Knowledge and Confidence Level Regarding Manual Removal of Placenta and Umbilical Cord Oxytocin Injection for Postpartum Haemorrhage Management among Midwives in Kwara State, Nigeria: A Quasi-Experimental Study

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@article{1723756,
      author = {Yusuf, S. I., Ogbeye, G. B.},
      title = {Knowledge and Confidence Level Regarding Manual Removal of Placenta and Umbilical Cord Oxytocin Injection for Postpartum Haemorrhage Management among Midwives in Kwara State, Nigeria: A Quasi-Experimental Study},
      journal = {Iconic Research And Engineering Journals},
      year = {2026},
      volume = {10},
      number = {4},
      pages = {1053-1065},
      issn = {2456-8880},
      url = {https://www.irejournals.com/formatedpaper/1723756.pdf},
      abstract = {Background: Manual removal of the placenta (MROP) and umbilical cord oxytocin injection (UCOI) are used in the management of retained placenta and postpartum haemorrhage (PPH), but evidence on midwives' knowledge of, and confidence in, these procedures in Nigeria is limited. This study assessed knowledge and self-confidence regarding MROP and UCOI among midwives in Kwara State, Nigeria, before and after simulation-based training.
Methods: A two-group pre-test/post-test quasi-experimental study was conducted among 276 midwives (134 experimental, 142 control) in 12 public hospitals across the three senatorial districts of Kwara State. Hospitals were randomly allocated to the experimental or control group. Knowledge of MROP and of UCOI (12 items each) and self-confidence (12 items) were assessed at baseline and at six and twelve weeks after a four-week training programme delivered to the experimental group. Item responses were scored and summed into composite scores, which were classified as good or poor knowledge and high or low self-confidence using the mean score. Data were analysed with chi-square, Friedman and Mann-Whitney U tests (p<0.05).
Results: Of the 276 participants, 258 (93.5%) were assessed at both follow-up points. At baseline, the control and experimental groups were similar in the proportions with good knowledge of MROP (43.7% vs 43.3%), good knowledge of UCOI (47.2% vs 43.3%) and high self-confidence (50.7% vs 56.0%; all p>0.05). At six weeks, the proportions in the control and experimental groups were 28.6% vs 88.0% for good MROP knowledge, 45.1% vs 68.8% for good UCOI knowledge and 47.4% vs 67.2% for high self-confidence (all p≤0.001); differences persisted at twelve weeks (27.1% vs 74.4%, 36.1% vs 65.6% and 42.1% vs 64.0%, respectively). In the experimental group, mean knowledge scores changed significantly over time for MROP (Friedman χ²=93.85, p<0.001) and UCOI (χ²=36.21, p<0.001), and were higher than in the control group at six weeks (both p<0.001). Mean self-confidence scores were also higher in the experimental group at six weeks (p<0.001), but the within-group change across the three assessments was not statistically significant (χ²=5.04, p=0.081).
Conclusion: Simulation-based training was associated with higher knowledge of MROP and UCOI and higher self-confidence among midwives, although gains declined by twelve weeks. Periodic refresher training, delivery of UCOI content in line with current guidelines, and assessment of observed skills alongside self-reported confidence are recommended.},
      keywords = {knowledge; self-confidence; manual removal of placenta; umbilical cord oxytocin injection; postpartum haemorrhage; midwives; simulation-based training; Kwara State; Nigeria},
      month = {October},
  }