Use Of Partograph Research Articles

Care Around Birth Approach: A Training, Mentoring, and Quality Improvement Model to Optimize Intrapartum and Immediate Postpartum Quality of Care in India.

With the highest risk of maternal and newborn mortality occurring during the period around birth, quality of care during the intrapartum and immediate postpartum periods is critical for maternal and neonatal survival. The United States Agency for International Development's Scaling Up Reproductive, Maternal, Newborn, Child, and Adolescent Health Interventions project, also known as the Vriddhi project, collaborated with the national and 6 state governments to design and implement the Care Around Birth approach in 141 high caseload facilities across 26 high-priority districts of India from January 2016 to December 2017. The approach aimed to synergize evidence-based technical interventions with quality improvement (QI) processes, respectful maternity care, and health system strengthening efforts. The approach was designed using experiential training, mentoring, and a QI model. A baseline assessment measured the care ecosystem, staff competencies, and labor room practices. At endline, the approach was externally evaluated. Availability of logistics, recording and reporting formats, and display of protocols improved across the intervention facilities. At endline (October-December 2017), delivery and newborn trays were available in 98% of facilities compared to 66% and 55% during baseline (October-December 2015), respectively. Competency scores (> 80%) for essential newborn care and newborn resuscitation improved from 7% to 70% and from 5% to 82% among health care providers, respectively. The use of partograph in monitoring labor improved from 29% at the baseline to 61%; administration of oxytocin within 1 minute of delivery from 35% to 93%; newborns successfully resuscitated from 71% to 96%; and postnatal monitoring of mothers from 52% to 94%. The approach successfully demonstrated an operational design to improve the provision and experience of care during the intrapartum and immediate postpartum periods, thereby augmenting efforts aimed at ending preventable child and maternal deaths.

Impact evaluation of a maternal and neonatal health training intervention in private Ugandan facilities.

Global and country-specific targets for reductions in maternal and neonatal mortality in low-resource settings will not be achieved without improvements in the quality of care for optimal facility-based obstetric and newborn care. This global call includes the private sector, which is increasingly serving low-resource pregnant women. The primary aim of this study was to estimate the impact of a clinical and management-training programme delivered by a non-governmental organization [LifeNet International] that partners with clinics on adherence to global standards of clinical quality during labour and delivery in rural Uganda. The secondary aim included describing the effect of the LifeNet training on pre-discharge neonatal and maternal mortality. The LifeNet programme delivered maternal and neonatal clinical trainings over a 10-month period in 2017–18. Direct clinical observations of obstetric deliveries were conducted at baseline (n = 263 pre-intervention) and endline (n = 321 post-intervention) for six faith-based, not-for-profit primary healthcare facilities in the greater Masaka area of Uganda. Direct observation comprised the entire delivery process, from initial client assessment to discharge, and included emergency management (e.g. postpartum haemorrhage and neonatal resuscitation). Data were supplemented by daily facility-based assessments of infrastructure during the study periods. Results showed positive and clinically meaningful increases in observed handwashing, observed delayed cord clamping, partograph use documentation and observed 1- and/or 5-minute APGAR assessments (rapid scoring system for assessing clinical status of newborn), in particular, between baseline and endline. High-quality intrapartum facility-based care is critical for reducing maternal and early neonatal mortality, and this evaluation of the LifeNet intervention indicates that their clinical training programme improved the practice of quality maternal and neonatal healthcare at all six primary care clinics in Uganda, at least over a relatively short-term period. However, for several of these quality indicators, the adherence rates, although improved, were still far from 100% and could benefit from further improvement via refresher trainings and/or a closer examination of the barriers to adherence.

Knowledge, Attitude and Practice of nurse-midwives on the use of partograph in health care centres of Bhutan

Introduction: World Health Organization recommends using partograph to reduce maternal and neonatal deaths due to obstetric complications. Proper utilization of partograph by health care providers was noted to be good when it is associated with better knowledge and a positive attitude towards partograph. There is a paucity of scientific study about knowledge, attitude and practice on the use of partograph among healthcare providers in Bhutan. Therefore, this study aimed to assess the knowledge, attitude and practice of nurse-midwives on the use and completeness of partograph in seven hospitals and one Basic Health Unit grade I. Methods: A descriptive study was carried out from September 2017 to February 2018. Non-probability sampling method was used to survey all nurse-midwives who attended deliveries in the selected health facilities using a standard semi-structured questionnaire. All partographs filled three months before the data collection was selected purposefully and reviewed using a checklist. Results: A total of 96 participants consisting of 66 (68.8%) females and 30(31.3%) males consented for the survey. Good knowledge of partograph was reported among 48(50%) of the participants with a mean score of 12.1 (SD: ± 1.52). Attitude on the usage of partograph was found to be favorable with a median of 42 (range 32-48). Partograph usage was reported by 86 (89.6%) while only 10.4% reported having received in-service training on partograph. Out of 426 partographs reviewed, only 68 (16.0%) were found to be complete. Conclusions: Despite the encouraging findings on the use of partograph, completeness of the partograph was very low. This study therefore, recommends the reinforcement of knowledge and practice through periodic continuous medical education and auditing of the partographs.

DETERMINATION OF MIDWIVES AND NURSES' KNOWLEDGE LEVEL WHO WERE GIVEN PARTOGRAPH TRAINING

Aim: The aim of this study is to assess midwives and nurses' knowledge and skills of the partograph before and after the training. Methods: This cross-sectional study was conducted in Balikesir in Turkey. This study was 45 midwifes and nurses who were given partograph training. A scale measuring the partograph knowledge before and after the training was administered and participants were asked to mark on the partograph by giving a case sample to measure skills of using partograph. The questions prepared to measure knowledge of the partograph were multi-item propositions. Correct answers to the partograph knowledge questions were scored "2", missing answers were scored "1" and wrong answers or unanswered questions were scored "0". Results: Partograph knowledge score averages were meaningfully higher in midwives and nurses who worked in obstetrics clinics, who used partograph and who received partograph training previously (p<0.05). Partograph recording skill score averages were meaningfully higher in midwives and nurses who worked less than 10 years, who had university education, who used partograph previously, and who received partograph training (p<0.05). Post-training score average of total knowledge was meaningfully higher (p<0.0001). Conclusions: There was a meaningful increase in knowledge and skill score averages in midwives and nurses after the training. Since use of current partograph is a new thing, knowledge of midwives and nurses in working obstetrics clinics should be updated and deficiencies should be made up.

HUBUNGAN PENGETAHUAN DENGAN SIKAP BIDAN TENTANG PARTOGRAF OLEH BIDAN PRAKTEK MANDIRI DI KECAMATAN BENGKONG KOTA BATAM TAHUN 2017

The World Health Organization recommends the use of partograph in the delivery room, 15% of complications in labor are not detected early due to the negligence of partograph filling. The purpose of this research is to know the correlation between the knowledge and attitude of a Midwife toward Partograf By Independent Midwifery Practice In Bengkong Regency, Batam Year 2017. This research is Analytical Observational with cross-sectional approach and using questioner as the primary data. Data sampling used is total sampling method. The study was conducted in June 2017, a sample size of 38 people. Data analysis using Chi-Square technique. The results showed that midwives, who were well-informed and had positive attitudes are numbered to 28 people (96.6%), those who had negative attitude are numbered only 1 (3.4%).Meanwhile, less knowledgeable midwives who had positive attitudes are 2 people (22.3 %) and negative attitude are 7 people (77,7%).There is a correlation between midwife knowledge with attitude toward partograph with p-value = 0.000. It Independent midwives are expected to improve the quality of their service and implement the use of partograph.

Determinants of use of partograph among primary healthcare workers in Enugu State, South-East Nigeria

Background: World Health Organization (WHO) recommended use of partograph during childbirth to ensure early identification of abnormalities and prompt referral for emergency obstetrics care. However, factors that determine use of partograph during childbirth among primary healthcare workers (PHCWs) remain inadequately documented. Objective: This study investigated the determinants of use of partograph in conduct of labor among PHCWs in Enugu, South-East Nigeria. Materials and Methods: It was a cross-sectional descriptive survey of public PHCWs in Enugu State, Nigeria. Multistage sampling technique was used to select 393 respondents. Data were collected using a structured self-administered questionnaire and analyzed with IBM-SPSS version 22. Tests of statistics were conducted using χ2 and binary logistic regression, and statistical significance was determined at P-value of < 0.05. Results: Majority (87.0%) of the respondents have good knowledge of partograph. Reported regular availability of partograph is 32.8% but regular use of it is 25.2%. Statistically significant association exists between use of partograph and reception of training on it (P=0.001), knowledge of it (P=0.001), and availability of it (P=0.001). Availability of partograph was a predictor of use of it (adjusted odds ratio (AOR)=27.129; confidence interval=14.780–49.797). Conclusion: Although there is high knowledge of partograph among PHCWs in Enugu state, there is poor usage of it. There are 27 times higher odds of using partograph when it is made available compared with when it is not. We recommend regular provision of partograph to labor ward personnel in PHCWs in Enugu state and other similar populations.

Are Mentorship and Training the Key in Provision of Emergency Obstetric and New-Born Care (EmONC) Services? A Formative Evaluation of Pre and Post in Samburu County, Kenya

Background: In Kenya, the Maternal Mortality Ratio (MMR) is approximated to 362 maternal deaths per 100,000 live births while the stillbirth rate stands at 23 deaths per 100 live births which are far below the target of 147 maternal mortality per 100,000 live births and 12 stillbirths per 100 live births respectively. Progress in addressing preventable maternal and newborn deaths and stillbirths depend on the improvement of the quality of maternal, fetal and newborn care throughout the continuum of care. Objective: To determine the effect of mentorship and training in improving the provision of Basic Emergency Obstetric Newborn Care (BEmONC) and Comprehensive Emergency Obstetric Newborn Care (CeMONC) services among health workers in Samburu County. Methodology: A one-week training intervention was carried among health workers in level three, four and five health facilities by master trainers. Using two tools adopted from MEASURE Evaluation and a structured questionnaire, a total of 54 (before the intervention) and 64 (after the intervention) health workers from 29 health facilities were interviewed. Training effectiveness was assessed by means of questionnaires administered pre- and post-training, by correlating post-training results of health workers, and through participatory observations at the time of on-site supervisory visits, mentorship and monthly meetings. An assessment was conducted to measure the level of confidence of the health workers in performing their duties. Results: Central Samburu had the majority of the health workers both at the pre-intervention (44.4%) and post-intervention (51.6%), North Samburu had an extra health worker at post-test while no change in numbers was recorded in East Samburu. A majority of the health workers across the three sub-counties were 31 - 40 years old, with only 2 (3.8%) aged 51 years and above. Following the interventions, improvements in the practice of BEmONC services were seen across the three sub-counties. There was an increase, at post analysis, in the use of the partograph to monitor labour (from 52% to 98.1%) and managing severe infection in the newborn (from 40.4% to 60.3%). Performing CS improved from 17.3% to 31% and the same was also recorded in carrying out blood transfusions. On post-survey, health workers reported the least confidence in performing manual vacuum. Other BEmONC services including active management of 3rd stage labor, use of partograph, manual removal of the placenta, managing maternal sepsis and identifying danger signs in the newborn had a high rate of confidence. Conclusions: This study finds that structured mentorship is an effective strategy to build the capacity of health workers. However, there is a need for further research to monitor and evaluate if such programmes improve clinical outcomes in the long run.

Strengthening Maternal Death Surveillance Systems for Evidence-Based Decision Making in Sub-Saharan Africa: The Case of the Center Region in Cameroon

Background:The article seeks to document the experience of implementing Maternal Death Surveillance and Response (MDSR) in the Center Region of Cameroon. The paper raises awareness on the need for implementing MDSR, shares progress and lessons learned and reflects on the implications for public health practice.Methods:A desk research involving the collection and analysis of secondary data using tables with specific themes in excel, following the review of existing resources at the Regional Delegation of Public Health-Center from the year 2016 to 2019.Results:The findings depict the existence of MDSR policies and sub-regional committees. Although, the number of regional maternal death notifications increased from 19 to 188 deaths between 2016 and 2019, the implementation of death review recommendations was only estimated at 10% in 2019. While 66% of deaths occurred in Yaoundé, 72% of these were deaths reported to have occurred in tertiary institutions out of which 75% were attributed to late referrals. Hemorrhage constituted 70/144 (48.6%) of the known direct causes of death. Maternal death related co-factors such as the use of partograph during labor had a high non-response rate (84%) and represents a weakness in the data set.Conclusion and Global Health Implications:Across the board, stakeholder engagement towards MDSR was increased through continuous awareness-raising, dissemination of surveillance tools, the institutionalization of the District Health Information Software (DHIS 2) and the “No Name No Blame” policy. However, the reporting and investigation of deaths for informed decisions remain a daunting challenge. For a resource-scarce setting with limited access to blood banks, the application of life-saving cost-effective interventions such as the use of partographs and the institution of a functional referral system among health units is likely to curb the occurrence of deaths from hemorrhage and other underlying causes. The success of these will require a robust strengthening of the health system.

The Effect of a two-day Training and Refresher Program on the Basic Emergency Obstetric and Newborn Care Knowledge and Skills of Health Workers in Legazpi City, Albay

Objectives. The availability of emergency obstetric and newborn care (EmONC) services is one of the key strategies in improving maternal health and achieving Sustainable Development Goal 3. Health staff knowledge and competency on these interventions are crucial to ensure the effective handling and management of obstetric and newborn emergencies. Health workers, despite having undergone formal training, require regular refresher courses to keep up with new, evidence-based information on EmONC intervention; and to ensure compliance with national and local referral guidelines. A two-day workshop was implemented to assess the knowledge and skills of healthworkers in Legazpi, Albay, regarding obstetric emergency cases and referral guidelines. Methods. A pretest was conducted on the first day to assess the knowledge of the participants. A series of lectures were given before administering a posttest at the end of these lectures. An Objective Structured Clinical Examination (OSCE) was conducted on the second day, which aimed to assess the skills of the participants. Results. The pretest findings indicated that the participants are generally knowledgeable about areas such as handwashing and prenatal care. Results of the posttest show that participants had difficulty with the category of referrals. Moreover, comparing the pretest and posttest scores, there is strong evidence that there is a difference in the median values of the pretest scores as compared to the posttest scores. The results of the OSCE also indicate the need for further training on partograph use and adherence to an EINC protocol. More than half of the participants passed all five parts of the OSCE. Conclusion. The workshop contributed to an improvement in the knowledge of health care workers in obstetric emergency cases. Skills–wise, more frequent training may need to be conducted to improve other competencies such as partograph utilization and the practice of EINC interventions.

MOTIVASI BIDAN DALAM PENGGUNAAN PARTOGRAF PADA IBU BERSALIN DI IBI RANTING WELERI KABUPATEN KENDAL

The use of partographs is active and open behavior which is a response to a stimulusin the form of real or open action. Partograph is a tool for early detection of problemsand complications in childbirth such as prolonged labor, bleeding and fetal distress,so that you can immediately take action or refer the mother in optimal conditions. Theresearch objective was to determine the motivation of the midwives in usingpartograph in IBI Weleri Branch, Kendal Regency.This research is an observationalstudy with a cross-sectional approach. The research instrument used a structuredquestionnaire and observation sheets. The number of samples was 81 respondents,using simple random sampling technique with proportional allocation. The resultsshowed that most of the respondents had a Diploma III education (53.3%), with anaverage working period of 1-10 years, and an average age 30 years. Most of therespondents have good motivation such as responsibility, recognition, and the jobitself. There is a relationship between responsibility, recognition, work itself and themotivation of the midwife in using partographs. The variable that becomes the basisfor the motivation of midwives in using partographs is responsibility. The Health Officeneeds to increase the sense of responsibility of the midwife through the explanationand understanding of the partograph as the main task of the midwife, the importanceof the partograph, providing awards, and periodic evaluation. In addition, midwivesare given the opportunity to take part in training, especially APN.

Partograph utilization as a decision-making tool and associated factors among obstetric care providers in Ethiopia: a systematic review and meta-analysis

BackgroundGlobally, a total of 13.6 million women have died due to maternal causes from 1990 to 2015. Majority of these deaths occurred in resource-limited countries. Among the causes of these deaths, obstructed and prolonged labor covers the highest percentage, which could be prevented by cost-effective and affordable health interventions like partograph use. Therefore, this systematic review and meta-analysis aimed to assess the level of partograph utilization among obstetric care providers and its associated factors in Ethiopia.MethodFor this review, we used the standard PRISMA checklist guideline. Different online databases were used for the review: PubMed/Medline, Google Scholar, EMBASE, Cochrane Library, HINARI, WHO Afro Library Databases, and African Online Journals. Based on the adapted PICO principles, different search terms were applied to achieve and access all the essential articles. Microsoft Excel was used for data entry and Stata version 11.0 (Stata Corporation, College Station, TX, USA) for data analysis.ResultNineteen studies were included in this systematic review and meta-analysis with a total of 6237 obstetric care providers. The overall pooled prevalence of partograph utilization was 59.95% (95% CI 46.8–73.09, I2 = 99.4%, P < 0.001). Being in midwifery profession (adjusted odds ratio (AOR) 3.97; 95% confidence interval (CI) 2.63–5.99, I2 = 28.8%, P = 0.198), presence of supervision (AOR = 3.21; 95% CI 2.22–4.66, I2 = 0.0%, P = 0.742), Basic Emergency Obstetric and Newborn Care (BEmONC) training (AOR = 2.90; 95% CI 2.19–3.84, I2 = 36.9%, P = 0.13), knowledge of partograph (AOR = 2.5; 95% CI 1.6–3.8, I2 = 64.58%, P = 0.024), on-the-job refresher training on partograph (AOR = 5.7; 95% CI 2.5–12.9, I2 = 87.8%, P < 0.001), favorable attitude (AOR = 2.12; 95% CI 1.48–3.04, I2 = 0.0%, P = 0.58), and working at health center (AOR = 3.50; 95% CI 2.49–4.92, I2 = 49.1%, P = 0.08) were the determinant factors for partograph use among obstetric care providers in Ethiopia.ConclusionThe overall pooled prevalence of partograph utilization among obstetric care providers was low. Therefore, supportive supervision, providing Basic Emergency Obstetric and Newborn Care training, on-the-job refresher training on partograph, and promoting midwifery profession are strongly recommended to increase the use of partograph.

Health care professionals\u2019 adherence to partograph use in Ethiopia: analysis of 2016 national emergency obstetric and newborn care survey

BackgroundThe period around childbirth and the first 24 hours postpartum remains a perilous time for both mother and newborn. Health care providers’ compliance to the World Health Organization modified partogram across the active first stage of labor is a graphic representation of a mother’s condition that is used as a guide in providing quality obstetrics care. However, little evidence is documented on the health providers’ adherence to the use of the partograph in Ethiopia, which limits health care providers’ ability to improve quality care services. Therefore, this study assessed the adherence of partograph use and associated factors in Ethiopia.MethodsData from the Ethiopian 2016 National Emergency Obstetric and Newborn Care survey of 3,804 health facilities that provided maternity services were used. We extracted 2611 partograph charts over a 12 months period prior to the survey to review the proper recording of each component. Data analyses were performed using SPSS version 22.0 software. A logistic regression analyses was used to identify the association of explanatory variables with the outcome variable. A p-value of <0.05 was considered as cut off point to declare the significance association in the multivariable analysis.ResultsOf the total 2611 partographs reviewed, 561(21.5%) of them were fully recorded as per the WHO guideline. Particularly, molding in 50%, color of liquor in 70.5%, fetal heart beat in 93.3%, cervical dilation in 89.6%, descent in 63.2%, uterine contraction in 94.5%, blood pressure in 80.5%, pulse rate in 70.5%, and temperature in 53% were accurately recorded. The odds of adherence to partograph use were 1.4 in rural health facilities when compared to their counterparts (AOR=1.44; 95% CI: 1.15, 1.80, P- 0.002).ConclusionThis study revealed a poor level of adherence in partograph use in Ethiopia. Molding, maternal temperature and decent were the least recorded parameters of the partograph. The odds of completion of partograph were high in rural facilities. Strong supporting supervision and mentoring the health workers to better record and use of partograph are needed mainly in urban health facilities. Moreover in the future, interventional research should be conducted to improve the current rate of adherence.

Hubungan Pengetahuan dengan Kepatuhan Bidan dalam Penggunaan Partograf di Kamar Bersalin RSUD Undata Palu

Compliance in the use of partographs is one of the most important thing done by midwives to make clinical decisions, monitoring, evaluation, handling labor, early problem detection and complicated labor so that they can plan actions to overcome the problem or to give refferal the mother in the right conditions. The purpose of this study was to find out the relationship between knowledge with the compliance of midwives in the use of partographs. This study used an analytical observational design with a cross-sectional approach. The subjects in the study were all midwives who worked in the Maternity Room of Undata Palu Hospital in March-June 2018 as many as 26 respondents. Bivariate analysis used the Sperman Rank test. The results of this study were good knowledgeable midwives as many as 18 respondents (69.3%), obedient midwives as many as 16 respondents (61.5%), and the results of bivariate analysis showed that the relationship of knowledge with midwife compliance in using partograph was rs 0.529 and p-value 0.005. Conclusion: There was a relationship between knowledge and compliance of midwives in using Partographs with medium correlation strength. Suggestion: This result can be an evaluation material for respondents about the use of partograph

Partograma: instrumento de segurança no cuidado multidisciplinar

Introdução: O partograma é um traçado de representação gráfica do trabalho de parto que concebe o desencadeamento de sua evolução, permitindo a visualização das alterações no decorrer do partejar. O estudo objetivou descrever o conhecimento sobre partograma por enfermeiros e médicos de uma maternidade escola. Materiais e Métodos: Estudo transversal realizado com enfermeiros e médicos em maternidade escola do nordeste brasileiro. A amostra foi constituída por 8 enfermeiros e 39 médicos. Resultados: Observou-se que a maior parte já fez curso ou treinamento relacionado à ferramenta. Todavia, em 27,6% dos casos ocorrem dúvidas sobre seu manejo. Sobrecarga no plantão; falta de conhecimento no preenchimento e ausência de continuidade foram considerados aspectos dificultadores. Quanto às situações nas quais se deve abrir o instrumento, as mais citadas foram gestantes em trabalho de parto na fase ativa e trabalho de parto normal. Discussão: É indiscutível a importância e necessidade do partograma no decorrer do trabalho de parto. As informações retiradas a partir dele orientam o profissional para os próximos passos a serem seguidos. Conclusão: Acredita-se que o uso do partograma é essencial no processo de parto, e que os conhecimentos referentes à sua utilização são fundamentais na prática. Contudo, mesmo na maternidade, o uso da ferramenta é incipiente.

Low Utilization of Partograph and Its Associated Factors among Obstetric Care Providers in Governmental Health Facilities at West Shoa Zone, Central Ethiopia.

Background Globally, prolonged and obstructed labors were among the common causes of maternal morbidity and mortality in low- and middle-income countries including Ethiopia. The World Health Organization (WHO) recommends the routine use of partograph as a key intervention to avoid prolonged and obstructed labor. Despite the recommendation, studies indicated that the partograph utilization among obstetric care providers (OCPs) is still low. Therefore, this study is aimed at assessing the level of utilization of partograph and associated factors among obstetric care providers working at health facilities in the West Shoa Zone, Central Ethiopia 2019. Methods Facility-based cross-sectional study was conducted from February 1st to 22nd March 2019. A computer-generated simple random sampling technique was used to select 325 study subjects. Data were collected using a self-administered structured questionnaire and using an observational checklist. Additionally, 200 partograph charts were reviewed. Both bivariate and multivariable logistic regression analyses were used to determine the association. Results A total of 322 obstetric care providers were included in the study, giving a response rate of 99.1%. The level of partograph utilization in the study area was revealed to be 31.1% (95% CI: 25.97-36.13). Only 3% of the reviewed partograph was recorded according to the recommended standard. In this study attending training (AOR = 3.94, 95% CI: 1.99-7.78), availability of partograph (AOR = 5.23, 95% CI: 1.69-16.22), perceived as not time-consuming task (AOR = 3.61, 95% CI: 1.19-10.96), adequate number of OCPs available (AOR = 2.92, 95% CI: 1.16-7.33), presence of supervision (AOR = 4.35, 95% CI: 2.11-8.97), having a positive attitude (AOR = 2.48, 95% CI: 1.23-5.02), availability of standard protocol in a health facility (AOR = 4.71, 95% CI: 2.31-9.60), and lack of commitment (AOR = 0.32, 95% CI: 0.16-0.63) were factors significantly associated with partograph utilization. Conclusion and Recommendation. Partograph utilization in the study area was found to be low. Almost all reviewed partograph charts were not recorded as to the recommended standard. Attending training, availability of partograph, perceived as it is not time-consuming, the available number of OCPs, presence of supervision, having a positive attitude, available standard protocol, and commitment were factors associated with partograph utilization. Therefore, all concerned stakeholders should emphatically consider those identified factors for intervention.

Perceived strengths and challenges of the World Health Organization modified partograph among obstetric care providers in Blantyre, Malawi

Background/Aims The partograph is a tool used to monitor events during labour and was recently modified by the World Health Organization to improve intrapartum care. However, it is unknown how obstetric care providers in Malawi perceive this modified partograph. This study aimed to evaluate the perceived strengths and challenges regarding the World Health Organization's modified partograph design among obstetric care providers in Malawi. Methods For this qualitative study, data were collected from a sample of 34 obstetric care providers from two purposively-selected urban health facilities through in-depth interviews and focus group discussions. The data were subjected to thematic analysis, with the strengths and challenges of using the modified partograph designated as the two major themes. Results The participants reported that there were more challenges than strengths with utilisation of the modified partograph. Two subthemes emerged among the strengths: the partograph is comprehensive and the partograph is clear. Three subthemes emerged from the challenges: 1) unrealistic fetal monitoring intervals, 2) confusing partograph design regarding documentation of caput and moulding and 3) small font. These challenges made partograph use impractical to complete, particularly in the context of chronic understaffing of the labour ward. Conclusions Until staffing levels are improved in Malawi and other resource-limited settings, it is unlikely that the modified partograph design will significantly improve maternal or neonatal outcomes. However, some improvements can be made to the design to help facilitate its use, and more training on its use is needed to prevent confusion.

Partograph Utilization and Associated Factors among Obstetric Care Providers Working in Public Health Facilities of Wolaita Zone, 2017.

Background Obstructed or prolonged labor is a major cause of maternal deaths. Prolonged and obstructed labor contributed to 13% of global maternal deaths which can be reduced by proper utilization of a partograph during labor. Obstetric caregivers' use of the partograph during labor has paramount importance in identifying any deviation during labor. Even though partograph use is influenced by different factors as obtained from the literatures, the magnitude of partograph utilization and the factors associated with its use are not well determined in the health facilities of Wolaita Zone. Objective To assess the magnitude of partograph utilization and factors that affect its utilization among obstetric caregivers in public health facilities of Wolaita Zone, Ethiopia, 2017. Methods An institution-based cross-sectional study was conducted on obstetric caregivers. A pretested and structured questionnaire was used to collect data. Data was entered to EpiData version 3.01 and exported to SPSS version 23.0 for further analysis. Logistic regression analyses were used to see the association of different variables. Result A total of 269 obstetric caregivers participated in the study. Among those who were utilizing the partograph, 193 (71.7%) routinely used it for all laboring mothers and 76 (28.3%) of participants reported that they do not routinely utilize it. Greater number of service years (AOR = 4.93, 95% CI: 1.53-15.88), on-the-job training (AOR = 0.16, 95% CI: 0.06-0.43), good knowledge (AOR = 3.35, 95% CI: 1.61-6.97), and favorable attitude towards partograph utilization (AOR = 2.99, 95% CI: 1.28-7.03) were significantly associated with partograph utilization. Conclusion and Recommendation. Partograph utilization among obstetric caregivers in the public health facilities was good. Greater years of work experience, in-service training, having good knowledge, and favorable attitude towards partograph utilization among obstetric caregivers independently determined partograph utilization. Provision of on-the-job training to make obstetric caregivers improve knowledge and skill on partograph utilization, maintaining caregivers' retention to decrease turnover by providing different incentives to more experienced obstetric care providers, and establishing favorable attitude could improve the proper use of the tool.

Augmentation of labor with oxytocin and its association with delivery outcomes: A large-scale cohort study in 12 public hospitals in Nepal.

The use of oxytocin to augment labor is increasing in many low-resource settings; however, little is known about the effects of such use in contexts where resources for intrapartum monitoring are scarce. In this study, we sought to assess the association between augmentation of labor with oxytocin and delivery outcomes. We conducted a cohort study in 12 public hospitals in Nepal, including all deliveries with and without augmentation of labor with oxytocin, but excluding elective cesarean sections, women with missing information on augmentation of labor, and women without fetal heart rate on admission. Bivariate and multivariate logistic regression calculating the crude and adjusted risk ratio (aRR) with corresponding 95% CI were performed, comparing (a) intrapartum stillbirth and first-day mortality (primary outcome); and (b) intrapartum monitoring, mode of delivery, postpartum hemorrhage, bag-and-mask ventilation of the newborn, Apgar score, and neonatal death before discharge (secondary outcomes) among women with and without oxytocin-augmented labor. The total cohort consisted of 78931 women, of whom 28915 (37%) had labor augmented with oxytocin and 50016 (63%) did not have labor augmented with oxytocin. Women with augmentation of labor had no increased risk of intrapartum stillbirth and first-day mortality (aRR 1.24, 95% CI 0.65-2.4), but decreased risks of suboptimal partograph use (aRR 0.71, 95% CI 0.68-0.74), suboptimal fetal heart rate monitoring (aRR 0.50, 95% CI 0.48-0.53), and emergency cesarean section (aRR 0.62, 95% CI 0.59-0.66), and increased risks of bag-and-mask ventilation (aRR 2.1, 95% CI 1.8-2.5), Apgar score <7 at 5minutes (aRR 1.65, 95% CI 1.49-1.86), and neonatal death (aRR 1.93, 95% CI 1.46-2.56). Although augmentation of labor with oxytocin might be associated with beneficial effects, such as improved monitoring and a decreased risk of cesarean section, its use may lead to an increased risk of adverse perinatal outcomes. We urge for a cautious use of oxytocin to augment labor in low-resource contexts, and call for evidence-based guidelines on augmentation of labor in low-resource settings.

Faktor yang Berhubungan dengan Penggunaan Partograf dalam Persalinan oleh Bidan Praktik Mandiri

Partographs are guidelines for childbirth observations that will facilitate labor assistants in first identifying emergency cases and complications for mothers and fetuses. Preliminary survey at the Sigi Community Health Sub-Center (Pustu) of the 8 Pustu midwives found two midwives (25%) to complete a complete partograph, six midwives (75%) incomplete. The purpose of this study was to determine the determinant factors associated with the use of partographs in labor. The design of this study used observational analytic methods with a cross-sectional approach. 24 BPM survey results were obtained with 30 samples of midwives who met the research criteria and data completeness. The sampling technique was by the total population. Data analysis used logistic regression. The multivariate analysis results showed that APN training was the most influential factor in the use of partographs in labor by midwives. Statistical test results obtained a POR value of 37.7 (95% CI 12.1 - 60.2). This study suggests that midwives must have APN certificates to be valid in providing services.

Partograph Utilization and Associated Factors among Obstetric Care Providers at Public Health Facilities in Hadiya Zone, Southern Ethiopia.

Background A partograph is a graphic representation of labor which is used by health professionals for monitoring labor progress and fetal and maternal wellbeing. However, its utilization and associated factors have not been studied yet in Hadiya Zone, Southern Ethiopia. Hence, the aim of this study was to determine partograph utilization and associated factors among obstetric care providers at public health facilities in Hadiya Zone, Southern Ethiopia. Methods A facility-based cross-sectional study was conducted on 436 health professionals. The study was conducted from March 04 to April 07, 2019. A simple random sampling method was carried out to select 19 health facilities and study participants from selected facilities. Data was collected using a pretested structured questionnaire, entered into EPI-data version 3.1 and exported to Statistical Package for Social Sciences (SPSS) version 20. Descriptive statistics and binary and multivariable logistic regression analyses were done. P values less than 0.05 were used to declare significant association between dependent and independent variables. Results The overall magnitude of partograph utilization was found to be 54.4%, and finding from data abstraction from a document revealed that out of 18 parameters, only 10 parameters were recorded completely. Type of health facility (hospital as compared to HC) (AOR = 2.96; CI = 1.71, 5.12), received on-the-job training on partograph (AOR = 7.06; CI = 4.3, 11.37), knowledgeable about partograph (AOR = 2.12; CI = 1.3, 3.9), and favorable attitude toward partograph use (AOR = 1.8; CI = 1.12 − 2.97) were significantly associated with partograph use. Conclusion Overall partograph utilization was low, and incomplete recording of required parameters on partograph was observed in this study. Participants who received on-the-job training on partograph, who are working in a hospital, who are knowledgeable about partograph, and who have favorable attitude toward partograph use were factors affecting partograph use positively.