Association of Workload and Practice of Respectful Maternity Care Among the Healthcare Providers, Before and During the COVID-19 Pandemic in South Western Nepal: A Cross-Sectional Study

  1. Alpha Pokharel
  2. Junko Kiriya
  3. Akira Shibanuma
  4. Ram Silwal
  5. Masamine Jimba

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Abstract

Introduction

Respectful maternity care is an approach that involves respecting women’s belief, choices, emotions, and dignity during the childbirth process. As the workload among maternity care workforce affects intrapartum quality care, respectful maternity care might have also been affected, particularly during the pandemic. Thus, this study was conducted to examine the association between workload among healthcare providers and their practice of respectful maternity care, before and during the pandemic.

Methods

A cross-sectional study was conducted in South Western Nepal. A total of 267 healthcare providers from 78 birthing centers were included. Data collection was done through telephone interviews. The exposure variable was workload among the healthcare providers, and the outcome variable was respectful maternity care practice before and during the COVID-19 pandemic. Multilevel mixed-effect linear regression was used to examine the association.

Results

The median client-provider ratio before and during the pandemic was 21.7 and 13.0, respectively. The mean score of respectful maternity care practice was 44.5 (SD 3.8) before the pandemic, which was decreased to 43.6 (SD 4.5) during the pandemic. Client-provider ratio was negatively associated with respectful maternity care practice for both times; before (Coef. −5.16; 95% CI −8.41 to −1.91) and during (Coef. −7.47; 95% CI −12.72 to −2.23) the pandemic.

Conclusions

While a higher client-provider was associated with a lower respectful maternity care practice score both before and during the COVID-19 pandemic, the coefficient was larger during the pandemic. Therefore, workload among the healthcare providers should be considered before the implementation of respectful maternity care, and more attention should be given during the pandemic.

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  1. ScreenIT

    SciScore for 10.1101/2022.02.21.22271309: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsConsent: The healthcare providers were contacted beforehand for verbal consent and data collection schedule.
    IRB: Research ethics: An ethics approval was obtained from the Research Ethics Committee, Graduate School of Medicine, the University of Tokyo, Japan (serial number: 2020101NI), and Nepal Health Research Council, Nepal (ERB protocol registration number: 524/2020 MT).
    Sex as a biological variablenot detected.
    RandomizationA two-level, mixed-effect linear regression analysis was performed with a random intercept at the health facility level.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Converting the Nepalese calendar to the Gregorian calendar, the two periods for calculating the client-provider ratio were: July/August 2019 to January/February 2020 (before COVID-19 pandemic declaration) and February/March 2020 to June/July 2020 (after COVID-19 pandemic declaration) (28).
    July/August
    suggested: None

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and weaknesses: This study has several strengths. It is one of the first on healthcare providers’ workload and its association with respectful maternity care during the COVID-19 pandemic. As this study included all the health facilities in the study area, it provides an overview of all levels of health facilities and all the cadre of healthcare providers in Nepal. It also has several limitations. The respectful maternity care practice was affected by social desirability bias. In order to overcome it, assurance of anonymity and confidentiality was provided. Also, the healthcare providers were well explained about the objectives of the study and its possible impact on the scientific literatures. The data related to respectful maternity care practice before the pandemic depended on the healthcare provider’s memory, which might have introduced a measurement error in the outcome assessment. Since the COVID-19 pandemic occurred during the data collection, the researcher had to rely on the self-reporting data for before the pandemic period. The visual rating of the NASA TXL scale was changed to auditory description, as the data collection was done through telephone for the prevention of spread of COVID-19 infection. The change of scale from visual to auditory could have caused over-reporting or under-reporting of the workload. This could be the reason why it did not show strong evidence for the association with the respectful maternity care practice (44).

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  2. Version published to 10.1101/2022.02.21.22271309v1 on medRxiv