Primary health care centers (PHCCs) are important components of health deliv-ery systems providing basic health services at the community level. The Alma Ata Declaration in 1978, which prompted health for all by the year 2000, prompted the establishment of primary health care centers throughout Saudi Arabia.1 These primary health care centers provide a variety of health functions including maternal and child health services. The overall objective of health services has been to provide a wide range of comprehensive and integrated medical care to all people by utilizing appropriate technologies at reasonable and affordable cost. Training of PHC staff in Hail region is a part of a national program being conducted all over the Kingdom. This study evaluated the impact of training Primary Health Care (PHC) doctors, nurses and midwives, on MCH services at Hail region, Saudi Arabia.
SUBJECTS AND METHODS
Currently, there are 84 PHCCs at Hail region, KSA. Maternal and Child Health (MCH) training courses started at Hail during 1412H. The objective was to train all PHC staff or at least a physician and a nurse or a midwife, in each center, on MCH services. This objective was attained by the end of year 1414H corresponding to the year 1994G. Training was conducted in the form of lectures, group discussions and practical training at the main general hospitals in the region. Training subjects included conduction of normal labour, diagnosis and management of obstructed labour and obstetric emergencies, high risk approach in MCH, breast feeding, monitoring growth of children, treatment of diarrhea by ORS, and vaccination during infancy and preschool age. The duration of each course was 14 days.
Trainers included consultants in Obstetrics, Pediatrics and Community Medicine. They were selected and had a training course for training MCH services. Thirteen training courses were conducted. Each course was attended by a maximum of 10 doctors and 10 nurses. Trainees were grouped into two groups, one for each of the two main hospitals in Hail region, during the practical part of training.
Pre and post tests were conducted during each course to evaluate the improvement in knowledge of the trainers.
Collection of data about MCH services was done by using structured forms, pre tested and distributed at the end of each year to all PHCCs. These forms were collected, data were encoded into the computer and analyzed by using SPSS for Windows statistical package.
Table 1, shows coverage of PHC staff by training. The objective of training a doctor and a nurse or a midwife was attained by the end of the year 1414H, corresponding to the year 1994G. Table 2 shows increasing percentages of deliveries conducted under medical supervision, mainly at hospitals. This is associated with a significant reduction in deliveries conducted at home without medical supervision. However, the percentage of deliveries conducted at PHCCs did not change. Table 3 shows a slight increase in Caesarean Section (CS) deliveries.
Table 4 describes the pregnancy outcome before and after training. Slight reduction in percentage of still births was noticed during the year 1415H. This was associated with a slight increase of neonatal deaths during the first week, however the perinatal mortality rate was slightly reduced. Table 5 shows increased frequencies of risk factors discovered among those registered at PHCCs during the year 1415H. Table 6 shows insignificant rise in percentage of breast fed infants. However, significant increase in risk factors discovered among children registered at well baby clinics were found (Table 7).
MCH service is considered as the most important element among PHC elements. This is due to the provision of health services to the vulnerable groups (mothers and children). The latter constitute 70% of the population. Also MCH services include other important elements of PHC, namely immunization, health education and nutrition. The utilization of MCH services is governed by a number of forces, including sociodemographic parameters, culture, state of pregnancy, and the psychology of pregnant women.3–8 Similarly, the attitudes of personnel attached to PHCCs and overall services, including the educational aspects of the antenatal checkups to pregnant women during visits to the health centers also affect the utilization of MCH services.1
As far as we know, this is the first study to evaluate the impact of training PHC staff on MCH services in Saudi Arabia. Improvement in the knowledge of the trainees was marked. Also intellectual skills, e.g., using growth charts were markedly improved. However, because of the short duration of the courses, manual skills, particularly management of normal labour was not improved significantly.
These results were reflected upon MCH services provided by the PHCCs. So increased frequencies of risk factors discovered among registered pregnant mothers and children was evident. This in turn increased referral and increased the percentages of hospital deliveries, however, deliveries at PHCCs were not increased partly due to insignificant improvement in the skills of the trainees, and partly due to insignificant change in their negative attitude toward conduction of normal deliveries at PHCCs. Improvement in discovery of more risk factors among pregnant mothers was reflected by increase in the percentage of C.S. deliveries and reduction of instrumental deliveries. Also discovery of more risk factors predisposed to reduction of still births, and perinatal mortality rate in Hail region. Improvement in using the growth curves, was reflected by increased frequency of children weighed < 80% of their weight discovered at PHCCs.
Improvement of knowledge of the staff about breast feeding was not reflected by increase in percentage of breast fed children. Increased efforts for health education about breast feeding at PHCCs, combined with supporting the implementat-ion of WHO/UNICEF program (baby friendly hospitals) is needed.
Improved utilization in MCH services, in Al-Qassim region, Saudi Arabia, during the years 1987-1992, was attributed to improved awareness of people about MCH services. However, the impact of imple-menting the same program of training MCH staff, in this region, was not considered.1 Increased awareness alone could not be the main cause of improved utilization of MCH at Hail during the short period of the study.
In conclusion, training of PHC staff had a positive impact on maternal health services in Hail region. However more time must be allowed to the practical part of training at the hospitals to give more chance for improving the manual skills of PHC staff, especially for diagnosis and management of labour and obstetric emergencies.
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