowledge about the maternal health services among the nurses.

Study Design

This study was a cross sectional descriptive study which conducted in Sylhet M. A. G. Osmani Medical College Hospital and Sylhet Sadar Hospital from June 2015 to December 2018.

Study Participants

The sample size was estimated using G power analysis with set significance (α) of 0.05, an expected power of 0.80 (1-β) and medium effect size of 0.30(y). This calculation revealed 65 sample size and by adding 20% extra subjects, total 80 participants were included in the study. The sample in this study was nurses of Sylhet M. A. G. Osmani Medical College Hospital and Sylhet Sadar Hospital who fill the following inclusion criteria:

• Nurses who had diploma in nursing and midwifery or others equivalent educational qualification. 

• 2 years’ service experience in nursing at this hospital. 

• Nurses who were willingly participate in this study.

A convenient sampling technique was used in this study to collect data from those hospitals. Researcher distributes the questionnaire to 85 nurses and the participant was filling up the questionnaire by self-reported. At last researcher got 80 questionnaire return from the participants.

Instrument

The instruments for data collection consist of one parts  Part 1 t was The Socio demographic Data Questionnaire (SDQ) was developed by the researchers to explore nurses’ socio-demographic characteristics: age, gender, marital status, educational level, and work place. Part II: knowledge regarding 9 items to identify the knowledge about MCH of nurses which was describe by likert scale. All data collection questionnaires were developed by researcher based on existing literature review. Three content experts were examined the content validity of the second part of the questionare.

Reliability of this instrument was tested by 10 from North East medical college hospital, Sylhet who were not included in the actual sample of the study before conducting actual research for checking the internal consistency of the instrument. The result of this study was 96.

Ethical Consideration 

Prior to the commencement of this study, the research protocol was approved by the research committee (Local Ethical committee) of Nort East University, Sylhet. The aims and objectives of the study along with its procedure, risks and benefits of this study was explained to the respondents in easily understandable and then informed consent was taken from both primary and secondary nurses. Then it was assured that all information and records will be kept confidential and the procedure is used only for research purpose and the findings is helpful for developing policy to understand nurses’ knowledge about the maternal health.

Data Analysis

Collected data were analyzed by using specially designed computerized “Statistical Package” (SPSS). Both descriptive and inferential statistics were used for data analysis. The descriptive statistics such as frequencies, percentages, mean, and standard deviation were used to organize and present socio-demographic characteristics. And the knowledge level of nurses regarding MCH.

Table 1 showed the distribution of demographic characteristics of study participants by frequency, percentages, mean and slandered deviation. The result revealed that among 80 study participants, the average age was 34 (6.8) years where range from 23 to 50 years. Almost half participants (52%) were between ages of 31-40 years. The majority of the participants (86%) were female. 90% of participants

Were married and 76% were religious Muslims. Around half (54%) were with Diploma-in Nursing followed by BSc in Nursing (35%).

Among to the participants 60% were from general ward and 22% from ICU/CCU. The majority of the participants (82%) working experience were within 2 to 7 years and average work experience 6 (5.8) years. In terms of monthly family income more than half of participants (66%) income level was30001 to 40000 taka. In work shift most of the participants (86%) were from shifting and rotational duty and work 7 to 12 hours in a duty. In a day 33% of participants said that were deal with 20 patients in a duty while 19% of reported that they deal less than 5 patients in a day

Were married and 76% were religious Muslims. Around half (54%) were with Diploma-in Nursing followed by BSc in Nursing (35%).

Among to the participants 60% were from general ward and 22% from ICU/CCU. The majority of the participants (82%) working experience were within 2 to 7 years and average work experience 6 (5.8) years. In terms of monthly family income more than half of participants (66%) income level was30001 to 40000 taka. In work shift most of the participants (86%) were from shifting and rotational duty and work 7 to 12 hours in a duty. In a day 33% of participants said that were deal with 20 patients in a duty while 19% of reported that they deal less than 5 patients in a day

Table 1: Distribution of socio demographic characteristic of the participant: (N=100)

Table 2: Distribution of knowledge of nurses regarding MCH (N =80)

Maternal and child care is a burning issue for all over the world. All medical team member like physicians, nurses, supporting staff should work together to reduce maternal and child mortality rate.  In the medical nurses are mainly involved at the care of mother and child that’s why they always stay belongs patient. In this study we just describe the knowledge of nurses of Bangladesh regarding this issue. 

In this study most of nurses were female and work in Gaynae ward which is same as another study in German7. We want to explore the knowledge of nurses regarding mother and child health care knowledge that’s why more nurses were in involve in this study from gaynae ward who always deal this kind of patient.

To explore knowledge Bangladeshi nurses are weak in reading latest article which is not same in Germany7 and same with Kenya.8. In our country most of nurses doing their job after maintain their family. In family they should done all the household work and they become tiered. So they do not get enough time to read article. All international medical journal are published in English language and it’s not our mother language so it’s a great problem which is overcome so difficult for the Nurses. Literature review is widely study in masters level in our country so after complete of graduation level our nurses not become a good critique in literature review. In this study few nurses only 11% nurses were include who passed Master’s In Nursing Science (MSN).

Knowledge for the prevention of infection like check the sign of sepsis, provide sterile clothes etc are have good knowledge of our nurses because infection control is a term which they study from the diploma level and also have much training on infection prevention and control. 

Tough the knowledge of nurses is very well regarding maternal and child health care in Bangladesh but maternal morbidity and mortality also high from development country because more non nurse like family welfare visitor, traditional unskilled person (dai) also handling the patient at home. Most of delivery in our country done at home whose are handle by this type of dai that are a major malpractice.

In Bangladesh, it is found that the nurses have the knowledge and attitude towards providing quality maternal care to increased utilization of care by the women is very important. Nurses are the one of the key patient handlers during providing in and out patient in the hospital. To improve the quality of care it is important to improve the knowledge of the nurses on specific issue. They also need training and on job motivation for improving their skill. Job satisfaction is another factor for improve the quality of care. Huge work load and deficiency of logistics hinders their service quality.

Recommendations

• Training on EOC and IMCI should be regular and refresher training should be arranged. At the same time there should be strict monitoring system from higher authority. 

• All guideline and protocol should be in place and should be followed by all providers. Hospital management committee members should be given specific job responsibility and accountability with monthly meeting and reporting system to the higher authority

• There should be a monitoring system for checking quality of care

• As the general ways to improve the quality of care, regular supply of logistics and equipments is essential. Drug and consumables should be in place for providing quality care

Further study should be needed for cause analysis

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