Section (1):-health care providers Table (1):- Distribution of doctors in the labor room and pediatric section in the study according to gender and category

Doctors in pediatric sectionDoctors in labor roomItem %Number %Number

Gender 40.2%4354.5%55Males 59.8%6445.5%46Females 100.0107100.0101Total

Category 28.0%3029.7%30Consultant50.5%5460.4%61Registrar21.5%239.9%10Medical100.0107100.0101Total

In the labor room male doctors (54.5%) are more than females (45.5%). In the pediatric section females (59.8%) are more than males .

Table (1-2):- Provides Information about Training Courses in Neonatal Resuscitation Programmed (NRP) and Years of Experience

Midwives Sisters Doctors in Ped .Doctors in LRItem %Number %Number %Number %Number

Training courses in NRP taken 663110.6512.11316.8%17During Formal Training:

Undergraduate--17.1844.94845.5%46After Graduation341672.33443.04637.6%38No Training1004710047100107100.0101Total

The Number of NRP Courses Attended35.51120.0161.5876.5131 Course32.21040.027.7117.632 Courses19.4620.017.715.913 Courses6.5220.017.71--4 Courses

Total Last Course Attended

20.0123.1341.271 Year Ago

20.0123.1323.542 Years Ago--23.1311.823 Years Ago60.030.8423.54More than 3 Years

Total Years of Experience After Graduation

6.4385.44143.44641.041Less than 5 Years25.51212.5638.74112.5435 – 10 Years25.5122.10111.3128.0810 – 15 Years42.620--6.668.08More than 15 Years

Total

Most of the training for doctors in labour room (45.5%) and doctors in paediatrics (44.9%) occurred after graduation, while most sisters and midwives had no training. Most of the training courses taken by the staff were one course and the last course being one year to 3 years ago.

Knowledge of midwives

Overall knowledge of midwives

The mean level of knowledge = 48.9 SD= 20.1

Minimum = 12.2 Maximum = 95.9

Knowledge about infection control

Poor (less than 25) 1 2.1

Less than average (25 – 50) 4 8.5

Above average (50 – 75) 2 4.3

High ( more than 75) 40 85.1

Total 47 100.0

Knowledge about follow up fetus and help neonate

Poor (less than 25) 8 17.0

Less than average (25 – 50) 17 36.2

Above average (50 – 75) 17 36.2

High ( more than 75) 5 10.6

Total 47 100.0

Overall knowledge about infection control, follow up for fetus and sick neonate management among midwives

infection control follow up for fetus sick neonate managementMean 90.7801 45.7447 50.4965

Std. deviation 23.77646 19.86205 12.25689

Minimum .00 10.87 20.00

Maximum 100.00 95.65 66.67

Overall knowledge of midwives (in groups of knowledge)

Level of knowledge Number %Poor (less than 25) 6 12.8Less than average (25 – 50) 18 38.3Above average (50 – 75) 17 36.2High ( more than 75) 6 12.8Total 47 100.0

Relationship between overall knowledge of midwives and type of job

Type of jobHealth visitor Nurse midwife Sister

Poor (less than 25) 33.3% 66.7% .0%Less than average (25 – 50) 50.0% 50.0% .0%Above average (50 – 75) 23.5% 76.5% .0%High ( more than 75) 16.7% 66.7% 16.7%Chi-Square = 10.245 p value = .115

There was no significant relationship between overall knowledge of midwives and type of job

Relationship between overall knowledge of midwives and years of experience

Years of experience Less than 5 5 - 10 11 – 15 More than 15

Poor (less than 25) .0% 50.0% 16.7% 33.3%Less than average (25 – 50) .0% 22.2% 27.8% 50.0%Above average (50 – 75) 11.8% 17.6% 23.5% 47.1%High ( more than 75) 16.7% 33.3% 33.3% 16.7%Chi-Square = 7.109 p= .626

There was no significant relationship between overall knowledge of midwives and years of experience

Relationship between overall knowledge of midwives and having training courses

Having training coursesYes No

Poor (less than 25) 83.3% 16.7%Less than average (25 – 50) 44.4% 55.6%Above average (50 – 75) 76.5% 23.5%High ( more than 75) 83.3% 16.7%

Chi-Square = 6.161 p value = .104

There was no significant relationship between overall knowledge of midwives and having training courses

Knowledge of sisters

Knowledge about infection control Grades of knowledge Number %Poor (less than 25) 13 27.1Less than average (25 – 50) 20 41.7Above average (50 – 75) 14 29.2Missing 1 2.1Total 48 100.0

Sick neonate management

Grades of knowledge Number %Poor (less than 25) 2 4.2Less than average (25 – 50) 13 27.1Above average (50 – 75) 32 66.7Missing 1 2.1Total 48 100.0

Over all knowledge Grades of knowledge Number %Poor (less than 25) 4 8.3Less than average (25 – 50) 23 47.9Above average (50 – 75) 20 41.7Missing 1 2.1Total 48 100.0

Overall ideal attitude

Grades of knowledge Number %Poor (less than 25) 11 22.9Less than average (25 – 50) 36 75.0Above average (50 – 75) 1 2.1Total 48 100.0

Relationship between overall ideal attitudes and over all knowledgeover all ideal attitude over all knowledge

Less than 25 25 - 50 50 - 75 Poor (less than 25) 9.1% 45.5% 45.5%Less than average (25 – 50) 8.6% 51.4% 40.0%Above average (50 – 75) .0% .0% 100.0%

Chi-Square= 1.502 p value = .826

There was no significant relationship between overall ideal attitudes and over all knowledge

Knowledge of Doctor in pediatric

Statistics Infection Sick neonate managenMean 20.3774 53.7107Std. Deviation 19.51432 22.28873Minimum .00 .00Maximum 60.00 100.00

Knowledge about infection control Grades of knowledge Number %Poor (less than 25) 67 62.6Less than average (25 – 50) 33 30.8Above average (50 – 75) 6 5.6Missing 1 .9Total 107 100.0

Sick neonate management

Grades of knowledge Number %Poor (less than 25) 11 10.3Less than average (25 – 50) 19 17.8Above average (50 – 75) 65 60.7Missing 1 .9Total 107 100.0

Over all knowledge Grades of knowledge Number %Poor (less than 25) 13 12.1Less than average (25 – 50) 37 34.6Above average (50 – 75) 46 43.0Missing 1 .9Total 107 100.0

Overall ideal attitude

Grades Number %Poor (less than 25) 57 53.3Less than average (25 – 50) 49 45.8Above average (50 – 75) 1 .9Total 107 100.0

Relationship between overall ideal attitudes and over all knowledgeover all ideal attitude over all knowledge

Less than 25 25 - 50 50 - 75 Higher than 75Poor (less than 25) 16.1% 32.1% 44.6% 7.1%

Less than average (25 – 50) 8.2% 36.7% 42.9%

12.2%

Above average (50 – 75) .0% 100.0% .0% .0%

Chi-Square= 4.113 p value = .661

There was no significant relationship between overall ideal attitudes and over all knowledge

Knowledge of Doctor in labour room

Knowledge about infection control Grades of knowledge Number %Poor (less than 25) 33 32.7Less than average (25 – 50) 32 31.7Above average (50 – 75) 30 29.7Higher than 75 3 3.0Missing 3 3.0Total 101 100.0

Knowledge about how to follow up the fetusGrades of knowledge Number %Poor (less than 25) 5 5.0Less than average (25 – 50) 3 3.0Above average (50 – 75) 85 84.2Higher than 75 5 5.0Missing 3 3.0Total 101 100.0

Knowledge about how to help neonate

Grades of knowledge Number %Poor (less than 25) 20 19.8Less than average (25 – 50) 8 7.9Above average (50 – 75) 66 65.3Higher than 75 4 4.0Missing 3 3.0Total 101 100.0

Over all knowledge

Grades of knowledge Number %Poor (less than 25) 11 10.9Less than average (25 – 50) 35 34.7Above average (50 – 75) 48 47.5Higher than 75 4 4.0Missing 3 3.0Total 101 100.0

Over all ideal attitude

Grades Number %Poor (less than 25) 47 46.5Less than average (25 – 50) 52 51.5Above average (50 – 75) 2 2.0Total 101 100.0

Relationship between overall ideal attitudes and over all knowledgeover all ideal attitude over all knowledge

Less than 25 25 - 50 50 - 75 Higher than 75Poor (less than 25) 15.2% 28.3% 50.0% 6.5%Less than average (25 – 50) 8.0% 44.0% 46.0% 2.0%

Above average (50 – 75) .0% .0% 100.0% .0%

Chi-Square= 6.179 p value = .403

Knowledge about guidelines among care providers

Care provider Mean SD Minimum MaximumSisters 77.6042 39.69283 .00 100.00doctors in labor room 56.4356 41.02643 .00 100.00doctors in pediatric section 49.2991 44.30516 .00 100.00

Section (2): Availability of resources, infrastructures and instrumentsPresence of intensive care unit and neonatal care unit in the hospital (n=15)Presence intensive care unit neonatal care unit

Number % Number %Yes 7 46.7 14 93.3No 8 53.3 1 6.7Total 15 100 15 100

Intensive care unit is present in46.7% of the hospitals, while the neonatal care unit is present in 93.3%

Different types of neonatal care units that are present in the hospitals studied

Different types Number %Preterm section 5 33.3Term 4 26.7Septic 6 46.7Total 15 100

Position of the neonatal care unit (Nursery) in the hospitalPosition Number %Near to delivery 9 60.0Far away from delivery room 1 6.7No connection with 1 6.7accessory area for sterillization 11 73.3accessory room for mpthers feeding 10 66.7accessory recreative rooms for staff 10 66.7

Availability of electricity, water and controlled environment in the hospitals studied

Items Yes available (No.)

%

electricity continuously 13 86.7back-up power supply in the case of a power cut 14 93.3running water continuously available 13 86.7controlled environment 11 73.3

Availability of infrastructures related to delivery room (n= 15)

infrastructures related to delivery room No. %Presence of a theatre 12 80.0Presence of delivery room 12 80.0Availability of electricity 10 66.7Backup power supply 13 86.7Availability of continuous running water 11 73.3Presence of a controlled environment 10 66.7

Laboratory Support

Lab Support Frequency (%)BLOOD GLUCOSE 15 (100%)HAEMOGLOBIN 15 (100%)HEAMATOCRIT 15 (100%)IMMATURE TO TOTAL NEUTROPHIL RATIO

13 (86.7%)

FULL BLOOD COUNT 15 (100%)LEUKOCYTES COUNT 15 (100%)BLOOD GASES ANALYSIS 6 (40%)BLOOD GROUPING AND CROSS MATCH

15 (100%)

BLOOD BILIRUBIN 15 (100%)RHESUS ANTIBODIES 15 (100%)URINE PROTINE 15 (100%)

URINE MICROSCOPY 15 (100%)BACTERIOLOGY - CLUTURE 12 (80%)BACTERIOSCOPY -SMEAR- 10 (71.4%)COAGULATION TESTS 12 (80%)LIVER FUNCTION 15 (100%)RENAL FUNCTION TESTS 15 (100%)ELECTROOLYTES 14 (93.3%)HIV TEST 15 (100%)COOMBS TEST DIRECT AND INDIRECT 13 (92.9%)MAJOR BLOOD GROUPS AND RH TYPING

14 (100%)

SERUM PROTIEN AND ALBUMIN 14 (100%)URINALYSIS 13 (92.9%)SEROLIGIC TEST FOR SYPHILIS 13 (92.9%)

Table (2-2):-

Delivery and Newborn Tests Frequency (%)ARE MICRO-SAMPLING METHODS FOR GLYCAEMIA, BILIRUBINEMA, HB AVAILABLE FOR NEW-BORN BABIES?

10 (66.7%)

ESSENTIAL TEST FOR DELIVERY AND NEWBORN CARE ARE FREE FORM CHARGE?

13 (86.7%)

):- Drugs Supply

Table (3-1):- Antibiotics, antiviral and antifungal Drugs

Drug Frequency (%)

ACYCLOVIR 9 (60.0%)AMIKACIN 7 (46.7%)AMPHOTERICIN B 6 (40.0%)AMPCILIN 9 (60.0%)CEFOTAXIME 12 (80.0%)CEFOTAZIDIME 12 (80.8%)CEFRIAXONE 13 (86.7%)

ERYTHROMYCINE 14 (93.3%)FLUCONAZOL 10 (66.7%)GENTAMICIN 15 (100.0%)METRONIDZOL 15 (100.0%)NTILMICIN 5 (33.3%)VANCOMICYN 11 (73.3%)

Table (3-2):- Cardiovascular Drugs

Drug Frequency (%)

ALPROSTADIL 7 (46.7%)ADENOSINE 6 (40.0%)CAPTOPRIL 10 (66.7%)DIGOXIN 11 (73.3%)DOBUTAMIN 8 (53.3%)DOPAMINE 14 (93.3%)ENOXAPARIN 7 (46.7%)EPINEPHRINE 13 (86.7%)FLECAINIDE 7 (46.7%)IBUPROFEN LYSIB\NE

10 (66.7%)

INDOMETHACIN 6 (40.0%)LIDOCAINE OR ANTIARRHYTHMIC

12 (80.0%)

PROPAOLOLO 11 (73.3%)

Table (3-3):- Central Nerves System Drugs

Drug Frequency (%)

CHLORAL HYDRATE

2 (13.3%)

FENTANY 1 2 (13.3%)MIDAZOLAM 6 (40.0%)MORPHINE 10 (66.7%)NALOXONE 8 (53.3%)PHENOBRABITAL 11 (73.3%)PHENYTOIN 14 (93.3%)

Table (3-4):- Diuretics

Name Frequency (%)FUROSEMIDE 15 (100.0%)HYDROCHLOOROTHIAZIDE

9 (60.0%)

SPIRONOLACTONE 11 (73.3%)

Table (3-5):- Respiratory Drugs

Drug Frequency (%)AMINOPHLLINE 15 (100.0%)CAFFIENE 4 (26.7%)DEXAMETHASONE 14 (93.3%)SURFACATANTS 7 (46.7%)

Table (3-6):- Miscellaneous Drugs

Drug Frequency (%)G-GLOULINE PROTOCL

4 (26.7%)

HYDROCORTISONE

11 (73.3%)

INSULINE 14 (93.3%)ISTONIC CRYSTALLOID

14 (93.3%)

Table (3-7):- Vitamins and Minerals

Drug FrequencyCALCIUM 13 (86.7%)CLACIUM GLUCONTE

13 (86.7%)

FERROUS SULFFATE

13 (86.7%)

POTASSIUM 14 (93.3%)SODIUM CHLORIDE

14 (93.3%)

VITAMIN K 13 (86.7%)

.

Equipments -1-

Table (4-1):- Illustrate the present of essential equipments in labour room and nursery

Nursery (%)Labour Room (%)14 (100%)11 (91.7%)Adequate lighting 10 (71.4%)8 (66.7%)Wall clock13 (92.9%)9 (75.0%)Towels for drying newborn13 (92.9%)9 (75.0%)Normal Thermometer13 (92.9%)12(100%)Low reading thermometer 12 (85.7%)9 (75.0%)Weight Scale for Newborns 10 (71.4%)6 (50.0%)Radiant Warmer13 (92.9%)7 (58.3%)Phototherapy Lamps14 (100%)0%Incubator4 (28.6%)2 (16.7%)CPAP Systems5 (35.7%)1 (8.3%)Mechanical ventilator12 (85.7%)6 (50.0%)Saturometer/Pulse-Oximeter13(92.9%)4 (33.3%)Glucometer3 (21.4%)1(8.3%)Transport Incubator with Ventilation System

Table (4-2):- Illustrate the present of guidelines in labour room and nursery

Nursery (%)Labour Room (%)6 (42.9%)4 (33.3%)Infection Control Guidelines6 (42.9%)2 (16.7%)Guidelines for Management of Pre-Term Neonate7 (50.0%)6 (50.0%)Guidelines for Resuscitation and Care of the Newborn7 (50.0 %)2 (16.7%)Guidelines for Management of Sick Newborn7 (50.0%)3 (25.0%)Guidelines for Management of Low Birth Weight

Table (4-3):- ):- Illustrate the present of equipments of oxygen supply in labour room and nursery

Nursery (%)Labour Room (%)

13 (92.9%)10 (82.3%)Oxygen source: Oxygen Cylinder6 (42.9%)4 (33.3%)Oxygen Source: Oxygen Concentrator

6 (42.9%)3 (25.0%)Oxygen Source: Oxygen Central Supply

8 (57.1%)5 (41.7%)Flow Meters for Oxygen13 (92.9%)9 (75.0%)Equipment for the Administration of Oxygen Nasal Prong

8 (57.1%)6 (50.0%)Equipment for the Administration of Oxygen Catheters

9 (64.3%)7 (58.3%)Equipment for the Administration of Oxygen Masks

12 (85.7%)6 (50.0%)Medical Air Centralized

Table (4-4):- Illustrate the present of essential infection control equipment and supply in labour room and nursery

Nursery (%)Labour Room (%)13 (92.9%)11 (91.7%)Sterilization14 (100%)11 (91.7%)Sterile Gauze13 (92.9%)8 (66.7%)Infusion Sets

14 (100%)10 (83.3%)Syringes13 (92.9%)9 (75.0%)Suturing Set14 (100%)11 (91.7%)Sterile Gloves13 (92.9%)10 (83.3%)Station for hand washing

Table (4-5):- Illustrate the present of other equipment and material in labour room and nursery

Nursery (%)Labour Room (%)0%9 (75.0%)Cord Cutting/Cord Clamping Set0%11 (91.7%)Vacuum Extractor Venture0%11 (91.7%)Forceps0%9 (75.0%)Delivery beds11 (78.6%)10 (83.3%)Suction Device10 (71.4%)10 (83.3%)Face Masks9 (64.3%)10 (83.3%)Resuscitation Bags 9 (64.3%)9 (75.0%)Breathing Valves8 (57.1%)3 (25.0%)Tracheal Tubes6 (42.9%)3 (16.7%)Laryngoscope with Tow Blades8 (57.1%)5 (41.7%)Oropharyngeal Airways10 (71.4%)9 (75.0%)Sphygmomanometer0%8 (66.7%)Foetal Stethoscope

Equipment -2-

Presence of labour rooms and nurseries

Frequency Percentlabour room 12 46.2nursery 14 53.8 Total 26 100.0

Labor rooms n = 12, nurseries n= 14

):- Illustrate the present of essential equipments in labour room and nursery

Item labor room nurseryavailable no. available % available no. available %

adequate lighting 11 91.7 14 100.0refrigerator with thermometer 7 58.3 12 85.7wall thermometer 6 50.0 9 64.3wall clock 8 66.7 10 71.4heat source 8 66.7 13 92.9towels for drying newborn 9 75.0 13 92.9heating lamp for neonates 9 75.0 13 92.9station for hand washing 10 83.3 13 92.9disposal container for sharps only 11 91.7 13 92.9normal thermometer 9 75.0 13 92.9weight scale for new born 9 75.0 12 85.7sphygmomanometer 9 75.0 10 71.4fetal stethoscope 8 66.7 0 0phototherapy lamp 8 66.7 14 100.0

Illustrate the present of guidelines in labour room and nursery

Items labor room nurseryavailable no.

available % available no. available %

infection control guidelines 4 33.3 6 42.9guidelines for management of pre-term neonate 2 16.7 6 42.9

guidelines for resuscitation and care of the newborn 6 50.0 7 50.0

guidelines for management of low birth 3 25.0 7 50.0guidelines for management of sick newborn 2 16.7 7 50.0

Illustrate the present of equipments of oxygen supply in labour room and nursery

Items labor room nurseryavailable no. available % available no. available %

oxygen source ,oxygen cylinder 10 83.3 13 92.9oxygen source ,oxygen concentrator 4 33.3 6 42.9oxygen source ,oxygen central supply 3 25.0 6 42.9flow meters for oxygen 5 41.7 8 57.1equipment for the administration of oxygen nasal prong 9 75.0 13 92.9

equipment for the administration of oxygen catheters 6 50.0 8 57.1

equipment for the administration of oxygen masks 7 58.3 9 64.3

Illustrate the present of essential infection control equipment and supply in labour room and nursery

Items labor room nurseryavailable no. available

%available no. available %

sterilization 11 91.7 13 92.9sterile gauze 11 91.7 14 100.0infusion sets 8 66.7 13 92.9infusion pumps/dosimeter 8 66.7 13 92.9iv catheters 9 75.0 12 85.7syringes 10 83.3 14 100.0needles 10 83.3 14 100.0suturing set 9 75.0 13 92.9sterile gloves 11 91.7 14 100.0

resterilized gloves 2 16.7 3 21.4disposable gloves 10 83.3 14 100.0sturing material 10 83.3 8 57.1catgut 8 66.7 7 50.0synthetic absorbable 9 75.0 8 57.1non absorbable 10 83.3

Illustrate the present of other equipment and material in labour room and nursery

labor room nursery available no. available

%available no. available %

balance for baby 8 66.7 8 57.1cord cutting /cord clamping set 9 75.0 0 0vacuum exertactor venture 11 91.7 0 0forceps 11 91.7 0 0

labor room nursery available no.

available % available no.

available %

face masks 10 83.3 10 83.3resuscitation bags 10 83.3 9 64.3breathing vavles 9 75.0 9 64.3tracheal tubes 3 25.0 8 57.1laryngoscope with tow blades 2 16.7 6 42.9oropharyngleal airways 5 41.7 8 57.1blood pressure-cuffs 8 66.7 9 64.3heated mattresses coats 2 16.7 8 57.1radiiant warmer 6 50.0 10 71.4incubrator 8 66.7 14 100.0beds 6 50.0 4 28.6functional 11 91.7 7 50.0regular 11 91.7 8 57.1dellivery bed 9 75.0 14 100.0suction device 10 83.3 11 78.6

Items labor room nursery available no.

available %

available no.

available %

photoltherapy lamps 7 58.3 13 92.9medical air centerlized 6 50.0 12 85.7oxygen 6 50.0 12 85.7air compressors 4 33.3 10 71.4cpap systems 2 16.7 4 28.6mechanical 1 8.3 5 35.7hfov ventilator 12 100.0 1 7.1multi-function mpnitor 12 100.0 4 28.6saturimeter/pulse-oximeter 6 50.0 12 85.7infusion pumps 3 25.0 10 71.4eco-sonography 1 8.3 1 7.1dedicated x-ray 1 8.3 1 7.1glucometre 4 33.3 13 92.9bilirubinometre 1 8.3 3 21.4hemogasesanalyser 12 100.0 2 14.3transport incubator with ventilationsystem 1 8.3 7 50.0availability of lab investigation on mini blood sample 3 25.0 10 71.4

Section (3): Questionnaire of mothers

Age of mothers Mean age = 27.7 years SD = 5.8 years Minimum = 15.0 years Maximum = 45 years

Residence of mothers Residence Number %Rural 54 23.8Urban 173 76.2Total 227 100.0

Occupation of mothers Occupation Number %Midwife 147 64.8Professional 58 25.6Worker 20 8.8Others 2 .9Total 227 100.0

Education level of mothers

Education level Number %Illiterate 73 32.2Primary/Basic 29 12.8Secondary 56 24.7University 69 30.4Total 227 100.0

Method of being referred to the hospital

Method Number %Referred by a health worker 72 31.7Coming directly (by her own) 155 68.3Total 227 100.0

Level (place) of referral Level Number %Public health center 71 98.6Private clinic 1 1.4Total 72 100.0

Satisfaction of respondents about specific items

Items Satisfied Average satisfaction

Not satisfied

Cleanliness and ventilation of waiting place

211(93.0%) 10 (4.4%) 6(2.6%)

Space of the waiting place 209 (92.1%) 10 (4.4%) 8 (3.5%)Nursing staff 217 (95.6%) 6(2.6%) 4 (1.8%)Enough time given to you discussing the 214 (94.3%) 5 (2.2%) 8 (3.5%)

case of your child with the doctorCost of doing analysis 198 (87.2%) 16 (7.0%) 13 (5.7%)Quality of investigations 217 (95.6%) 9 (4.0%) 1 (0.4%)Availability of drugs 208 (91.6%) 13 (5.7%) 6 (2.6%)Cost of drugs 188 (82.8%) 29 (12.8%) 10 (4.4%)

Overall satisfaction

Level of satisfaction Scores of satisfaction Per cent (%)Very satisfied 26 11.5Satisfied 26 11.5Somehow satisfied 10 4.4Not satisfied 6 2.6

Relationship between satisfaction and residence

Residence Level of satisfactionNot satisfied Somehow satisfied Satisfied Very satisfied

Rural 9.3% 11.1% 9.3% 70.4%Urban .6% 2.3% 12.2% 84.9%

Chi-Square = 20.200 p value = .000

Relationship between satisfaction and occupation

Occupation Level of satisfactionNot satisfied Somehow satisfied Satisfied Very satisfied

Housewife 4.1% 6.1% 15.6% 74.1%Professional .0% .0% 3.4% 96.6%Worker .0% 5.0% .0% 95.0%Others .0% .0% 50.0% 50.0%

Chi-Square = 20.572 p value =.015

Relationship between satisfaction and education level education level Level of satisfaction

Not satisfied Somehow satisfied Satisfied Very satisfied

Illiterate 1.4% 4.1% 13.7% 80.8%Primary/ Basic 10.3% 10.3% 20.7% 58.6%Secondary 1.8% 5.4% 7.1% 85.7%University 1.4% 1.4% 8.7% 88.4%

Chi-Square = 17.545 p value =.041

Summary of results of in-depth interview of staff

Labor room

Most labor rooms in the hospitals have local guidelines (for management of normal labor, obstructed labor, infection control, management of preterm babies, low birth and sick neonates).

Some hospitals have no guidelines for the above items.

In most of the cases the staff depends on the local guidelines or the clinical experience for management of the above conditions.

In almost all hospitals there is no essential drug list for neonatal conditions.

In almost all hospitals there are discharge and referral clinics (weekly).

Intervention for managing neonates is done mostly through general routine work.

Performance of doctors and midwives is assessed in the labour room through inspection and follow up of their work.

Pediatricians are called when there is problem or emergency.

The main problems facing effective diagnosis and management of neonates in labor room are shortage of staff and equipment.

Neonatal unit

Most of the neonatal units have no protocols and guidelines for infection control, management of preterm babies, low birth and sick neonates. Some have got local and others international guidelines for the above items.

In most of the cases the staff depends the clinical experience for management of the above conditions.

In almost all hospitals there is no essential drug list for neonatal conditions.

Some of the hospitals have discharge and referral clinics (weekly). Some also hold clinical meetings weekly or monthly.

Intervention for managing neonates is done mostly through general routine work.

Performance of doctors and sistersis assessed through inspection and follow up of their work in the section.

The main problems facing effective diagnosis and management of neonates are shortage of staff and equipment.