Directorate of Postgraduate Studies

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Browsing Directorate of Postgraduate Studies by Author "Chugulu, George W."

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    Assessment of the filling of partograph in monitoring progress of labour in selected hospitals in Dar es salaam from October 2016 to 30th March 2017.
    (Hubert Kairuki Memorial University, 2017-07) Chugulu, George W.
    Background: To reduce prolonged and obstructed labor and consequently maternal and perinatal mortality, the WHO recommends the use of partograph so as to help obstretric care givers to make early diagnosis and management of prolonged and obstructed labor. The complete filled partograph helps to alert obstretric care providers to take an immediate action for any deviation from normal. However, the tool is not widely used as it should be. Objectives: The aim of this study is to assess the filling of partograph in monitoring progress of labour in selected hospitals in Dar es Salaam Methodology; This was a cross section study which involved the reviewing of partograph fillings in selected hospitals from 1 October 2016 to 3 March 2017 in four selected health facilities from Temeke and Kinondoni districts. A total of 359 partographs were reviewed and information from them regarding the component of progress of labour was recorded. Also, it involved conducting direct interviews of 87 obstetric care givers to determine the common reasons for improper filling of partograph in their respective hospitals. Data was managed and analyzed in a computer through a statistical package for social science (SPSS) version 20. 0. Descriptive statistics were summarized as percentages and presented as frequency tables and cross tabulations. Chi- square or Fisher's exact was employed as a test for association and statistical significance was accepted at p-values of <0.05. Results: A total of 359 partographs of women delivery at four health facilities were sampled and reviewed and a total of 87 obstetric care givers giving the response rate of 87/100 (87%) consented and participated in this study. The mean age and standard deviation (SD) in bracket of the obstetric care givers was 34.6 (8.9) years. More than half of the care givers were recruited from Temeke district (55.2%) About two thirds (69.4%) of the partographs were incompletely filled. The proportion of incompletely filled partograph was significantly high at district hospital than regional hospital level (81.6% vs. 60.4%). Checking and recording blood pressure (88.4% vs. 14.6%, p<0.0001), descent ofthe baby (18.2% vs 10.7%, p=0.029) and assessment of the cervix in 4hours interval (31.5% vs 9.6%, p<0.0001) were partograph's parameters which were significantly not filled in Kinondoni district than the counterpart district. Recording of fetal heart rate at least once in Ihour interval was significantly not done at district hospital than at regional referral hospital level (48.7% vs 9.2%, p<0.0001). The most given reasons by care givers for improper filling partographs included negligence/negative attitude of obstetric care givers 69(79.3%), the tool was time consuming 51(58.6%) and inadequate knowledge on filling the partographs 37(42.5%) while others were shortage of stuffs 20(23%) and unavailability of partographs 16(18.4%). The care givers from district hospital significantly considered filling partograph as time consuming than those from regional referral hospital level (78.9% vs 42.9%, p<0.001) Conclusion: Improper filling of partographs in monitoring progress of labour was still a major problem in our health facilities which has led to poor fetal and maternal outcomes. Information such as uterine contraction, fetal decent and fetal heart rate monitoring had been highly missing in partographs compared to other parameters. Negligence/negative altitude towards feeling of partographs was the leading common reason for improper filling of partograph mentioned by majority of obstetric care givers. Recommendation: • Strong ethical measures should be taken to all medical personnel contributing to negligence of filling of partographs. • Frequent trainings to obstetric care givers on the use and proper filling of the partograph must conducted to cover new care givers with less knowledge and remind the others. • Further studies assessing negligence/negative attitude of obstetric care givers toward effective utilization of partographs should be conducted since it's among the most common reason for improper filing of partographs.