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Table 4 Main findings and recommendations of the CoP implementation research projects. Mexico and Nicaragua, 2013–2015

From: Evaluation of Communities of Practice performance developing implementation research to enhance maternal health decision-making in Mexico and Nicaragua

Community of practice Main findings Main recommendations
Chontales Almost 50% of the personnel is unaware of the need to measure the nutritional level based on maternal weight increase Organize workshops to strengthen the personnel’s knowledge on this subject
Most health units have all necessary equipment but 65% of them lack pinard stethoscopes Assure all health units have these stethoscopes as the pregnant women healthcare norms demand to do
Regarding laboratory inputs over 90% of the health units lack such tests as rapid plasma reagase, HIV, and toxotest Regularly check for laboratory inputs in relation to geographical localization of health units
The main pregnancy alarm signs explained during prenatal consultations were bleeding, headache and abortion Review the pregnancy alarm signs presented to women to include counseling on edema, particularly in rural communities
Hidalgo Only 35% of the analyzed medical records satisfactorily comply with the registration of at least 80% of the required information Develop sensitization activities for prenatal healthcare personnel on the importance of correctly filling in medical records; regularly supervise prenatal care medical records and offer support to the personnel to improve them
Over 60% of the evaluated personnel responsible for antenatal care do not know how to face obstetric emergencies Train all personnel on essential actions to face obstetric emergencies and draw flowcharts of these actions to strengthen training
53% of the personnel consider that the norm requires updating Organize workshops and meetings with experts to generate evidence and promote the norm’s updating at the national level
Matagalpa 1 Over 50% of the personnel knows the risk classification according to the norms but cannot distinguish potential from real risks; only 23% recognize low risk Knowledge of pregnancy risk factors must be improved to include clear concepts’ classification and how to handle them properly
Clinical records show deficient noting of information, particularly for proteinuria (74%), Streptococcus B (67%), multiple antecedents (69%), last registered weight (71%), toxoplasmosis (75%), fetal heart rhythm, and others Health personnel must be regularly trained and assessed to guarantee the correct use and filling in of clinical records from the very first antenatal care consultation
Deficient coordination between primary care and the other levels; 53% of the patients were not correctly referred to another level Promote good coordination between the different levels of care to assure the quality of maternal healthcare.
There is no plan for risk management, nor specific actions for the personnel to implement the risk identification strategy other than the census of pregnant women A special sheet must be included to note the main actions of risk management for each pregnant woman
Matagalpa 2 Among pregnant women 37% do not understand the concept and advantages of the Plan Parto and 28% do not recognize its importance Organize information workshops on the Plan Parto in communities according to the educational level of the population
78% of the community leaders understand the concept of the Plan Parto, but around 45% do not recognize its advantages and importance Train community leaders and midwives to assure they have better knowledge of the Plan Parto and can thus help the community
Almost 90% of the community leaders say there are no transport brigades for the pregnant women Work with the municipality and the community to create transport brigades for the zone taking turns to support women suffering pregnancy risks
Morelos 46% of the interviewed pregnant beneficiaries of Oportunidades do not thoroughly identify pregnancy alarm signs, while only 50% correctly recognize the need to look for medical assistance when these signs are present Use all available means to improve the quality of the Self-healthcare workshops
Make sure that complete information on pregnancy alarm signs and the Security Plan are provided in all medical visits, nursery or health promotion interventions
Periodically assess and strengthen pregnant women’s knowledge on alarm signs and the Security Plan
There is general consensus on the lack of adequate physical spaces and didactic material for the self-healthcare workshops Create, adapt, or simply assign the appropriate places for workshops
Guarantee the availability of all necessary didactic material
Non-beneficiaries of Oportunidades pregnant women in a control group show worse knowledge of pregnancy alarm signs than beneficiaries Accept and promote the participation in the self-healthcare workshops of all women attending prenatal control visits in the health centers