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.
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Date
2017-07
Authors
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Journal ISSN
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Publisher
Hubert Kairuki Memorial University
Abstract
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.
Description
A dissertation submitted in partial fulfillment of the requirements for the degree of
Master of Medicine in Obstetrics and Gynaecology of Hubert Kairuki Memorial
University
Keywords
Partograph, Labour, Dar es salaam
Citation
Chugulu, G. W., 2017. Assessment of the filling of partograph in monitoring progress of labour in selected hospitals in Dar es salaam from October 2016 to 30™ March 2017.HKMU