Use Of Partograph Research Articles

Quality of intrapartum and newborn care in Tigray, Northern Ethiopia

BackgroundQuality intrapartum and newborn care is considered to be poor in Sub-Saharan Africa. However, studies done in Ethiopia are limited. Therefore, this study was conducted to assess the magnitude and factors associated with quality intrapartum and newborn care in Tigray, Northern Ethiopia.MethodsFacility based survey was conducted from December 2014 to February 2015 in Tigray, Northern Ethiopia. The quality of intrapartum care provided by a total of 106 skilled birth attendants to 216 labouring mothers and newborns were observed during childbirth in the health facilities. Standardized questionnaires and checklist were utilized to collect data. Quality of intrapartum service was measured using standard intrapartum criteria. Thus, good quality service was considered if the mother and newborn scored 75% or more of the intrapartum criteria during childbirth. Binary and multiple logistic regression model was used to determine the factors associated with quality intrapartum and newborn care services.Results29.2% of mothers and 67.6% newborns received good quality care during intrapartum and immediate postpartum periods respectively. However, only 47.2% of mothers and newborns received a friendly care during childbirths. The independent predictors of quality intrapartum and newborn care were the appropriate use of partograph (AOR 3.92; 95% CI 1.78, 8.63), friendly maternal and newborn care services (AOR 7.9; 95% CI 3.59, 17.33), more than two years working experience (AOR 0.31; 95% CI 0.13, 0.73) and using services in different Zones in the study area.ConclusionsThe quality intrapartum care is poor in the study area and it is associated with inappropriate use of partograph, unfriendly care, and experience of health providers. Scaling up obstetric service, continuous training and motivation of service providers and revising the criterion for accreditation of service providers are important.

Quality of intrapartum care for healthy women with spontaneous onset of labour in Rwanda: A health facility-based, cross-sectional study

ObjectiveTo investigate the quality of intrapartum care provided at Rwandan healthcare facilities to women undergoing normal pregnancy and spontaneous full-term labour. MethodsA cross-sectional study was conducted over eight weeks during 2014–2015 in 18 healthcare facilities in Kigali City and the Northern Province: eight health centres, seven district hospitals, one provincial hospital, one private hospital, and one referral hospital. Data were collected from medical records and a questionnaire including the Bologna score with its five variables: presence of a companion, use of partograph, no augmentation of labour, birth in a non-supine position, and skin-to skin contact. ResultsAmong the 435 women who fulfilled the inclusion criteria during the study period, mean age was 27.4 years and 41.8% were primiparous. The assisting healthcare professionals were midwives (49.4%), nurses (28.8%), and physicians (22%), and birth occurred at health centres (29%), district hospitals (40%), and the referral hospital (31%). Mean Bologna score was 2.03 of the maximum 5 (range: 0–4). Only one woman (0.2%) had a companion present (her husband). A partograph was used for the majority (84.8%), and 88.0% had no augmentation of labour with oxytocin. Few (6.2%) gave birth in a non-supine position, and few (12.4%) had early skin-to-skin contact with their newborn. ConclusionThere are several areas for improving childbirth care according to the Bologna score. Healthy newborns should be placed skin-to-skin with their mothers shortly after birth, non-supine birthing positions should be encouraged, and the importance of a companion during labour and birth should be considered.

Effectiveness of Structured Teaching Program upon Midwives’ Knowledge Concerning Use of Partograph during First Stage of Labor in Al-Hilla Hospitals

Teaching program prepare nurse midwife to teach laboring women for labor by providing information and practicing that promote women's self-control and may contribute for a satisfactory birthing experience. Therefore, the aim of this study is to improve the knowledge of nurse midwives in a scientific and applicable way by implementing the teaching program that focus on knowledge upon the use of partograph during labor. A quasi-experimental design was carried out throughout the present study during September 26th 2017 to December 20th 2018. A Non-probability (purposive) sample were selected consisted of (50) nurse midwives who worked in delivery rooms in Babylon Teaching Hospitals for Maternity and pediatric who attended the teaching program as the study group and the other group of (25) midwives who were employed in AL-Hilla General Teaching Hospital who did not attend the teaching program and considered as a control group. Data were analyzed through using the descriptive and inferential analysis. The study results revealed that no statistically significant differences in the proportions of participants in both groups who did have previous knowledge about the use of partograph in all comparisons, (P>0.05).

Progress in childbirth care in Brazil: preliminary results of two evaluation studies.

This article aims to describe the preliminary results of two evaluations studies, one about the Stork Network program and the other about the Adequate Birth program, called Stork Network Assessment and Healthy Birth, and to identify possible improvements in comparison to the Birth in Brazil study. Both studies used a cross-sectional design and were conducted in 2017. The Stork Network Assessment study included all 606 public and mixed maternity hospitals from the Stork Network and a total of 10,675 postpartum women. The Healthy Birth study included a convenience sample of 12 private hospitals and 4,798 women. Indicators of labour and childbirth care were: presence of a companion person, care by obstetric nurse, use of partograph, use of non-pharmacological methods, walking during labor, eating, use of peripheral venous catheter, position for delivery, episiotomy, and Kristeller maneuver. The indicators were compared to those verified in Birth in Brazil, a nationwide population-based study in 2011-2012, before the start of the two intervention programs. Comparisons used the chi-square test for independent samples and 95% confidence interval. There was a significant increase in the number of women with access to appropriate technology for labour and childbirth from 2011 to 2017 and a reduction in harmful practices. The private sector also showed a decrease in cesarean rates and an increase in gestational age at birth. The study's results show that properly conducted public policies can change the scenario of care for labor and childbirth, helping to reduce in negative maternal and neonatal outcomes.

A Study to assess the effectiveness of Self Instructional module regarding knowledge and practice related to use of partograph among staff nurses working in labor room of the selected hospitals of Indore

A Study to assess the effectiveness of Self Instructional module regarding knowledge and practice related to use of partograph among staff nurses working in labor room of the selected hospitals of Indore

Contribution of Completed Modified World Health Organization Partograph on Maternal and Foetal Mortality Reduction in Health Facilities in Makueni County, Kenya

Background: Maternal and foetal mortality is one of the major health problem facing low income countries as compared to the high income countries. This burden is mostly felt in sub Saharan Africa and Southeast Asia where 99% of the global burden of maternal death is found. The World Health Organization (WHO) promotes partograph use in the monitoring and management of mothers in labour enabling timely decision-making regarding interventions to be undertaken. Objective: To assess the relationship between complete modified world health organization partograph and maternal and foetal outcomes in health facilities in Makueni County, Kenya Methods: This was a cross sectional study design. The study used a structured questionnaire to collect data from the partographs retrospectively. Data analysis was done using SPSS version 20.0 and chi-square tests were used to assess the relationship of variables. The cut off point for the level of significance was 0.05. Phi and Cramer’s V test was used to determine the strength of association Findings: Descriptive statistics and frequency tables were used to describe the extent to which the partograph was used. The use of partograph had effects on both foetal and maternal outcomes. The study established method of delivery had a significance association with foetal monitoring (foetal heart rate, liquor, and moulding), labour progress monitoring (descent, contractions and cervical dilatation) and referral monitoring at α = 0.05. The study also found significant association between foetal outcome and contraction, gravidity, parity, foetal heart rate and moulding at α = 0.05. Conclusion: There is a significant association between maternal, foetal outcomes and labour progress and partograph completeness in Makueni County. The study therefore recommends increased mobilization and routine check by supervisors to ensure partographs are filed on time and hospitals to embrace training programme to enable midwifery care-providers acquire relevant skills to complete partographs during the labour process.

Uterine rupture among mothers admitted for obstetrics care and associated factors in referral hospitals of Amhara regional state, institution-based cross-sectional study, Northern Ethiopia, 2013-2017.

BackgroundMaternal morbidity and mortality have been one of the most challenging health problems that concern the globe over the years. Uterine rupture is one of the peripartum complications, which cause nearly about one out of thirteen maternal deaths. This study aimed to assess the prevalence and associated factors of uterine rupture among obstetric case in referral hospitals of Amhara Regional State, Northern Ethiopia.MethodsInstitution based cross sectional study was conducted from Dec 5-2017-Jan 5–2018 on uterine rupture. During the study randomly selected 750 charts were included by using simple random sampling method. Data were checked, coded and entered into Epi info version 7.2 and then exported to SPSS Version 20 for Analysis. Binary Logistic regression was used to identify the predictors of uterine rupture and 95% Confidence Interval of odds ratio at p-value less than 0.05 was taken as a significance level.ResultThe overall prevalence of uterine rupture was 16.68% (95% CI: 14%, 19.2%). Distance from health facility >10km (Adjusted Odds Ratio (AOR) = 2.44; 95%CI:1.13,5.28), parity between II and IV (AOR = 7.26;95% (3.06,17.22)) and ≥V (AOR = 12.55;95% CI 3.64,43.20), laboring for >24hours(AO = 3.44; 95% CI:1.49,7.92), with referral paper(AOR = 2.94;95%CI:1.28,6.55) diagnosed with obstructed labor (AOR = 4.88;95%CI: 2.22,10.70), precipitated labor (AOR = 3.59;95%CI:1.10,11.77), destructive delivery (AOR = 5.18;95%: 1.22,20.08), No partograph (AOR = 5.21; 95% CI: 2.72,9.97), CPD(AOR = 4.08;95%CI:1.99,8.33), morbidly adherent placenta (AOR = 9.00;95%:2.46,27.11), gestational diabetic militias (AOR = 5.78; 95%CI:1. 12,20 .00 ), history of myomectomy(AOR = 5.00;95%CI:1.33,18.73), induction and augmentation of labor (AOR = 2.34;95%:1.15,4.72) obstetric procedure (AOR = 2.54;95%: 1.09,5.91), previous caesarian deliveries 4.90 (2.13,11.26) were found to be significantly associated with uterine rupture.ConclusionThis finding showed that the prevalence of uterine rupture is higher. A more vigilant approach to prevent prolonged and obstructed labor, use of partograph, quick referral to a well-equipped center and prevention of other obstetrics complications need to be focused on.

Health facility structure and maternal characteristics related to essential newborn care in Brazil: a cross-sectional study.

ObjectivesTo assess the use of the WHO’s Essential Newborn Care (ENC) programme items and to investigate how the non-use of such technologies associates with the mothers' characteristics and hospital structure.DesignA cross-sectional observational health facility assessment.SettingThis is a secondary analysis of the ‘Birth in Brazil’ study, a national population-based survey on postnatal women/newborn babies and of 266 publicly and privately funded health facilities (secondary and tertiary level of care).ParticipantsData on 23 894 postnatal women and their newborn babies were analysed.Main outcome measuresThe facility structure was assessed by evaluating the availability of medicines and equipment for perinatal care, a paediatrician on call 24/7, a neonatal intensive care unit (NICU) and kangaroo mother care. The use of each ENC item was assessed according to the health facility structure and the mothers’ sociodemographic characteristics.ResultsThe utilisation of ENC items is low in Brazil. The factors associated with failure in pregnant woman reference were: pregnant adolescents (ORadj 1.17; 95% CI 1.06 to 1.29), ≤7 years of schooling (ORadj 1.47; 95% CI 1.22 to 1.78), inadequate antenatal care (ORadj 1.67; 95% CI 1.47 to 1.89). The non-use of corticosteroids was more frequently associated with the absence of an NICU (ORadj 3.93; 95% CI 2.34 to 6,66), inadequate equipment and medicines (ORadj 2.16; 95% CI 1.17 to 4.01). In caesarean deliveries, there was a less frequent use of a partograph (ORadj 4,93; 95% CI 3.77 to 6.46), early skin-to-skin contact (ORadj 3.07; 95% CI 3.37 to 4.90) and breast feeding in the first hour after birth (ORadj 2.55; 95% CI 2.21 to 2.96).ConclusionsThe coverage of ENC technologies use is low throughout Brazil and shows regional differences. We found a positive effect of adequate structure at health facilities on antenatal corticosteroids use and on partograph use during labour. We found a negative effect of caesarean section on early skin-to-skin contact and early breast feeding.

Obstetric Fistula: Existing Challenge of Developing Countries

Developing countries are the home ground of obstetric fistula. It is usually the result of injury following childbirth or its consequences. The most common type of obstetric fistula is vesico-vaginal. Neglected obstructed labour is considered as the major etiology. Persistent leakage of urine is the most common presentation. It usually develops 3 to 14 days following childbirth. It degrades the quality of life of females. It may lead to medical, social, economic and psychological effects on reproductive age females. It is the marker to determine the quality of health system of any country. Proper use of partograph and timely intervention decreases its prevalence. History, examination and dye test are usually taken as main diagnostic tools in resource poor settings. It is a treatable condition at usual times. Social awareness regarding fistula is the need of developing countries. Drink, Dry and Drain are the key parameters of fistula repair success. Social rehabilitation following surgical repair is of prime importance.

A cross-sectional study of partograph utilization as a decision making tool for referral of abnormal labour in primary health care facilities of Bangladesh.

BackgroundIn Bangladesh, female paramedics known as Family Welfare Visitors (FWVs), conduct normal deliveries in first-level primary care facilities, or Union Health and Family Welfare Centres (UH&FWC). Utilization of partographs allow for early identification of abnormal labour and referral for advanced care to Emergency Obstetric Care (EmOC) facilities. A systematic assessment of the quality of partograph utilization in clinical-decision making will contribute to understanding the use of the tool by health workers.MethodsIn 2013, the USAID supported MaMoni HSS project, led in country by Save the Children, trained FWVs on the use of partographs in five UH&FWCs in Habiganj district. As part of the follow-up after training, intrapartum case record forms, accompanying partographs, and referral registers for all obstetric cases managed in these five facilities from July 2013 to June 2014 were reviewed. Partographs were reviewed to identify abnormal labour cases based on pre-defined indications. All referred cases were ascertained from the case records in the referral registers. Five health workers were interviewed to assess their knowledge, attitude and experience in partograph use and to explore the challenges for referral decision making associated with the tool.ResultsA total of 1,198 deliveries were managed at the study sites, of which 663 presented with cervical dilatation of 8 cm or less. Partographs were initiated in 98% of these cases. Indication of abnormal labour was found in 71 partographs (11%) and among them, only 1 was referred to a higher-level facility. Foetal heart rate and cervical dilatation were appropriately recorded in 61% and 70% of the partographs, respectively. Interviews with health workers revealed poor interpretation of referral indications from the partographs. Limited accessibility to the nearest EmOC facility, inadequate time for referral, and non-compliance to referral by clients were identified by the interviewed health workers as the key barriers for referral decision making.ConclusionsSupporting the health workers at first-level primary care facilities to better interpret and act on partograph data in a timely manner, and strengthening the referral systems are needed to ensure that women in labour receive the prompt quality care they and their babies require to survive.

Effect of partograph use on outcomes for women in spontaneous labour at term and their babies.

Effect of partograph use on outcomes for women in spontaneous labour at term and their babies.

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

IntroductionThe 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.MethodsA 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.ResultAbout 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.ConclusionThe 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.

Use of an electronic Partograph: feasibility and acceptability study in Zanzibar, Tanzania

BackgroundThe ePartogram is a tablet-based application developed to improve care for women in labor by addressing documented challenges in partograph use. The application is designed to provide real-time decision support, improve data entry, and increase access to information for appropriate labor management. This study’s primary objective was to evaluate the feasibility and acceptability of ePartogram use in resource-constrained clinical settings.MethodsThe ePartogram was introduced at three facilities in Zanzibar, Tanzania. Following 3 days of training, skilled birth attendants (SBAs) were observed for 2 weeks using the ePartogram to monitor laboring women. During each observed shift, data collectors used a structured observation form to document SBA comfort, confidence, and ability to use the ePartogram. Results were analyzed by shift. Short interviews, conducted with SBAs (n = 82) after each of their first five ePartogram-monitored labors, detected differences over time. After the observation period, in-depth interviews were conducted (n = 15). A thematic analysis of interview transcripts was completed.ResultsObservations of 23 SBAs using the ePartogram to monitor 103 women over 84 shifts showed that the majority of SBAs (87–91%) completed each of four fundamental ePartogram tasks—registering a client, entering first and subsequent measurements, and navigating between screens—with ease or increasing ease on their first shift; this increased to 100% by the fifth shift. Nearly all SBAs (93%) demonstrated confidence and all SBAs demonstrated comfort in using the ePartogram by the fifth shift. SBAs expressed positive impressions of the ePartogram and found it efficient and easy to use, beginning with first client use. SBAs noted the helpfulness of auditory reminders (indicating that measurements were due) and visual alerts (signaling abnormal measurements). SBAs expressed confidence in their ability to interpret and act on these reminders and alerts.ConclusionsIt is feasible and acceptable for SBAs to use the ePartogram to support labor management and care. With structured training and support during initial use, SBAs quickly became competent and confident in ePartogram use. Qualitative findings revealed that SBAs felt the ePartogram improved timeliness of care and supported decision-making. These findings point to the ePartogram’s potential to improve quality of care in resource-constrained labor and delivery settings.

Maternal Mortality in Malaysia

Maternal health and well-being have extended to international consideration since the global launching of WHO’s Safe Motherhood Initiative in 1987. In 1990, Malaysia set itself an ambitious vision to achieve high income and developed status by 2020. A relatively low maternal mortality rate (23.2 in 2012), noteworthy increase in the proportion of safe deliveries and antenatal coverage have been achieved. Introduction of Confidential Enquiries into Maternal Deaths (CEMD) in 1991 was an important step towards a full-fledged audit taking into consideration the identification of shortfalls in the care of pregnant mothers and taking cognizance of the remedial measures set forth, thus improving standards of care. The High-Risk Approach system, the introduction of a colour coding system for identification of pregnancies that were at greater risk than average risk, the strengthening of referral systems, and home based maternity assessment cards kept by the patient present at any level of antenatal care were used as additional tools. Swift development of rural infrastructure, increase in skilled personnel to attend deliveries, and recruitment of traditional birth attendants (TBAs) as a short-gap measure was undertaken. In addition, midwives in rural areas were allowed to administer heparin as thromboprophylaxis, antenatal steroids to mothers with preterm labour and intramuscular magnesium sulphate to mothers with hypertension. These drugs are given under guidance by the Ministry of Health protocols and given before transfer to tertiary centres. In addition, partograph use, protocol development and creation of a “red alert system” in hospitals to mobilize specialists and other healthcare personnel were deployed to reinforce existing measures. In 1985, MOH initiated a national quality assurance programme (QAP). This programme was used as a managerial tool to justify the needs for further resources in terms of money, manpower, machinery and materials. Malaysia’s significant decline in maternal mortality has been as a result of development of rural health services (introduction of maternal and child health programmes and TBAs) , adopting specific approaches (strengthening of referral system and colour coding system), assuring quality of care by tracking progress (outcome), providing standardize care, and identifying outliers that needed further improvement.

PARTOGRAPH CHART USE AMONG OBSTETRIC CAREGIVERS IN PUBLIC HEALTH INSTITUTIONS OF WEST SHEWA ZONE, OROMIA REGIONAL STATE, ETHIOPIA, 2015

ABSTRACT BACKGROUND: Partograph chart is recommended by WHO for developing countries to be used as an early warning system to identify prolonged labour and allow timely transfer. In Ethiopia, although most health institutions have been using partograph chart, there is limited information about its proper use and challenges faced by health workers. OBJECTIVE: The aim of this study was to assess the magnitude of partograph use, factors that affect its use and challenges faced among obstetric caregivers in public health institutions of West Shewa Zone, Oromia Regional State, Ethiopia. METHODS: The study used both quantitative and qualitative research approaches from December 2014 to February 2015. It was conducted in two randomly selected hospitals and five health centres. The study used logistic regressions model to assess independent predictors of partograph use among health providers. RESULT: Out of 44 clients in the labour ward, only five items out of fifteen parameters listed on the partograph were completed. A fourth (24.7%) of all professionals did not know when to start partograph mapping and 36% had unfavourable attitude toward partograph use. Most (73%) indicated that partograph predisposes labouring women for unnecessary and untimely intervention. Midwives (AOR=13 CI=2.6-66.2), health workers who had knowledge about partograph use (AOR=7, CI= (2.8-21.8) and who work in facilities who had access to the tool (AOR=8.8 CI: 2.8-27.6), were more likely to use partograph. Health workers in higher institutions (hospitals) were less likely to use partograph (AOR=0.09, CI: 0.03-0.26). CONCLUSION: Most health workers do not complete the tool properly. Lack of knowledge about the right start time of partograph plotting and its benefits has affected proper identification of the action line which will farther affect maternal and fetal outcome. In-service and pre-service training on partograph use, continuous mentoring, supervision and staff motivation could improve the proper use of the tool. KEY WORDS: Partograph, knowledge, obstetric caregivers, public health institutions, Oromia Regional State, Ethiopia. (Ethiopian Journal of Reproductive Health 2017;9:36-44)

A facility-based study of factors associated with perinatal mortality in Tigray, northern Ethiopia.

To identify perinatal mortality risk factors in the Southern Zone of Tigray, northern Ethiopia. The present unmatched case-control study included data from 20 health facilities; stillbirths and neonatal deaths were included as a case group and patients with neonates who survived until discharge or day 7 postpartum were included as a control group. Perinatal mortality risk factors were investigated using bivariate and multivariate logistic regression analyses. There were 126 and 252 patients included in the case and control groups, respectively. Prematurity (adjusted odds ratio [AOR] 12.2; 95% confidence interval [CI] 3.46-43.17; P<0.001), delivery weight below 2500g (AOR 11.5, 95% CI 3.16-42.36; P<0.001), and fewer prenatal visits (AOR 5.4; 95% CI 0.80-36.63; P=0.028) were determinants of perinatal mortality. Partograph use (AOR 0.2; 95% CI 0.08-0.48; P<0.001) and seeking labor care at the start of labor (AOR 0.1; 95% CI 0.01-0.96; P=0.010) were protective. Short childbirth interval (<2years) (AOR 2.2; 95% CI 1.03-5.09; P=0.013), distance to facility (AOR 3.7; 95% CI 1.56-9.02; P=0.007), and lack of iron supplementation (AOR 3.3; 95% CI 1.16-9.76; P=0.021) were also predictors of perinatal mortality. Perinatal mortality was linked to prematurity and low delivery weight. Interventions including partograph and auscultation, as well as subsidizing transport and iron supplementation, could help in this region.

Magnitude of Partograph Use and Associated Factors among Obstetric Care Givers in Public Health Institution in Sidama Zone, Southern Ethiopia, 2017

Background: In Ethiopia, maternal death is still high (estimated 412 per 100,000 live births). Partograph is inexpensive and easily applicable health interventions, that can help prevent the majority of maternal and neonatal deaths. However, use of partograph of birth care vary throughout the country. Thus, this study is intended to assess knowledge and utilization of partograph among birth care givers in public health institution in Sidama zone, Southern Ethiopia. Objective: To assess magnitude of partograph use of and associated factors among obstetric care givers in public health institution in Sidama zone, Southern Ethiopia. Materials and method: Facility based cross-sectional study was conducted from May 1 to 30, 2016. Two stage sampling techniques were used to select participants. Six Woredas and 1 city administration were selected by simple random method and after proportional allocation; a total 286 participants were recruited in the study. Structured and pretested questionnaire was administered to collect data. SPSS Version 20 was employed for data entry and statistical analysis. Logistic regression analyses were used to comprehend the association of different variables. Results: Among total respondents, 94.3% knew what a partograph is and 58.6% defined it correctly. Only 42.9% and 55% of respondents correctly explained the function of alert line and action line respectively. Only 43.9% had good knowledge on appropriate use of partograph. Almost half (51%), 38.2% and 5.7% of the respondents used partograph routinely, sometimes, and occasionally respectfully. Diploma graduates had 3.7 times good level of knowledge compared to graduates of Bachelor of Science (B.Sc.) with (adjusted odds ratio (AOR)=3.7 (1.23-11.33)). There was also statistically significant relationship between the years of service and their knowledge of partograph (AOR=0.25(0.11-0.6)). Conclusion: knowledge and utilization of partograph identified poor among obstetric care givers in Sidama zone. It needs crucial intervention to avert maternal mortality, thus all responsible bodies have to do much more to improve knowledge and skill gap of professionals and further investigation is recommended in wide range.

Effectiveness of Structured Teaching Programme on the Knowledge and Practice of Partograph among Nurse Midwives

Partograph is a graphical record used to monitor the progress of labour. It helps the caregiver to identify deviations from normal and make prompt decisions and interventions in treating complications related to labour. World Health Organization (WHO) recommends use of partograph to monitor all labour, still, it is not widely used in the developing world. Caregivers feel that completing the partograph is a time-consuming task. This study was undertaken with the aim to assess the effectiveness of structured teaching programme on knowledge and practice of partograph among nurse midwives working in labour room of a tertiary hospital. Knowledge was assessed using a self-administered questionnaire and a checklist was used to assess the practice of partograph among 51 nurse midwives. It was found that 74.5% of nurse midwives had moderately adequate knowledge and 52.9% of the nurse midwives had adequate knowledge before and after the structured teaching programme respectively. In regard to practice of partograph it was found that 62.7% of them had inadequate practice before the structured teaching programme. After the teaching programme it was found that 52.9% of the nurse midwives had moderately adequate practice. Practice was assessed three months after the structured teaching programme and it was found that 58.8% of them had moderately adequate practice. While comparing the knowledge and the skill before and after the intervention it was found that there was significant increase in knowledge and practice among the nurse midwives. It was also found that there was no significant correlation between knowledge and practice and also there was no association between knowledge, practice and the selected demographic variables. The findings of this study revealed that constant reinforcement and support with supervision will enable the nurse midwives to practice partograph adequately.

Is the Unavailability of Partograph a Reason for its Low Usage? The Case of Jimma University Medical Center

Background: Partograph is a pre-printed paper that provides a visual display of recorded observations carried out on mother and fetus during labor process. It enables health professionals to monitor feto-maternal wellbeing and progress of labor. It also alerts the care providers to take timely intervention when required. Despite its importance and WHO recommendation its utilization is inadequate in low and middle income countries. Therefore, the aim of this study is to explore barriers for utilization of partograph during labor delivery at Jimma University Medical Center 2017. Methods: A programmatic research design was employed. Data was collected through key informant interview and client record review. A purposive sampling technique was used to select the key informants and random sampling was used to select the client’s document. Data were collected using interview guide and check list for record review. Results: Data were analyzed qualitatively by means of the ATLAS.ti 7 software and four themes emerged namely, type of the institution, perception of care providers to ward partograph, previous trends, and absence of follow up and control mechanism. The study found that some health workers were more informed about the importance of partograph, others have negative attitude on its utilization. The study also revealed the use of partograph was determined by diverse factors like type of the institution, perception of care providers toward partograph, previous situation (trends), lack of controlling mechanism. Therefore, availing monitoring mechanisms and periodic review of trends of utilization reviewing trends, securing sufficient staffing, and training to brining all care providers under same umbrella as some of the health workers had little knowledge which was evidenced by record review and negative attitude are recommended.

Improvements in Essential Newborn Care and Newborn Resuscitation Services Following a Capacity Building and Quality Improvement Program in Three Districts of Uttar Pradesh, India.

Background:Neonatal death remains a global challenge contributing to 45% of underfive deaths. With rising institutional delivery, to accelerate decline in neonatal mortality rate (NMR) improvement in the quality of perinatal care requires attention.Objectives:This implementation research targeted improving service delivery readiness for quality of newborn care at public health facilities in three districts of Uttar Pradesh, India, with high NMR.Materials and Methods:This before-after study assessed the facility readiness and quality of newborn services at 42 health facilities. The changes in 26 signal functions for routine and emergency obstetric and newborn care were tracked.Results:There was marked improvement in newborn service availability: skilled birth attendants (51%), resuscitation (30%), and kangaroo mother care (27%) at these facilities. A multifold rise in newborn resuscitation efforts and documentation (n = 4431 vs. n = 144 in preintervention period) with high success rate (98.6%) was observed. There was also improvement in obstetric care services including partograph use (31%) and active management of third stage of labor (46%). However, several infrastructural indicators (electricity, water supply, toilets, and sanitation) remained unchanged.Conclusion:Overall improvements were observed in the majority of the signal functions for perinatal care and newborn resuscitation efforts. There was a limited impact on the infrastructural and supervision components.