Partograph use among skilled birth attendants in selected counties, Western Kenya

Abstract

Participants was 35.3 (standard deviation: 7.1) years. The demographics (98%), foetal heart rate (80.5%), temperature, pulse and respiratory (74.5%) and maternal blood pressure (73.2%) section of the partograph were the most charted. The least charted sections were foetal descent (19.5%), cervical dilatation (21.5%) and uterine contractions (24.8%). Use of the partograph was associated with the female gender with a 58% (aOR: 0.42. 95% CI: 0.19-0.91) lower odds compared to male nurses. The findings highlight a persistent gap in the use of the partograph in Kenya despite the recent countrywide BEmONC training. There is a need for enhanced on-job training for nurses and midwives on the use of the partograph but also a need to explore the possibility of using the electronic partograph that are effective in reducing adverse foetal outcomes and improve adherence to labour care and strengthen routine support supervision to review nurses-midwives in the use of the partograph. In low resource setting, the completion rate of partograph is low despite heavy investment in training of healthcare workers on Basic Emergency Obstetric and Neonatal Care (BEmONC), which promotes the use of partographs to monitor the progress of labour. In Kenya, the rate of caesarean section, instrumental delivery and APGAR score less than 7 at 1 min has increased. Therefore, this study determined the extent of use of partograph as a tool for monitoring the progress of the mother and the foetus during labour in selected Western counties in Kenya. This cross-sectional study was conducted in Kisumu and Vihiga counties in Western Kenya between May and June 2019. Validated self-administered questionnaires and checklists were used to collect data from participants and randomly chosen participant-filled partograph. Sample characteristic and extent of use of partograph were described using frequencies and percentages while factors associated with partograph use were assessed using multivariable logistic regression. Statistical significance was set at p<0.05. Out of 149 participants, 104 (69.8%) were female, 144 (96.6%) were nurses, 52% worked in health centres, 37% had worked for seven or more years and trained on BEmONC within 1 to 2 years.