Effect of clinicians training on their knowledge of abortion and post abortion care in six hospitals in Rwanda

Abstract Introduction: Complications of unsafe abortion are public health issue and account for 13% of maternal mortalities globally. Maternal mortality in Rwanda remains high at 203/100,000 live births. Prevalence of unintended pregnancy in Rwanda is estimated at 12% ,abortion related complications are estimated at 10.7 per 1,000 and abortion related maternal mortality remains high (8%). Clinicians need to be empowered (through in-service training among other interventions) so as to deliver reproductive health services including abortion and post abortion care with confidence. To the best of our knowledge, no study has been conducted in Rwanda about effect of clinicians training on their knowledge of abortion and post abortion care services, including current Rwandan law Objective: This study aimed to assess the effect of training medical doctors on their knowledge of abortion and post-abortion care in Rwanda. Methodology: A quasi- experimental design was used. Investigators trained clinicians from six hospitals in Rwanda on abortion and post abortion care using updated national guidelines and the WHO Safe Abortion Care Guideline. Clinicians were trained in three hour-long sessions over three months including lecture and self-learning using shared guidelines books during this period. A pre- and post-test was implemented. Training sessions were conducted online and every participant attended using shared Google meet link. Online trainings were conducted in evening hours after work to maximize attendance. In total 4 training sessions were held. Training sessions were conducted by national trainers, obstetricians, gynecologist and consultants in forensic medicine with experience in training on abortion law in Rwanda, safe abortion and post abortion care. Training was theoretical only. All participants completed a pre- and 3 months post-test assessment of knowledge of abortion and post abortion care. Marks below 60% were considered low, 61% to 79% were considered good and 80% and above were considered excellent. We compared pretest and post-test scores using paired t-test, P-value < 0.05 was considered statistically significant. Results: Thirty medical doctors from district and referral hospitals were trained. There was an increase in marks between pre- and post- test. This increase was statistically significant among trainees from three district hospitals with p values 0.046 and p value <0.001, p<0.001 respectively. This increase was statistically significant among both gender groups of participants with p value of 0.005 and 0.001 for male and female trainees respectively. There was no statistically increase in marks for trainees in teaching hospitals (p value=0.168). Conclusion and recommendations: We found a statistical increase in marks comparing pre and post-test scores for clinicians attending district hospitals. This increase was observed in both male and female trainees. Future training should target primarily district hospitals. To ensure patient outcomes, the Ministry of Health needs to keep providing continuous training on abortion and post abortion care to clinicians attending non-teaching district hospitals. More studies are also needed to assess practical skills among medical doctors attending teaching and non-teaching district hospitals for management of patient with abortion and post abortion care provision.