{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T12:58:25Z","timestamp":1765889905192,"version":"3.48.0"},"reference-count":25,"publisher":"BMJ","issue":"6","funder":[{"DOI":"10.13039\/501100001137","name":"Australia Awards","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001137","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100008561","name":"Burnet Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008561","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2017,5,22]]},"published-print":{"date-parts":[[2017,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The re-emergence of community-based health workers such as the auxiliary midwives (AMWs) in Myanmar, who are local female volunteers, has been an important strategy to address global health workforce shortages. The Myanmar government recommends one AMW for every village. The aim of this study is to investigate the current knowledge of critical danger signs and practices for safe childbirth and immediate newborn care of AMWs to inform potential task shifting of additional healthcare responsibilities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional survey was conducted from July 2015 to June 2016 in three hard-to-reach areas in Myanmar. Face-to-face interviews were conducted using a pretested questionnaire.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 262 AMWs participating in the study, only 8% of AMWs were able to identify at least 80% of 20 critical danger signs. Factors associated with greater knowledge of critical danger signs included older age over 35 years (adjusted OR (AOR) 2.19, 95% CI 0.99 to 4.83), having received refresher training within the last year (AOR 2.20, 95% CI 1.21 to 4.01) and receiving adequate supervision (AOR 5.04, 95% CI 2.74 to 9.29). Those who employed all six safe childbirth and immediate newborn care practices were more likely to report greater knowledge of danger signs (AOR 2.81, 95% CI 1.50 to 5.26), adequate work supervision (AOR 3.18 95% CI 1.62 to 6.24) and less education (AOR 0.44, 95% CI 0.23 to 0.88).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The low level of knowledge of critical danger signs and reported practices for safe childbirth identified suggest that an evaluation of the current AMW training and supervision programme needs to be revisited to ensure that existing practices, including recognition of danger signs, meet quality care standards before new interventions are introduced or new responsibilities given to AMWs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2017-017180","type":"journal-article","created":{"date-parts":[[2017,7,5]],"date-time":"2017-07-05T20:10:47Z","timestamp":1499285447000},"page":"e017180","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Determinants of knowledge of critical danger signs, safe childbirth and immediate newborn care practices among auxiliary midwives: a cross sectional survey in Myanmar"],"prefix":"10.1136","volume":"7","author":[{"given":"Kyu Kyu","family":"Than","sequence":"first","affiliation":[{"name":"Burnet Institute, Melbourne, Australia"},{"name":"Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alison","family":"Morgan","sequence":"additional","affiliation":[{"name":"Nossal Institute for Global Health, Melbourne School of Population and Global Health, Victoria, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Minh Duc","family":"Pham","sequence":"additional","affiliation":[{"name":"Burnet Institute, Melbourne, Australia"},{"name":"Department of Epidemiology and Preventive Medicine and Central Clinical School, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James G","family":"Beeson","sequence":"additional","affiliation":[{"name":"Burnet Institute, Melbourne, Australia"},{"name":"Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stanley","family":"Luchters","sequence":"additional","affiliation":[{"name":"Burnet Institute, Melbourne, Australia"},{"name":"Department of Epidemiology and Preventive Medicine and Central Clinical School, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Australia"},{"name":"Department of Obstetrics and Gynaecology, International Centre for Reproductive Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2017,7,5]]},"reference":[{"key":"2025121604540176000_7.6.e017180.1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-publhealth-032013-182354"},{"key":"2025121604540176000_7.6.e017180.2","unstructured":"Lehmann U , Sanders D . Community health workers: what do we know about them. The state of the evidence on programmes, activities, costs and impact on health outcomes of using community health workers. Geneva: World Health Organization, 2007:1\u201342."},{"key":"2025121604540176000_7.6.e017180.3","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.85.8_Pt_1.1055"},{"key":"2025121604540176000_7.6.e017180.4","unstructured":"Department of Health - Ministry of Health Myanmar. Situational analysis on training and utilization of auxiliary midwives, 1985."},{"key":"2025121604540176000_7.6.e017180.5","unstructured":"Department of Health - Ministry of Health Myanmar. Auxiliary midwife training manual (Myanmar Language. Department of Health, 2015."},{"key":"2025121604540176000_7.6.e017180.6","unstructured":"Ministry of Health Myanmar. Health workforce strategic plan 2012\u20132017, 2012."},{"key":"2025121604540176000_7.6.e017180.7","unstructured":"Department of Health, Ministry of Health Myanmar. Microplan for auxiliary midwives (2013\u20132016). Department of Health, 2013."},{"key":"2025121604540176000_7.6.e017180.8","unstructured":"World Health Organization. WHO recommendations: optimizing health worker roles to improve access to key maternal and newborn health interventions through task shifting OPTIMINIZEMNH. Geneva, 2012."},{"key":"2025121604540176000_7.6.e017180.9","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0160020","article-title":"Barriers, facilitators and priorities for implementation of WHO maternal and perinatal health guidelines in four\u00a0lower-income countries: a GREAT network research activity","volume":"11","author":"Vogel","year":"2016","journal-title":"PLoS One"},{"key":"2025121604540176000_7.6.e017180.10","unstructured":"The three millennium development goal fund. 2015 Annual report. 2016."},{"key":"2025121604540176000_7.6.e017180.11","unstructured":"Burnet Institute Myanmar. 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Thematic report on mortality, census report volume 4-B, 2016:1\u2013115."},{"key":"2025121604540176000_7.6.e017180.16","unstructured":"Ministry of Health and Sports (MoHS) and ICF. Myanmar demographic and health survey 2015\u201316. 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World Health Report 2006: Working Together for Health, WHO, Geneva."},{"key":"2025121604540176000_7.6.e017180.21","first-page":"395","article-title":"Improving community health workers' knowledge and behaviour about proper content in malaria education","volume":"59","author":"Rakhshani","year":"2009","journal-title":"J Pak Med Assoc"},{"key":"2025121604540176000_7.6.e017180.22","doi-asserted-by":"publisher","DOI":"10.3402\/gha.v7.24085"},{"key":"2025121604540176000_7.6.e017180.23","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2458-13-847","article-title":"Effectiveness of community health workers delivering preventive interventions for maternal and child health in low- and middle-income countries: a systematic review","volume":"13","author":"Gilmore","year":"2013","journal-title":"BMC Public Health"},{"key":"2025121604540176000_7.6.e017180.24","first-page":"S32","article-title":"Experiences engaging community health workers to provide maternal and newborn health services: implementation of four programs","volume":"130 Suppl 2","author":"Haver","year":"2015","journal-title":"Int J Gynaecol Obstet"},{"key":"2025121604540176000_7.6.e017180.25","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)69381-1"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2017-017180","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T12:54:12Z","timestamp":1765889652000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2017-017180"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,6]]},"references-count":25,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2017,7,5]]},"published-print":{"date-parts":[[2017,6]]}},"alternative-id":["10.1136\/bmjopen-2017-017180"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2017-017180","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"type":"print","value":"2044-6055"},{"type":"electronic","value":"2044-6055"}],"subject":[],"published":{"date-parts":[[2017,6]]}}}