{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T07:45:47Z","timestamp":1785743147625,"version":"3.56.0"},"reference-count":32,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004423","name":"World Health Organization","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100004423","id-type":"DOI","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/01f80g185","id-type":"ROR","asserted-by":"publisher"}]},{"name":"GIZ\u2014German Cooperation","award":["81280780"],"award-info":[{"award-number":["81280780"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nurs. Rep.","Nursing Reports"],"abstract":"<jats:p>Background: Quality perinatal health care depends considerably on health workforce competency. Improving Maternal and Child Health Nurse (MCHN) competency is urgently needed in low\u2013middle-income countries, especially to manage key perinatal conditions related to prevalent poor maternal health outcomes, such as pre-eclampsia and hemorrhage. Objective: This study assesses the competency of MCHNs in addressing severe pre-eclampsia and antepartum hemorrhage. Methodology: A cross-sectional study was conducted from 4 November to 10 December 2022. A structured questionnaire and clinical vignettes concerning severe pre-eclampsia and antepartum hemorrhage were administered to all available MCHNs working at a convenience sample of 80 primary-level health facilities in southern Mozambique. Participant characteristics and competency scores were described using frequency distributions or measures of central tendency, as appropriate. Mixed-effects ordinal regression was used to assess the association between participant characteristics and competency levels. All analyses were performed using Jamovi version 2.6.22 at a 5% significance level. Results: Out of 191 participants, most (61.8%, 118) were mid-level MCHNs, with an average age of 33 years (95% CI: 32.05; 34.2). The majority (82.7%, 158) provided prenatal consultation on the day of the interview, and about half (50.7%, 97) knew the national standards for prenatal consultation. MCHNs scoring above 50 percentage points on competency comprised 44.5% (95% CI: 37.4; 51.6%). A higher level of knowledge about guidelines and equipment was associated with increased odds ratios for having a higher-level competency score (OR = 2.21 for \u201cgood\u201d vs. reference \u201cpoor\u201d competency; 95% CI: 1.07; 4.57, p &lt; 0.033). Conclusions: About six in 10 MCHNs in Mozambique have poor competency in addressing severe pre-eclampsia and antepartum hemorrhage. The competency level was only associated with knowledge of standards.<\/jats:p>","DOI":"10.3390\/nursrep16080266","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:32:13Z","timestamp":1785403933000},"page":"266","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Maternal Health Nurse Competency in Addressing Emergency Obstetric Care: An Assessment in Southern Mozambique"],"prefix":"10.3390","volume":"16","author":[{"given":"Janeth","family":"Dula","sequence":"first","affiliation":[{"name":"Health Systems Program, Instituto Nacional de Sa\u00fade, Estrada Nacional n\u00b01, Vila de Marracuene, Parcela 3943, Marracuene District, Maputo CEP 0205-02, Maputo Province, Mozambique"},{"name":"Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine, Universidade Nova de Lisboa, 1349-008 Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8296-212X","authenticated-orcid":false,"given":"S\u00f3nia","family":"Nhancale","sequence":"additional","affiliation":[{"name":"Health Systems Program, Instituto Nacional de Sa\u00fade, Estrada Nacional n\u00b01, Vila de Marracuene, Parcela 3943, Marracuene District, Maputo CEP 0205-02, Maputo Province, Mozambique"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7524-1592","authenticated-orcid":false,"given":"Laurentino","family":"Cumbi","sequence":"additional","affiliation":[{"name":"Health Systems Program, Instituto Nacional de Sa\u00fade, Estrada Nacional n\u00b01, Vila de Marracuene, Parcela 3943, Marracuene District, Maputo CEP 0205-02, Maputo Province, Mozambique"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0005-3968","authenticated-orcid":false,"given":"Orvalho","family":"Augusto","sequence":"additional","affiliation":[{"name":"Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98195, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7941-0285","authenticated-orcid":false,"given":"Maria do Ros\u00e1rio Oliveira","family":"Martins","sequence":"additional","affiliation":[{"name":"Global Health and Tropical Medicine (GHTM), Institute of Hygiene and Tropical Medicine, Universidade Nova de Lisboa, 1349-008 Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2498-9373","authenticated-orcid":false,"given":"S\u00e9rgio","family":"Chicumbe","sequence":"additional","affiliation":[{"name":"Health Systems Program, Instituto Nacional de Sa\u00fade, Estrada Nacional n\u00b01, Vila de Marracuene, Parcela 3943, Marracuene District, Maputo CEP 0205-02, Maputo Province, Mozambique"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e014556","DOI":"10.1136\/bmjgh-2023-014556","article-title":"Human resources for health: A framework synthesis to put health workers at the centre of healthcare","volume":"9","author":"Nwankwo","year":"2024","journal-title":"BMJ Glob. Health"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"O\u2019Sullivan, B.G., Couper, I., Kumar, P., and McGrail, M.R. (2021). Editorial: Effective Strategies to Develop Rural Health Workforce in Low and Middle-Income Countries (LMICs). Front. Public Health, 9.","DOI":"10.3389\/fpubh.2021.702362"},{"key":"ref_3","unstructured":"World Health Organization (2006). Neonatal and Perinatal Mortality: Country, Regional and Global Estimates, World Health Organization. Available online: https:\/\/apps.who.int\/iris\/handle\/10665\/43444."},{"key":"ref_4","unstructured":"World Health Organization (2016). WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience, World Health Organization. Available online: https:\/\/iris.who.int\/handle\/10665\/250796."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Shikuku, D.N., Mwaura, C., Nandikove, P., Uyara, A., Allott, H., Waweru, L., and Ameh, C. (2024). An evaluation of the effectiveness of an updated pre-service midwifery curriculum integrated with emergency obstetric and newborn care in Kenya: A cluster randomised controlled trial. BMC Med. Educ., 24.","DOI":"10.1186\/s12909-024-06581-x"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Moller, A.B., Newby, H., Hanson, C., Morgan, A., El Arifeen, S., Chou, D., and Moran, A.C. (2018). Measures matter: A scoping review of maternal and newborn indicators. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0204763"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"191","DOI":"10.5116\/ijme.5d9b.0c37","article-title":"Revisiting Miller\u2019s pyramid in medical education: The gap between traditional assessment and diagnostic reasoning","volume":"10","author":"Witheridge","year":"2019","journal-title":"Int. J. Med. Educ."},{"key":"ref_8","first-page":"534","article-title":"The assessment of medical competencies","volume":"217","year":"2017","journal-title":"Rev. Cl\u00edn. Esp. Engl. Ed."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"33362","DOI":"10.34172\/rdme.025.33362","article-title":"Competency-based medical education and anemia in pregnancy: A mixed-methods intervention study among medical students in India","volume":"14","author":"Bala","year":"2025","journal-title":"Res. Dev. Med. Educ."},{"key":"ref_10","first-page":"658","article-title":"Assessing the Impact of Simulation-Based Learning in Nursing Education: A Scoping Review","volume":"13","author":"Aldousari","year":"2025","journal-title":"Int. J. Healthc. Sci."},{"key":"ref_11","first-page":"2","article-title":"Midwives\u2019 Thoughts on Professional Proficiency and Competency: A Qualitative Study","volume":"15","author":"Uncu","year":"2025","journal-title":"Sa\u011fl\u0131k Bilim De\u011fer"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Sinz, E., Banerjee, A., Steadman, R., Shotwell, M.S., Slagle, J., McIvor, W.R., and Boulet, J.R. (2021). Reliability of simulation-based assessment for practicing physicians: Performance is context-specific. BMC Med. Educ., 21.","DOI":"10.1186\/s12909-021-02617-8"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1007\/S40037-017-0376-7","article-title":"Guidelines: The do\u2019s, don\u2019ts and don\u2019t knows of direct observation of clinical skills in medical education","volume":"6","author":"Kogan","year":"2017","journal-title":"Perspect. Med. Educ."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e057095","DOI":"10.1136\/bmjopen-2021-057095","article-title":"Development and use of research vignettes to collect qualitative data from healthcare professionals: A scoping review","volume":"12","author":"Tremblay","year":"2022","journal-title":"BMJ Open"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Payton, K.S.E., and Gould, J.B. (2022). Vignette Research Methodology: An Essential Tool for Quality Improvement Collaboratives. Healthcare, 11.","DOI":"10.3390\/healthcare11010007"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1016\/j.jval.2020.12.017","article-title":"Vignette-Based Utilities: Usefulness, Limitations, and Methodological Recommendations","volume":"24","author":"Matza","year":"2021","journal-title":"Value Health J. Int. Soc. Pharmacoecon. Outcomes Res."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Khan, A.N.S., Karim, F., Chowdhury, M.A.K., Zaka, N., Manu, A., Arifeen, S.E., and Billah, S.M. (2019). 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. Health Serv. Res.","DOI":"10.1136\/bmjopen-2018-028670"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e010963","DOI":"10.1136\/bmjopen-2015-010963","article-title":"Competence of health workers in emergency obstetric care: An assessment using clinical vignettes in Brong Ahafo region, Ghana","volume":"6","author":"Lohela","year":"2016","journal-title":"BMJ Open"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Yoon, J., and Son, H. (2021). Factors Associated with School Nurses\u2019 Triage Competency in South Korea. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18168279"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Abdu, H., Gebrselassie, M., Abdu, M., Mare, K.U., Tadesse, W., and Liben, M.L. (2019). Knowledge and practice of immediate newborn care among midwives and nurses in public health facilities of Afar regional state, Northeast Ethiopia. BMC Pregnancy Childbirth, 19.","DOI":"10.1186\/s12884-019-2581-3"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1186\/s12978-022-01376-z","article-title":"A descriptive, cross-sectional study of postpartum education: Midwives\u2019 self-reported knowledge and teaching of postpartum complications in Ghana","volume":"19","author":"Adams","year":"2022","journal-title":"Reprod. Health"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e003377","DOI":"10.1136\/bmjgh-2020-003377","article-title":"Analysis of clinical knowledge, absenteeism and availability of resources for maternal and child health: A cross-sectional quality of care study in 10 African countries","volume":"5","author":"Giorgio","year":"2020","journal-title":"BMJ Glob. Health"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1016\/j.midw.2014.12.002","article-title":"Evaluating midwife-led antenatal care: Choice, experience, effectiveness, and preparation for pregnancy","volume":"31","author":"Butler","year":"2015","journal-title":"Midwifery"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1002\/ijgo.13947","article-title":"Assessing provider performance of intrapartum care using simulated encounters and clinical vignettes: A comparison study from Tanzania","volume":"158","author":"Young","year":"2022","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_25","unstructured":"World Health Organization (2026, July 13). Increasing Access to Health Workers in Remote and Rural Areas Through Improved Retention, Increasing Access to Health Workers in Remote and Rural Areas Through Improved Retention: Global Policy Recommendations, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK138620\/."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"37","DOI":"10.4103\/0970-0218.199796","article-title":"Quality of Antenatal Care Provided by Nurse Midwives in an Urban Health Centre with Regard to Low-Risk Antenatal Mothers","volume":"42","author":"Pricilla","year":"2017","journal-title":"Indian J. Community Med."},{"key":"ref_27","unstructured":"Direc\u00e7\u00e3o Nacional de Recursos Humanos do MISA (2026, July 13). Plano Nacional de Desenvolvimento de Recursos Humanos para a Sa\u00fade 2016-2025, Available online: https:\/\/pt.scribd.com\/document\/473952171\/MISAU-PNDRH-2016-2025-final-pdf."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/s12960-023-00815-7","article-title":"Scrutinizing human resources for health availability and distribution in Mozambique between 2016 and 2020: A subnational descriptive longitudinal study","volume":"21","author":"Fernandes","year":"2023","journal-title":"Hum. Resour. Health"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Musie, M.R., Tagutanazvo, O.B., Sepeng, N.V., Mulaudzi, F.M., and Hlongwane, T. (2025). A scoping review on continuing professional development programs for midwives: Optimising management of obstetric emergencies and complications. BMC Med. Educ., 25.","DOI":"10.1186\/s12909-025-06830-7"},{"key":"ref_30","unstructured":"Instituto Nacional de Sa\u00fade, Organiza\u00e7\u00e3o Mundial de Sa\u00fade, and Minist\u00e9rio da Sa\u00fade (2026, July 13). Invent\u00e1rio Nacional sobre a Disponibilidade e Prontid\u00e3o de Infra-estruturas, Recursos e Servi\u00e7os de Sa\u00fade [Internet]. Maputo: Instituto Nacional de Sa\u00fade, Organiza\u00e7\u00e3o Mundial de Sa\u00fade e Minist\u00e9rio da Sa\u00fade, Available online: https:\/\/www.afro.who.int\/pt\/publications\/sara-2018-inventario-nacional."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Temane, A.M., Magagula, F.N., and Nolte, A.G.W. (2024). Midwives\u2019 lived experiences of caring for women with mobility disabilities during pregnancy, labour and puerperium in Eswatini: A qualitative study. BMC Women\u2019s Health, 24.","DOI":"10.1186\/s12905-024-03032-z"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"61","author":"Altman","year":"2008","journal-title":"J. Clin. Epidemiol."}],"container-title":["Nursing Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2039-4403\/16\/8\/266\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T07:01:25Z","timestamp":1785740485000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2039-4403\/16\/8\/266"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,30]]},"references-count":32,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["nursrep16080266"],"URL":"https:\/\/doi.org\/10.3390\/nursrep16080266","relation":{},"ISSN":["2039-4403"],"issn-type":[{"value":"2039-4403","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,30]]}}}