By

Engida YismaSchool of Allied Health Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia

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BackgroundPartograph is a single sheet of paper;

Includes information about the foetus’ heart rate, uterine contractions, cervical dilation and other important factors.

The modified WHO partograph defines the beginning of the active phase at 4 cm cervical dilatation [1].

A study conducted in Addis Ababa showed that over half (57.3%) of the obstetric care givers reported use of the modified WHO partograph to monitor mothers in labour [2].

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3Modified WHO

partograph

ObjectivesGeneral objectiveTo assess completion of the modified WHO partographs for mothers in labour in public health institutions of Addis Ababa, Ethiopia from December 2011—February 2012.

Specific objectivesTo describe extent to which each parameters were recorded on the partographsTo assess correct completion of the partographs

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MethodsStudy Period & Area

•February 28 to March 30, 2012 in Addis Ababa, Ethiopia

Study DesignA descriptive study based on a retrospective document review

PopulationThe source population comprised all the modified WHO partographs that had been used to monitor labour in public health institutions of Addis Ababa from December 2011—February 2012. Study subjects were comprised of a random sample of the modified WHO partographs.

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Inclusion & exclusion criteria Included all the modified WHO partographs having complete

or partially complete information

And excluded those modified WHO partographs which had records of mothers who were admitted in second stage of labour.

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Sampling method Sample size determination

P is the estimate of the proportion of the modified WHO partographs (assumed to be 24% as obtained from a previous study) [3].

Due to multistage nature of the study, a design effect 1.5 was considered.

And accordingly, the final sample size was 420 modified WHO partographs.

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Public health institutions in Addis Ababa, Ethiopia

Yekatit 12

hospital

Gandhi Memorial

hospital

Lideta health centre

Kotebe health centre

Gulele health centre

234 partograph

s

420 Modified WHO partographs

114 partographs

17

partographs

28

partographss

27

partographs

Data collectionA pre-tested and structured checklistStandard protocols which were defined based on the time

inter val as follows were used [4]:-

1)Cervical dilatation, moulding, descent of head and BP monitored every four hours;

2)Foetal heart rate, maternal pulse and uterine contractions monitored every 30 minutes;

3)Condition of the baby after birth should always be recorded on the card.

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Data collection cont…Records not meeting any one of the protocol standards or with

parts misplaced/missing or inadequate for each parameter of the partograph were judged as substandard,

Or not recorded if no information was documented on each parameters of the partograph

And standard if all the criteria are met for each parameter on the partograph.

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Data analysisData was entered using the software Epi Info version 3.5.1 and

then exported to SPSS version 16 for further analysis.

Frequency distributions, cross-tabulations and a graph were

used to describe the variables of the study.

Ethical clearanceConducted after obtaining ethical clearance from the ethical

review committee of the Department of Nursing and Midwifery of Addis Ababa University

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Results and discussion 420 of the modified WHO partographs that had been used for

labour management in 5 health facilities during the period of this study were reviewed.

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Table 1: Recording of parameters of feotal and maternal wellbeing, public health institutions of Addis Ababa, December 2011—February 2012

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Parameters of labour Frequency (n=420) %

Feotal heart rate

Not recorded 174 41.4

Substandard 117 27.9

Monitored to Standard 129 30.7

Moulding

Not recorded 364 86.7

Substandard 26 6.2

Monitored to Standard 30 7.1

Was the status of membranes recorded?

Yes 113 26.9

No 307 73.1

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Parameters of labour Frequency (n=420) %

Descent of foetal head

Not recorded 353 84.0

Substandard 38 9.0

Monitored to Standard 29 6.9

Cervical dilatation

Not recorded 172 41.0

Substandard 110 26.2

Monitored to Standard 138 32.9

Uterine contraction

Not recorded 189 45.0

Substandard 144 34.3

Monitored to Standard 87 20.7

Action line crossed (n=138)

Yes 15 10.9

No 123 89.1

Blood pressure

Not recorded 203 48.3

Substandard 139 33.1

Monitored to Standard 78 18.6

Condition of the baby after birth

Not recorded 17 4.0

Recorded

Good (Apgar score 7- 10) 333 79.3

Not good (Apgar score 1-6) 57 13.6

Still birth 13 3.1

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Figure 2 Proportions of partographs on which parameters were recorded to standard, public health institutions of Addis Ababa, December 2011—February 2012.

Results and discussion cont…In this study only 32.9%, 30.70% and 20.70% of the foetal

heart rate, cervical dilation and uterine contraction respectively were recorded according to the standard protocol.

These findings are similar with studies done in Tanzania, Uganda and Benin [4-6]

This necessitates the need for regular pre-service and on-job training of obstetric care givers & mandatory health facility policy on the completion of the partograph

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ConclusionsThe present study showed a poor completion of the modified

WHO partographs during labour in public health institutions of Addis Ababa, Ethiopia.

The findings may reflect poor management of labour or simply inappropriate completion of the instrument.

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RecommendationsPre-service and periodic on-job training of health workers on

the completion of the partograph; Regular supportive supervision; Provision of guidelines;And mandatory health facility policy are recommended.

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Acknowledgments

WHO, Ethiopia

Hirut Gemeda

Mohammed Seid

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Disclaimer

This PowerPoint presentation is produced based on a published research article; “Yisma E, Dessalegn B, Astatkie A, Fesseha N: Completion of the modified World Health Organization (WHO) partograph during labour in public health institutions of Addis Ababa, Ethiopia. Reproductive Health 2013 10:23.” (http://www.reproductive-health journal.com/content/10/1/23).

The authors declare that they have no competing interests.

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References1. Levin K, Kabagema Jd A: Use of the partograph: effectiveness, training,

modifications, and barriers—a literature review. New York: Engender Health/Fistula Care; 2011

2. Yisma E, Dessalegn B, Astatkie A, Fesseha N: Knowledge and utilization of partograph among obstetric care givers in public health institutions of Addis Ababa, Ethiopia. BMC Pregnancy Childbirth 2013,13:17.

3. Mugerwa KY, Namagembe I., OnongeS.,OmoniG.,MwuivaM.,WasicheJ., Masbayi V, (2008) “unpublished observations”

4. Nyamtema AS, Urassa DP, Massawe S, Massawe A, Lindmark G, Van Roosmalen J:Partogram use in the Dares Salaam perinatal care study. Int J Gynaecolgy Obstetrics 2008,100:37–40

5. Ogwang S, Karyabakabo Z, Rutebemberwa E: Assessment of partogram use during labour in rujumbura health Sub district, Rukungiri district, Uganda. Afr Health Sci 2009, 9 (Suppl1):27–34.

6. Azandegbe N, Testa J, Makoutode M: Assessment of partogram utilization in Benin [article in French]. Sante 2004,14:251–255.

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