{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T01:53:45Z","timestamp":1789523625688,"version":"build-2803163510"},"reference-count":37,"publisher":"BMJ","issue":"8","funder":[{"name":"Bill and Melinda Gates Foundation through UNICEF Headquarter","award":["OPP1112117"],"award-info":[{"award-number":["OPP1112117"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,7,17]]},"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This study assesses the competency of maternal and neonatal health (MNH) professionals at district-level and subdistrict-level health facilities in northern Bangladesh in managing maternal and newborn complications using clinical vignettes. The study also examines whether the professional\u2019s characteristics and provision of MNH services in health facilities influence their competencies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>134 MNH professionals in 15 government hospitals were interviewed during August and September 2016 using structured questionnaire with clinical vignettes on obstetric complications (antepartum haemorrhage and pre-eclampsia) and neonatal care (low birthweight and immediate newborn care). Summative scores were calculated for each vignette and median scores were compared across different individual-level and health facility-level attributes to examine their association with competency score. Kruskal-Wallis test was performed to identify the significance of association considering a p value&lt;0.05 as statistically significant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The competency of MNH professionals was low. About 10% and 24% of the health professionals received \u2018high\u2019 scores (&gt;75% of total) in maternal and neonatal vignettes, respectively. Medical doctors had higher competency than nurses and midwives (score=11 vs 8 out of 19, respectively; p=0.0002) for maternal vignettes, but similar competency for neonatal vignettes (score=30.3 vs 30.9 out of 50, respectively). Professionals working in health facilities with higher use of normal deliveries had better competency than their counterparts. Professionals had higher competency in newborn vignettes (significant) and maternal vignettes (statistically not significant) if they worked in health facilities that provided more specialised newborn care services and emergency obstetric care, respectively, in the last 6 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Despite the overall low competency of MNH professionals, exposure to a higher number of obstetric cases at the workplace was associated with their competency. Arrangement of periodic skill-based and drill-based in-service training for MNH professionals in high-use neighbouring health facilities could be a feasible intervention to improve their knowledge and skill in obstetric and neonatal care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2018-028670","type":"journal-article","created":{"date-parts":[[2019,8,19]],"date-time":"2019-08-19T06:12:20Z","timestamp":1566195140000},"page":"e028670","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Competence of healthcare professionals in diagnosing and managing obstetric complications and conducting neonatal care: a clinical vignette-based assessment in district and subdistrict hospitals in northern Bangladesh"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8694-4349","authenticated-orcid":false,"given":"Abdullah Nurus Salam","family":"Khan","sequence":"first","affiliation":[{"name":"Health Promotion, Education and Behavior, University of South Carolina, Columbia, South Carolina, USA"},{"name":"Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farhana","family":"Karim","sequence":"additional","affiliation":[{"name":"Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohiuddin Ahsanul Kabir","family":"Chowdhury","sequence":"additional","affiliation":[{"name":"Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh"},{"name":"Epidemiology, University of South Carolina, Columbia, South Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nabila","family":"Zaka","sequence":"additional","affiliation":[{"name":"Health Section, Maternal and Newborn Health, UNICEF USA, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Manu","sequence":"additional","affiliation":[{"name":"Department of Population Health, Liverpool School of Tropical Medicine, Liverpool, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shams El","family":"Arifeen","sequence":"additional","affiliation":[{"name":"Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sk Masum","family":"Billah","sequence":"additional","affiliation":[{"name":"Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,8,18]]},"reference":[{"key":"2025121221110010000_9.8.e028670.1","doi-asserted-by":"crossref","first-page":"2206","DOI":"10.1016\/S0140-6736(12)60685-0","article-title":"From millennium development goals to sustainable development goals","volume":"379","author":"Sachs","year":"2012","journal-title":"The Lancet"},{"key":"2025121221110010000_9.8.e028670.2","unstructured":"WHO, U. and C . 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