Barriers to and incentives for achieving partograph use in obstetric practice in low- and middle-income countries: a systematic review

Abstract

BackgroundThe partograph is a graphic display of the progress of labour, recommended by the World Health Organization, but often underused in practice in low- and middle-income countries. We were interested in going beyond demonstration of potential efficacy – on which the existing literature concentrates - through a systematic review to identify barriers to and incentives for achieving partograph use.MethodsWe searched Ovid MEDLINE, Ovid Maternity and Infant Care, POPLINE, Web of Science, and Scopus, from 1st January 1994 to 30th September 2013, using the term ‘partogra*’ to include ‘partograph’, ‘partogram’, or ‘partogramme’. The selection criteria were for primary or secondary research describing barriers to and incentives for partograph use in low- and middle-income countries, in English, reported in peer-reviewed publications since 1994. Thematic analysis of text on partograph use was applied to a commonly used framework for change in clinical practice, with levels describing the innovation, the individual professional, the woman, and social, organisational, economic and political contexts.ResultsReported barriers to and incentives for partograph use related to the partograph itself, professional skills and practice, clinical leadership and quality assurance, and the organisational environment within the wider provision of obstetric care. Neither the evidence base for its effectiveness, nor its credibility, was reported as a barrier to use.ConclusionIdentifying and addressing local barriers and incentives in low- and middle-income countries, based on those in published research, could inform strategies to improve partograph use. Emerging technologies could be used to address some barriers. The thresholds for essential maternity care at which the partograph adds value should be further evaluated.

Evaluation of Factors Affecting the Utilization of Partograph by Nurses/ Midwives in Primary/Secondary Health Facilities in Enugu Metropolis

“…This implies that provision of enabling environment such as provision of partograph chart and observation tools may make the nurses /midwives to use the partograph if they are skilled as they implicated non availability of resources as determinant of their non-utilization of the partograph. This agreed with Ollerhead and Osrin [15] who included clinical leadership and quality assurance, as well as organizational environment as part of the barriers to use of partograph.…”

“…The same study found out that non -availability of partograph charts in labour wards and poor knowledge of the partograph were factors affecting its use. Ollerhead and Osri [15] included clinical leadership and quality assurance, as well as organizational environment as part of the barriers to use of partograph.…”

Improving institutional childbirth services in rural Southern Tanzania: a qualitative study of healthcare workers’ perspective

“…[34][35][36] A partograph is a graphic display of the progress of labour, which helps skilled birth attendants to recognise emerging difficulties and take action according to a clinical management protocol. 37 The overall health facility deliveries improved by 46% from a median of 110 to 161 deliveries per month in a collaborative of 23 health facilities from February 2010 to June 2011. The target was to achieve a median of 220 deliveries per month.…”

Comparative Analysis of Life Curve Mobile Application: an Easier Alternative to Existing Traditional Paper Partograph

“…Overburdened health systems in Bangladesh are often unable to supply the administrative and organizational support needed for proper and consistent use of the partograph. Shortage of trained personnel 31 who are competent in labor management and inadequate referral systems for women in labor who experience complications are more evident in low resource countries. Moreover, the tool itself may present difficulties for health care providers as they lack the underlying knowledge and skills that is required for proper monitoring of the patient, drawing of the partograph with the findings and ultimately manual interpretation of data.…”

“…Trainers and supervisors must recognize that, while the partograph appears to be simple, it assumes a foundation of knowledge and skills in assessment of labor, gathering of data, presentation and interpretation of data are also essential 31 . Every facility that serves laboring women must have clearly articulated protocols of care that is synchronized with the partograph.…”