Evaluating the effectiveness of preservice midwifery curricula in Ethiopia: A comparison of neonatal resuscitation and infection prevention practice of midwifery graduates trained in competency-based versus conventional curricula

Abstract

BACKGROUND: Infection control and neonatal resuscitation are essential midwifery practices that can reduce maternal and neonatal mortality. However, in Ethiopia, theory-heavy midwifery education leads to limited clinical competence. To address this, Debre Tabor University implemented a competency-based curriculum in 2013. This study examines whether competency-based midwifery education produces graduates with significantly better performance in neonatal resuscitation and infection prevention compared to conventional education, thereby framing a testable argument about the curriculum's effectiveness. METHODS: A comparative cross-sectional study assessed the infection prevention and neonatal resuscitation performance of 68 BSc midwifery graduates (32 competency-based vs. 36 conventional) from third-generation Ethiopian universities. Performance was measured using a validated observation tool in clinical settings for infection prevention and simulations for neonatal resuscitation. Mean percentage scores were compared using t-tests, with effect size illustrated via Gardner-Altman plots. RESULTS: Overall, midwives demonstrated 63.6% of essential neonatal resuscitation tasks, with competency-based curriculum graduates (CBCGs) having higher performance than conventional curriculum graduates (CCGs) (71.6% vs. 56.5%; t (66.0) = 3.82, p < .001; difference = 15.1%), particularly in airway suctioning and chest rise assessment. For infection prevention, midwives performed 71.7% of the required tasks, with CBCGs again scoring higher (76.9% vs. 67.0%; t (55.4) = 2.79, p < .01; difference = 9.9%). Key differences were observed in hand hygiene, the use of personal protective equipment, and apron decontamination. Despite these improvements, persistent deficiencies remained in both groups, particularly in checking breathing/pulse during neonatal resuscitation and in disinfecting aprons during infection prevention practices. CONCLUSIONS: CBCGs demonstrated better performance in neonatal resuscitation and infection prevention compared to those from the conventional program, suggesting clinical relevance. However, performance gaps in both groups underscore the need for enhanced simulation training, ongoing skill reinforcement, and curriculum refinement.