Knowledge of partograph and its associated factors among obstetric care providers in North Shoa Zone, Central Ethiopia: a cross sectional study

Middle-East OBGYN graduate education (MOGGE) foundation practice guidelines: use of labor charts in management of labor. Practice guideline no. 04-O-21

Since the 50 s of the last century, labor charts have been proposed and appraised as a tool to diagnose labor abnormalities and guide decision-making. The partogram, the most widely adopted form of labor charts, has been endorsed by the world health organization (WHO) since 1994. Nevertheless, recent studies and systematic reviews did not support clinical significance of application of the WHO partogram. These results have led to further studies that investigate modifications to the structure of the partogram, or more recently, to reconstruct new labor charts to improve their clinical efficacy. This guideline appraises current evidence on use of labor charts in management of labor specially in low-resource settings.

Feasibility and effectiveness of electronic vs. paper partograph on improving birth outcomes: A prospective crossover study design

BACKGROUND

The partograph has been endorsed by World Health Organization (WHO) since 1994 which presents an algorithm for assessing maternal and foetal conditions and labor progression. Monitoring labour with a partograph can reduce adverse pregnancy outcomes such as prolonged labor, emergency C-sections, birth asphyxia and stillbirths. However, partograph use is still very low, particularly in low and middle income countries (LMICs). In Bangladesh the reported partograph user rate varies from 1.4% to 33.0%. Recently, an electronic version of the partograph, with the provision of online data entry and user aid for emergency clinical support, has been tested successfully in different settings. With this proven evidence, we conducted and operations research to test the feasibility and effectiveness of implementing an e-partograph, for the first time, in 2 public hospitals in Bangladesh.

METHODS

We followed a prospective crossover design. Two secondary level referral hospitals, Jessore and Kushtia District Hospital (DH) were the study sites. All pregnant women who delivered in the study hospitals were the study participants. All nurse-midwives working in the labor ward of study hospitals were trained on appropriate use of both types of partograph along with standard labour management guidelines. Collected quantitative data was analyzed using SPSS 23 statistical software. Discrete variables were expressed as percentages and presented as frequency distribution and cross tabulations. Chi square tests were employed to test the association between exposure and outcome variables. Potential confounding factors were adjusted using multivariate binary logistic regression methods. Ethical approval was obtained from the institutional review board of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b).

FINDINGS

In total 2918 deliveries were conducted at Jessore DH and 2312 at Kushtia DH during one-year study period. Of them, 1012 (506 in each facility) deliveries were monitored using partograph (paper or electronic). The trends of facility based C-section rates was downwards in both the hospitals; 43% to 37% in Jessore and from 36% to 25% in Kushtia Hospital. There was a significant reduction of prolonged labour with e-partograph use. In Kushtia DH, the prolonged labour rate was 42% during phase 1 with the paper version which came down to 29% during phase-2 with the e-partograph use. The similar result was observed in Jessore DH where the prolonged labour rate reduced to 7% with paper partograph from the reported 30% prolonged labour with e-partograph. The e-partograph user rate was higher than the paper partograph during both phases (phase 1: 3.31, CI: 2.04-5.38, p < .001 and in phase 2: 15.20 CI: 6.36-36.33, p < .001) after adjusting for maternal age, parity, gestational age, religion, mother's education, husband's education, and fetal sex.

CONCLUSION

The partograph user rate has significantly improved with the e- partograph and was associated with an overall reduction in cesarean births. Use of the e-partograph was also associated with reduced rates of prolonged labour. This study has added to the growing body of evidence on the positive impact of e-partograph use. We recommend implementing e-partograph intervention at scale in both public and private hospitals in Bangladesh.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03509103.

Willingness to Use Mobile based e-Partograph and Associated Factors among Care Providers in North Gondar Zone, Northwest Ethiopia

BACKGROUND

The proper use of Partograph supports to capture key maternal and fetal data. Paper-based Partograph are prone to error, incompleteness, delayed decisions and loss of clients' information. Electronic (e-Partograph) enables to easily retain and retrieve client data to ensure quality of care. Mobile technologies found an opportunity for resource-limited countries to improve access and quality of health care. Evidences were lacking on end users' acceptance to e-Partograph.

OBJECTIVE

This study aimed to assess obstetric care providers' willingness to use mobile based e-Partograph and its associated factors.

METHODS

Institutional based cross-sectional study was conducted from December 30, 2016 to January 21, 2017. A total 466 obstetric care providers were selected using multistage sampling technique in North Gondar Zone, Northwest Ethiopia. A structured self-administered questionnaire was used to collect the data. The data were entered in to Epi info version 7 and analyzed by using SPSS version 20. Cronbach's Alpha test was calculated to evaluate the reliability of data. A multivariable logistic regression analysis were used to identify factors associated with dependent variable. Adjusted odds ratio with 95%CI was used to determine the presence of association.

RESULTS

The study found that 460(99.6%) of care providers owned mobile phone. Smartphone owners accounted only 102(22%). Of them, 205(46%) were willing to use mobile-phone for e-Partograph. Care providers aged >30 years (AOR=2.85, 95% C.I: 1.34-6.05), medical doctors and higher level clinicians (AOR=8.35, 95% C.I: 2.07-33.63), Health Center (AOR=4.41, 95% C.I:0.10-9.26), favorable attitude towards Partograph (AOR=2.76, 95% C.I: 1.49-5.09) and related in-service trainings (AOR=7.63, 95% C.I: 3.96-14.69) were enabling factors for willingness to use mobile phone.

CONCLUSIONS

Almost all obstetric care providers had access to mobile phone, however; smartphone ownership is still low. Willingness to use mobile-phone for e-Partograph was low. Younger aged, lower level clinicians, Hospital based workers, unfavorable attitude on Partograph and lack of in-service trainings were main factors for non-willingness. Hence awareness creation on partograph use and digital capacity building are crucial for effective e-partograph management.

Intrapartum monitoring using partograph at secondary level public health facilities-A cross-sectional study in Odisha, India

Context:

Partograph is a simple, effective and low-cost intrapartum monitoring tool that helps in early identification of complications if any and helps in prompt intervention to save the life of the mother and the newborn. There is limited study about its usage and challenges in plotting from India particularly Odisha.

Aim:

To determine the usage of partograph and explore the issues/challenges in its plotting at various levels of health facilities

Settings and Design:

A cross-sectional study was carried out from April to June 2018 in ten different public health facilities from two tribal districts of Odisha, India. Materials and Methods: Quantitative information from 1552 mothers using pre-tested epi-info questionnaire tool and qualitative information through 22 in-depth interviews among health care providers.

Statistical Analysis Used:

Quantitative data using Ms Excel 10 and IBM SPSS ver. 22 and qualitative data using the inductive content analysis method.

Results:

Partograph plotting was found in 48.7% (adherence) while its completeness was only 1.03%. Partograph plotting was significantly better at CHCs compared to DHH and SDH (P = 0.000). No significant association of partograph adherence was observed with the birth outcome, complications, referral status and type of delivery. Though majority health care providers knew the importance of the partograph, hardly they use it. The main reasons were increased workload, shortage of staff, cases arriving at a later stage and lack of monitoring from a higher level.

Conclusions:

On job training on partograph, regular monitoring and strict policy will improve the adherence and completeness in partograph plotting.

Use of the partogram in a private hospital in South Africa

OBJECTIVE

to explore and describe the use of the partogram in private hospitals in South Africa.

DESIGN

an explanatory mixed method design. In-depth interviews were conducted with the midwives and midwife specialists to explicate the significance of the initial quantitative questionnaires.

SETTING

a private maternity hospital in Gauteng Province, South Africa.

PARTICIPANTS

11 midwives and 3 advanced midwives working in the labour unit of the private maternity hospital.

FINDINGS

although all the midwives and midwife specialists knew the purpose of the partogram, where to find the recommendations on the use of the partogram and the signs of true labour, not all were sure when the partogram had to be completed and who is accountable for plotting the findings. Fetal heart rate monitoring during the active phase of labour remains a concern.

KEY CONCLUSION

the findings revealed that the midwives understood the importance of the partogram but are not using it within the parameters for which it was intended. The obstetricians intervened during labour with no or little use of the partogram.

IMPLICATIONS FOR PRACTICE

the study identified the knowledge strengths and deficits of midwives working in a private hospital on partogram use that would benefit from training interventions and professional development. Evidence suggests a culture where the partogram is not central to care as obstetricians are not using the partogram. The purpose of the partogram in the private sector needs to be reviewed.

Level of partograph utilization and its associated factors among obstetric caregivers at public health facilities in East Gojam Zone, Northwest Ethiopia

Introduction

The discrepancy regarding maternal mortality continues to be a health concern between developing and developed countries. The majority of global maternal deaths occur in developing countries, specifically, in the sub-Sahara African region which alone accounts for more than half of these deaths. It has been indicated that utilization of the partograph was significantly associated with improved maternal and neonatal outcomes of labour and that is why the World Health Organization recommends the universal use of the tool during labour. Therefore, this study has assessed the level of partograph use and its associated factors among obstetric caregivers in East Gojam Zone, Northwest Ethiopia.

Methods

A health facility based cross-sectional study was conducted among randomly selected obstetric caregivers in Northwest Ethiopia. The data were collected using a self-administered questionnaire and a clinical observation checklist. The data were entered into Epidata version 3.1, and cleaned and analyzed using SPSS version 24.0 statistical software.

Result

About three quarters, or 198 (72.53%), of the obstetric caregivers, had attained diploma level of education. However, 153 (56.04%) of the obstetric caregivers had what was considered to be good knowledge about the partograph, but utilization of the tool was slightly lower than their level of knowledge, 147 (53.85%). Utilization of the partograph was significantly higher among obstetric caregivers holding a Bachelor of Science degree and above, than Diploma holders (AOR (95% C.I) 2.07 (1.15–3.75)) and the use was higher among those who were regularly working in the delivery ward compared to those regularly working in the Adult Outpatient Department (AOR (95% C.I): 2.25 (1.07–4.72)). Moreover, caregivers who had a good knowledge about the partograph and who had received on the job training in obstetric care were also more likely to use the partograph during labour and delivery (AOR (95% C.I): 1.79 (1.05–3.06) and 4.85 (2.63–8.96)) respectively.

Conclusion

The results of this study revealed that although more than half of obstetric caregivers had a good knowledge of the partograph, the actual utilization of the tool was slightly lower than the knowledge they had. Therefore, in this study, we suggest that providing on the job obstetric care training for obstetric caregivers, about the partograph in particular, would improve partograph utilization.

Health professional's knowledge and use of the partograph in public health institutions in eastern Ethiopia: a cross-sectional study

Background

The partograph is a vital tool for health professionals who need to be able to identify pathological labor. It is used to recognize complications in childbirth on time and to take appropriate actions. We aimed to assess the knowledge and utilization of the partograph and associated factors among health professionals at public health institutions in eastern Ethiopia.

Methods

An institution based cross-sectional quantitative study was carried out among health professionals who were working in public health institutions. Multistage sampling with proportional to size allocation was used to recruit a total of 441 study participants. Self-administered questionnaire was used to collect data in this study. Eight midwives were recruited and trained to facilitate the data collection activities. Data were entered into Epi data software and exported into SPSS (22.0) for analysis. Descriptive statistics, bivariate and multiple logistic regression were computed to determine proportions and significant association with knowledge and use of the partograph among health professionals.

Results

More than half of health professionals, 232(53.7%) had a good level of knowledge about the partograph. However, only 196(45.4%) of health professionals had fair knowledge of partograph. Nevertheless, the proportion of the partograph utilization to follow labor progress by health professionals was 92.6%. Working in the health center [AOR = 0.31, 95% CI: 0.20, 0.48], being a midwife [AOR = 2.80, 95% CI: 1.60, 5.60] and in-service training [AOR = 2.0, 95% CI: 1.22, 3.42] were significantly associated with good level of knowledge. Health professionals who had in-service training about the partograph [AOR = 3.10, 95% CI: 1.35, 4.98] and who had positive attitude about the partograph [AOR = 2.90, 95% CI: 1.30, 6.30] were significantly associated with utilization of the partograph.

Conclusion

Only less than half of health professionals had fair knowledge about the partograph. Having in-service obstetric care training, type of health institutions and profession were significantly associated with knowledge of the partograph. Health professionals who had positive attitude towards use of the partograph were significantly associated with the partograph utilization. We suggest regular in-service training of health professionals can enhance their knowledge and utilization of the partograph.

The perceptions of midwives regarding audit and feedback on the use of the partogram at Vhembe District of Limpopo Province, South Africa

BACKGROUND

Audit and feedback is regarded as the cornerstone of clinical teaching to guarantee good practice and to correct poor performance. Feedback given to health professionals assists in narrowing the gap between the actual and the desired information. The findings of the research study on perceptions of midwives on audit and feedback highlighted aspects that needed improvement to address challenges on the use and documentation of the partogram.

OBJECTIVES

The objectives of this article were to explore and describe the perceptions of midwives on auditing of the partogram by health professionals and to explore and describe the perceptions of midwives on the feedback that was given after audit was done.

METHOD

A qualitative, exploratory and descriptive study was conducted to answer the two research objectives. Semi-structured face-to-face interviews were conducted with 17 midwives who were working in the labour wards of three hospitals. Eight steps of qualitative data analysis as indicated by Tesch were used to analyse the data.

RESULTS

The findings revealed that auditing and feedback is sometimes done by midwives themselves, midwives' managers and district managers. Audit is done monthly or on a daily basis and sometimes inconsistently because of shortage of staff. Challenges indicated were lack of knowledge on the use of the partogram and lack of encouragement and praise when documentation was done correctly and that emphasis was mostly placed on negative aspects.

CONCLUSION

The findings revealed that auditing and feedback and in-service education is done at the three hospitals, although challenges such as inconsistency in auditing because of shortage of staff, lack of knowledge on partogram use and on principles of giving feedback were highlighted.

Knowledge and utilization of the partograph: A cross-sectional survey among obstetric care providers in urban referral public health institutions in northwest and southwest Cameroon

Background

The enormous challenge to maternal well-being with associated maternal wastages during labour has remained an unsurmountable problem in Cameroon which reflects the current high maternal mortality rate. Evidence abounds that cost-effective and affordable health interventions like the use of the partograph will contribute to curb the alarming number of intrapartum maternal deaths. However, little is known about the level of knowledge and utilization of this simple life-saving tool in the North–and South–West Regions, Cameroon.

Methods

Using a self-administered structured questionnaire, a cross-sectional study was conducted from January 4^th–March 25^th 2016 among non-physician obstetric care providers (OCPs) across urban public health institutions in these regions. Logistic regression models were used to identify factors associated with good knowledge and routine utilization of the partograph.

Results

Of the 79 eligible participants, 71 (89.9%) took part in the study. The mean age of the respondents was 37.9±10.0 years with majority being female (85.9%). Less than one-third (29.6%) of the respondents had good knowledge on the partograph and only 23 (32.4%) routinely used it in monitoring labour. OCPs working in Maternal and Infant Welfare Clinics were about 4 times more likely than those working in Regional/District Hospitals to have good knowledge on the partograph [AOR = 3.88 (95% CI:1.07–14.04)], p = 0.04. Little or no knowledge of the partograph and poor staff strength in the study centres were factors militating against its routine use.

Conclusions

The knowledge and use of the partograph in this study is sub-optimal. Regular in-service training of OCPs superimposed with periodic workshops and seminars, provision of reasonable staff numbers, and mandatory institutional policies on routine use of the partograph are recommended as vital first steps towards ensuring the safety of women in labour in the North–and South–West Regions of Cameroon.

Knowledge and Attitude of Obstetric Care Providers on Partograph and Its Associated Factors in East Gojjam Zone, Northwest Ethiopia

Introduction. Universal use of partograph is recommended during labor, to improve maternal and fetal outcome. The aim was to assess knowledge and attitude of obstetric caregivers about partograph and associated factors. Methods. Facility based cross-sectional study was conducted on 273 study participants. Study facilities and study units were selected using simple random sampling technique. Midwives, Nurses, Public Health Officers, Medical Doctors, and masters in Emergency Surgery and Obstetric were included in the study. Epi-data and SPSS statistical software were used. Results. About 153 (56.04%) and 150 (54.95%) of the obstetric caregivers had good knowledge and favorable attitude about partograph, respectively. Knowledge of partograph was significantly higher among obstetric caregivers that learnt about partograph during their College and who had received partograph on job training (AOR: 2.14, 95% C.I (1.17-3.93)) and (AOR: 2.25, 95% C.I (1.21-4.19)), respectively. Favorable attitude towards partograph was significantly higher among obstetrical caregivers who had training and learnt about partograph during their college (AOR: 3.37, 95% C.I (1.49-5.65)) and (AOR: 2.134, 95% C.I (1.175-3.877)), correspondingly. Conclusion. Above half of obstetric caregivers had good knowledge and a favorable attitude on partograph. The provision of on preservice and job training is necessary to improve caregivers' knowledge and attitude.