Health workers' knowledge, attitude and practices regarding guidelines for misoprostol use during induction of labor at Kawempe National Referral Hospital

Abstract

Background: Globally, up to 33% of deliveries involve induction of labor, with misoprostol being used in 14.5-15.8% of these cases. The World Health Organization (WHO) supports the use of misoprostol for this purpose, and Uganda has incorporated its use into the Essential Maternal and Newborn Clinical Care Guidelines (EMNCG) following WHO recommendations. However, improper use of misoprostol has led to significant maternal and perinatal morbidity and mortality, including 11.5% of uterine rupture cases attributed to its misuse. Despite the availability of guidelines, issues of morbidity and mortality associated with incorrect use of misoprostol persist. This study aimed to assess health workers' knowledge, attitudes, and practices regarding the use of misoprostol for labor induction as outlined in the EMNCG. Objectives: To determine health workers’ level of knowledge concerning EMNCG for misoprostol use during induction of labor. To describe the attitude of health workers towards EMNCG for misoprostol use during induction of labor. To describe the health workers’ practice of use of EMNCG for misoprostol use during induction of labor. Methods: A descriptive cross sectional study was conducted at Kawempe National Referral Hospital. We used proportionate sampling followed by simple random sampling to enroll 253 health workers including 144 midwives, 36 Junior House Officers, 61 Senior House Officers and 12 Specialists. Data was collected using a self-administered questionnaire with sections on socio-demographics, knowledge, attitude and practices and then analysed with STATA version 16. Results: Most participants were female (162, 64%). The majority had practiced for over 5 years (148, 58.5%). The proportion of knowledgeable health workers was low at 15%. Knowledgeable doctors were more common than knowledgeable midwives, with approximately 3 in 10 doctors (29.4%) being knowledgeable compared to about 1 in 24 midwives (4.2%). Among specialists, 66.7% were knowledgeable, which was higher than the proportion among Senior House Officers (SHOs) at 32.8%, and Junior House Officers (JHOs) at 11.1%. Additionally, 22% of health workers had a positive attitude, and 87% demonstrated good practice. Conclusion: Health workers had low level of knowledge on EMNCG concerning use of misoprostol during induction of labor. However, having a copy of the guidelines, specialization and having worked for less than 5 years increased the level of knowledge. Although most health workers agreed that using guidelines is preferred to use of experience, many preferred international guidelines to local guidelines. Generally health workers had good practice although this could not be assessed by observation in this study.