Maternal Health Nurse Competency in Addressing Emergency Obstetric Care: An Assessment in Southern Mozambique

Background: Quality perinatal health care depends considerably on health workforce competency. Improving Maternal and Child Health Nurse (MCHN) competency is urgently needed in low-middle-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 "good" vs. reference "poor" competency; 95% CI: 1.07; 4.57, p < 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.