Effect of in service training on maternal and child health services utilization

Abstract

Although the WHO recommended providing practical in-service training to health care providers to support high-quality maternity and child health care services and improve health outcomes, limited information exists on the impact of such training on maternal and child health care utilization, especially in Ethiopia. Thus, this study aimed to evaluate the impact of providing in-service training to health care providers on maternal and child health care utilization in Tigray, Ethiopia. Both community- and facility-based cross-sectional studies were conducted in six accessible zones in Tigray, Ethiopia. For the community-based component, 7,908 mothers of children under 30 months were randomly selected from districts and sub-districts using a multistage cluster sampling technique; for the facility-based component, 733 healthcare providers from different levels of health facilities participated. Structured questionnaires were used to collect data, which were then exported from a cloud server to STATA 19 for cleaning and analysis. Descriptive statistics summarized categorical and continuous variables, and Poisson regression was used to examine the effect of provider training on maternal health service utilization. Results were reported as incidence rate ratios with 95% confidence intervals, and a two-way scatter plot with fitted values was used to visualize the relationship. Each additional provider trained in preconception care (PCC) was associated with a 3.6% increase in maternal awareness. One additional antenatal care (ANC)-trained healthcare provider increased the likelihood of mothers attending at least one ANC visit by 6.5% and of attending four or more visits by 7.0%. Adding a maternal health service-trained provider raised facility delivery rates by 2.9%, and each additional BEmONC-trained professional increased institutional delivery by 5.3%. Enhanced newborn care training led to a 3.9% increase in skin-to-skin contact and a 4.3% rise in early breastfeeding initiation. Moreover, optimization training for the health extension program (HEP) was associated with a 10.4% increase in postnatal visits by health extension workers and a 1.8% improvement in child vaccination coverage. In-service training significantly improved the utilization of maternal and child health services. Therefore, health bureaus and other concerned stakeholders should strengthen in-service training to improve the quality and utilization of maternal and child health services and accelerate progress toward achieving Sustainable Development Goal (SDG) 3.