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

Abstract

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.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-1760-y) contains supplementary material, which is available to authorized users.

Effectiveness of an Electronic Partogram: A Mixed-Method, Quasi-Experimental Study Among Skilled Birth Attendants in Kenya

“…Interviews confirmed the ease of entry with the ePartogram, and ePartogram users appreciated the drop-down menus, as also noted by Litwin et al 22 Further, interviewed in-charges and SBAs stressed that the ePartogram prompted action, and they discussed specific examples of the ease of use during labor management and decisions to refer the laboring client or operate.…”

“…The app can be tailored to the needs of the country by adding or removing clinical rules. The technical details of the ePartogram are described elsewhere 22 …”

“…The usability and functionality of the ePartogram underwent field validation exercises in Kenya and Tanzania and a feasibility study in Zanzibar 22 . Qualitative feedback from the Zanzibar study informed additional functional enhancements to the ePartogram, including the ability to print a paper record of the ePartogram, inclusion of a dashboard for supervisors and managers, the ability to digitally transfer the full labor record to referral sites, and use of more intuitive icons on the app.…”

“…Several developers have focused on low-cost digital applications to address deficiencies in the paper partograph, improve recordkeeping, support decision making, and enhance quality of care during labor and delivery 18 – 21 . In one of the first published evaluations of digital labor-support applications, Litwin et al reported on the use of an Android tablet-electronic partogram application (ePartogram) in Zanzibar 22 . Health workers quickly became competent and confident in using the ePartogram application on a tablet and believed its use improved timeliness of care and supported decision making.…”

Score Detection and Anemia Education Prospective Bridals Using Android Based Macca Botting Application

“…The mobile smartphone application is more accessible to the public, especially women of childbearing age because it has several advantages, including speed and accuracy in making decisions and as a good data storage medium (Hidayah, Nurazizah, and Rahmawati 2019). In addition it has the ability to interpret and act on reminders and can detect differences over time (monitoring behavior change) (Litwin et al 2018). In Indonesia the anemia application has been successfully made by Hamid et al (2020), this application has an early detection feature of anemia, but the application is still in the design stage and has not been tested in the community (Hamid et al 2020).…”