Determinants of nurse-midwives’ compliance with delayed cord clamping in primary and secondary health facilities, Tanga Region: A cross-sectional study

Abstract

BACKGROUND: Delayed Cord Clamping (DCC) is a proven intervention that improves both maternal and newborn outcome. However, adherence to DCC remains low, and its determinants are not yet well understood.Therefore, this study aimed to assess the level of compliance with DCC and its determinants among nurse-midwives working in primary and secondary health facilities in the Tanga Region. METHODS: The study employed a quantitative approach with a cross-sectional study design, conducted from 5th April, 2024-15th May, 2024. The multistage, clustered sampling design was employed to select both health facilities and study participants. The observation checklist and structured questionnaire, adapted from previous studies, were both used as data collection tools. A multivariable binary logistic regression model was used to assess the determinants of DDC compliance. The final results were reported using adjusted odds ratios (aORs) with their 95% confidence intervals (CI) and a significance level of p < 0.05. The data were analyzed using IBM-SPSS V. 27 software. RESULTS: Only 30.6% of nurse-midwives were found to comply with DCC. The levels of DCC compliance among nurse-midwives were statistically significantly associated with a higher level of nurse-midwives' education (aOR=12.26, 95% CI: 2.95-50.88), exposure to DCC-related training (aOR=5.88, 95%CI: 2.02-13.14), and availability of DCC guidelines (aOR=3.417, 95% CI: 1.331-8.768). Additionally, those who conducted 1-2 deliveries per shift (aOR=3.99, 95%CI: 1.57-10.14), and the nurse-midwives with adequate knowledge on DCC (AOR = 7.64, 95% CI: 3.04-19.17) were also found to be significantly associated with increased Odds of compliance to DCC. CONCLUSION: The study revealed that adequate DCC training, availability of DCC guidelines, and sufficient staffing levels per shift significantly influence nurse-midwives' compliance with delayed cord clamping. Therefore, the government should prioritize institutionalizing regular DCC training, standardizing and disseminating updated guidelines nationwide, and investing in optimal staffing levels across primary and secondary health facilities to enhance compliance and improve maternal-newborn outcomes.