Level of Partograph completion and healthcare workers\u2019 perspectives on its use in Mulago National Referral and teaching hospital, Kampala, Uganda

John Mukisa,Patrick Z Lumala,Andrew S Ssemata,Jonathan Magala,Josaphat Byamugisha,Isha Grant

doi:10.1186/s12913-019-3934-3

John Mukisa, Patrick Z Lumala + Show 4 more

Open Access

https://doi.org/10.1186/s12913-019-3934-3

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Abstract

BackgroundThe appropriate use of the Partograph allows early identification of labour related complications and prevents deaths. We, therefore, sought to determine the level of Partograph completion and healthcare worker perspectives towards its utilization.MethodsThis study had two components; a hospital-based cross-sectional descriptive chart review at the Mulago National Referral Hospital, Kampala, Uganda and a qualitative study involving four Focus Group Discussions (FGDs) with ward nurses, midwives and postgraduate residents. Data from the FGDs were analyzed using thematic -content analysis in Open Code software. The quantitative data were summarized using descriptive statistical analysis, means and proportions.ResultsAmong the 355 Partographs reviewed, 79.1% had incomplete documentation of age, 52.7% gravidity, and 3.2% parity. In about 61%, the specific parameters for fetal monitoring, maternal monitoring and labour progress were incomplete. From the FGDs, the healthcare workers reported being unable to complete the Partographs due to the overwhelming numbers of expectant mothers and other staff responsibilities. Congestion in the maternity ward reduced the Partograph completion rates. The availability of other monitoring tools, limitation in skills, inadequate equipment and supplies, and the state of the mother at the presentation to the hospital all made Partograph use and completion challenging.ConclusionsThe majority of Partographs started by health workers were incomplete. The time required to document, health system challenges, status of mother at presentation, and the high workload undermined completion of the Partograph at this high volume facility.

Highlights

The appropriate use of the Partograph allows early identification of labour related complications and prevents deaths
Skilled birth attendant care needs to be available across all levels of the health system in order to reduce the delays for a referral to a higher care level if problems are expected to arise or do arise during labour
We present the findings from a study that determined the rate of completion of Partographs in Mulago National Referral and teaching Hospital in Kampala, Uganda

Summary

Introduction

The appropriate use of the Partograph allows early identification of labour related complications and prevents deaths. Approximately 1000 women die from preventable causes related to pregnancy and childbirth, with 99% of these maternal deaths occurring in low and middle-income countries [1]. According to World Health Organization (WHO), one of the key important requirement for averting these deaths is the provision of care by a skilled birth attendant before, during and after childbirth [7]. Skilled birth attendant care needs to be available across all levels of the health system in order to reduce the delays for a referral to a higher care level if problems are expected to arise or do arise during labour. It has action and alert lines to stimulate commencement of additional interventions by a skilled birth attendant monitoring the progress of labour [9]

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