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

Ayenew, Asteray Assmie; Zewdu, Biruk Ferede

doi:10.21203/rs.3.rs-30599/v3

Cited by 2 publications

(2 citation statements)

References 27 publications

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“…Showing an overall low initial utilization of the partogram. Utilisation of the partogram is low in most countries as highlighted out by 13 , 14 . From our Study: trainings, supervision, provision of the partographs and QI projects improved partograph utilization from 3% to 80% in one year, these interventions were also found to improve partograph utilization in other parts of the country 15 Regarding monitoring during the progression of labour, the study highlighted a concerning trend of decreasing monitoring rates with subsequent monitoring times.…”

Section: Discussionmentioning

confidence: 99%

Bridging the Gap: Leveraging Partograph Utilization Insights to Facilitate the Smooth Implementation of the Labour Care Guide at Mbale Regional Referral Hospital, Eastern, Uganda

KIBUUKA,

Apoya,

Nsubuga

et al. 2023

Preprint

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Introduction: Maternal and newborn care has seen significant advancements through evidence-based guidelines, including the labour care guide introduced by the World Health Organization (WHO). However, the successful implementation of these guidelines relies on analysing the level of effective utilization of tools such as the partogram. In this study, we aim to assess the effects of a QI project aimed at improving the utilization of the partogram, and the current level of its utilization at Mbale Regional Referral Hospital, Uganda, and identify the possible challenges in its use and design effective procedures in rolling out of the labour care guide into existing clinical practices. Methodology: A retrospective study combining quantitative and qualitative approaches was conducted. In March 2021 200 files were randomly sampled and checked for presence or absence of a partograph and this formed the baseline data before starting a QI project to improve utilization of a partograph to improve partograph utilization. In March 2023, 1120 patient files were reviewed from deliveries that happened between April to December 2022, these were analyzed to determine the presence or absence of a partogram in the file and the level of utilization. 6 key informant interviews were also conducted with healthcare workers to explore factors influencing partograph utilization and recommendations. Results: While certain mothers’ particulars were well-documented, critical information such as LNMP, EDD, and risk factors displayed higher rates of missing data. Monitoring rates decreased with subsequent times with an average level of partograph utilization of 39%. The presence of a partograph in patients’ files improved from 3% in March 2021 to 80% from April to December 2022. Key informant interviews revealed challenges related to heavy workload, inadequate human resources, poor attitudes towards partograph utilization, knowledge gaps, and policy-related issues. Conclusions: The level of partograph utilization at Mbale Regional Referral Hospital remains suboptimal (<50%), Which could hinder the successful rolling out of the LCG. Addressing the identified challenges is essential for improving maternal and newborn care practices. With the above insights in mind and with support from Seed Global Health, the team is set to effectively change its goal from improving the level of utilization, which improved from 3% to 80%, towards rolling out the LCG. Recommendations: To enhance partograph utilization and facilitate the smooth implementation of the labour care guide, we recommend increasing human resources, providing targeted training and education, improving hospital infrastructure, fostering positive attitudes among healthcare workers, and implementing continuous quality improvement programs.

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Section: Discussionmentioning

confidence: 99%

Bridging the Gap: Leveraging Partograph Utilization Insights to Facilitate the Smooth Implementation of the Labour Care Guide at Mbale Regional Referral Hospital, Eastern, Uganda

KIBUUKA,

Apoya,

Nsubuga

et al. 2023

Preprint

View full text Add to dashboard Cite

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“…Inadequate provider training and skills, heavy staff workloads, a lack of clinical equipment and supplies, and restrictive hospital policies are known barriers to partograph use. (15)(16)(17) In 2018, WHO published 56 updated recommendations to improve quality of intrapartum care and enhance women's childbirth experiences. (8) Key recommendations included changing the definition of active first stage of labour from the widely used 3cm or 4cm to starting from 5cm of cervical dilation, and removal of the 'alert' and 'action' lines.…”

Section: Mainmentioning

confidence: 99%

Effects of introducing the WHO Labour Care Guide on Caesarean section: a pragmatic, stepped-wedge, cluster randomized trial in India

Vogel

Pujar

Vernekar

et al. 2023

Preprint

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The World Health Organization’s Labour Care Guide (LCG) is the “next generation” partograph, designed to improve the quality of intrapartum care and enhance women’s experiences. However, the effects of the LCG on maternal and newborn outcomes have not been evaluated. We developed a novel strategy to introduce the LCG into routine intrapartum care, comprising a co-designed training program for labour ward clinicians, alongside monthly audit and feedback. We implemented the strategy and measured its effects using a stepped-wedge, randomised trial in four hospitals in India. We captured data from 26,331 women who gave birth at >=20 weeks’ gestation, over a 54-week period. Following implementation, a 5.5% crude absolute reduction in the Caesarean section rate amongst women in Robson Group 1 was observed (45.2% vs 39.7%; relative risk 0.85, 95% confidence interval 0.54-1.33). Maternal process-of-care measures were not significantly different, though labour augmentation with oxytocin was 18.0% lower with the LCG strategy. No differences were observed for maternal, fetal or newborn health outcomes, or women’s birth experiences. This “proof of concept” study provides important evidence on the effects of introducing LCG into routine practice, suggesting a 15% relative risk reduction in Caesarean section use amongst women in Robson Group 1. Larger trials are warranted, particularly in settings where urgent reversal of the Caesarean section epidemic is needed.

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

Cited by 2 publications

References 27 publications

Bridging the Gap: Leveraging Partograph Utilization Insights to Facilitate the Smooth Implementation of the Labour Care Guide at Mbale Regional Referral Hospital, Eastern, Uganda

Bridging the Gap: Leveraging Partograph Utilization Insights to Facilitate the Smooth Implementation of the Labour Care Guide at Mbale Regional Referral Hospital, Eastern, Uganda

Effects of introducing the WHO Labour Care Guide on Caesarean section: a pragmatic, stepped-wedge, cluster randomized trial in India

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