Strengthening the use of partograph in high caseload public health facilities in India through an integrated quality improvement approach

Abstract

Background: The effective implementation of evidence-based practices including the use of partograph to improve maternal and newborn outcomes is critical on account of increased institutional delivery. However, despite clear guidelines, partograph use in India is not widely practiced. Materials and Methods: Quality improvement (QI) efforts along with training and mentoring were operationalized in a total of 141 facilities across 26 high priority districts of India. Assessments were conducted across baseline, intervention period, and end line. These included reviewing the availability of partograph and staff competency in filling them at baseline and end line, as well as reviewing monthly data for use and completeness of filling. The monthly data were tabulated quarter wise to study trends. Competency scores were tabulated to show the difference across assessments. Results: An overall upward trend from 29% to 61% was seen in the practice of partograph use. Simultaneously, completeness in filling up the partograph increased from 32% to 81%. Staff competency in filling partograph improved considerably: proportion of staff scoring low decreased over the intervention period from 63% to 2.5% ( P < 0.0001), and the proportion scoring high increased from 13% to 72% ( P < 0.0001) from baseline to end line. Conclusion: The integrated approach of training, mentoring, and QI can be used in similar settings to strengthen partograph use.

Estimating maternal mortality and identifying causes of maternal deaths in Jammu and Kashmir: a two-year epidemiological study

“…The age distribution is comparable to multiple previous studies which have also seen this age group contribute to most number of deaths. 19,30 As the death is related to pregnancy and child birth, the age at death is expected to be closely correlated with the marital norms in the community. Most of the women who died were literate with more than half of women having at least secondary level education.…”

“…Other studies have also concluded that the time around delivery and the period immediately after delivery is the most common time period for maternal deaths. 19,30 Keeping in view that almost all deliveries happen with health facilities, there is a great opportunity to address deaths during delivery and within the early post-natal period as the patient is under the care of health systems. Strengthening of health systems and provision of essential care around birth interventions can go a long way in further decreasing maternal mortality.…”

Utilization of Partograph for Labor Management Among Healthcare Providers in Healthcare Facilities in India: A Systematic Review

“…The identified challenges in the utilization of partographs encompassed multiple findings obtained from a comprehensive analysis of four scholarly articles. The foremost challenge entailed by healthcare providers was the unavailability of partographs [ 13 , 19 , 20 ], followed by shortages in healthcare providers [ 10 , 20 ], time-intensive processes [ 20 ], inadequate monitoring [ 13 , 19 ], insufficient knowledge and competence [ 13 , 19 , 20 ], limited training opportunities [ 13 ], and waste of time and effort [ 10 ].…”

“…The prevalent concern highlighted in these articles is the significant gaps in knowledge, practice, and attitude among nurse-midwives towards the utilization of partographs, and addressing these gaps is of utmost importance [ 8 - 17 ]. It has been proven in many studies that training and mentoring nurses increased their confidence to use and interpret partographs effectively [ 19 , 21 - 27 ]. The involvement of clinical mentors in monitoring and providing support has the potential to enhance the appropriate and consistent utilization of partographs by labor room nurses and midwives.…”

“…This review has identified that the foremost challenges or barriers among healthcare providers were the unavailability of partographs, a shortage of healthcare providers, insufficient knowledge and competence, and limited training opportunities [ 10 , 13 , 19 , 20 ]. A study suggested that the implementation of a hospital policy of routine plotting of partographs has the potential to enhance the utilization of partographs within tertiary care public hospitals in India [ 9 ].…”