Low Utilization of Partograph and Its Associated Factors among Obstetric Care Providers in Governmental Health Facilities at West Shoa Zone, Central Ethiopia

Abstract

Background. Globally, prolonged and obstructed labors were among the common causes of maternal morbidity and mortality in low- and middle-income countries including Ethiopia. The World Health Organization (WHO) recommends the routine use of partograph as a key intervention to avoid prolonged and obstructed labor. Despite the recommendation, studies indicated that the partograph utilization among obstetric care providers (OCPs) is still low. Therefore, this study is aimed at assessing the level of utilization of partograph and associated factors among obstetric care providers working at health facilities in the West Shoa Zone, Central Ethiopia 2019. Methods. Facility-based cross-sectional study was conducted from February 1st to 22nd March 2019. A computer-generated simple random sampling technique was used to select 325 study subjects. Data were collected using a self-administered structured questionnaire and using an observational checklist. Additionally, 200 partograph charts were reviewed. Both bivariate and multivariable logistic regression analyses were used to determine the association. Results. A total of 322 obstetric care providers were included in the study, giving a response rate of 99.1%. The level of partograph utilization in the study area was revealed to be 31.1% (95% CI: 25.97-36.13). Only 3% of the reviewed partograph was recorded according to the recommended standard. In this study attending training (AOR=3.94, 95% CI: 1.99-7.78), availability of partograph (AOR=5.23, 95% CI: 1.69-16.22), perceived as not time-consuming task (AOR=3.61, 95% CI: 1.19-10.96), adequate number of OCPs available (AOR=2.92, 95% CI: 1.16-7.33), presence of supervision (AOR=4.35, 95% CI: 2.11-8.97), having a positive attitude (AOR=2.48, 95% CI: 1.23-5.02), availability of standard protocol in a health facility (AOR=4.71, 95% CI: 2.31-9.60), and lack of commitment (AOR=0.32, 95% CI: 0.16-0.63) were factors significantly associated with partograph utilization. Conclusion and Recommendation. Partograph utilization in the study area was found to be low. Almost all reviewed partograph charts were not recorded as to the recommended standard. Attending training, availability of partograph, perceived as it is not time-consuming, the available number of OCPs, presence of supervision, having a positive attitude, available standard protocol, and commitment were factors associated with partograph utilization. Therefore, all concerned stakeholders should emphatically consider those identified factors for intervention.

Utilization of partograph and its associated factors among obstetric caregivers in public health institutions of Southwest Ethiopia

“…But it is lower than simiar study conducted in Tigray, Oromia and SNNPRE [ 10 – 14 , 16 ]. However, this finding was higher than a similar study conducted in cameron, Nigeria and West Shoa zone of oromia [ 6 , 8 , 9 ]. These differences could be due to the socio-political and economic differences of the studied area and also due to professional differences as indicated in some studies, only midwifery caregivers were studied [ 7 , 11 ].…”

“…According to different studies done in Ethiopia the magnitude of the utilization of partograph shown to have a wide variation from region to region and across zones of the same region [ 9 – 18 ]. Studies from the Central and Eastern zone of Tigray regional state reported the highest level of utilization from around 70 to 83 % [ 10 , 13 ].…”

“…Studies from the Central and Eastern zone of Tigray regional state reported the highest level of utilization from around 70 to 83 % [ 10 , 13 ]. While a study from the west shoa zone of Oromiya regional state reported the lowest utilization of partograph which was 31 % [ 9 ]. The magnitude of utilization of partograph in others region such as East Gojam Amhara Region, was 53 % [ 19 ], in SNNPRE Hadiya zone 54 %, and Wolayita Zone 71 % [ 12 , 17 ].…”

“…In Addis Ababa, 57 to 69 % of obstetric caregivers utilized partograph routinely [ 11 , 16 ]. The largest diference in the utilization of partograph is seen in different zones of Oromia region ranging from 31, to 71 % [ 9 ].…”

WHO next‐generation partograph: revolutionary steps towards individualised labour care

“…Despite its global acceptance, utilisation and correct completion rates as low as 31 and 3%, respectively, have been reported. 4 Following the update of its global recommendations on intrapartum care in 2018, 5 the WHO initiated a process to revise the partograph in light of recent evidence, including a new understanding of the individual variability of the progress of labours resulting in good perinatal outcomes, and the fact that many women do not experience a labour that conforms to the average rate on which the partograph design was based. 6,7 A large study and corresponding systematic reviews published in this journal [8][9][10] and subsequent analysis 11 failed to find evidence to support the use of a cervical dilatation rate of 1 cm/hour as a screening tool to predict adverse labour outcomes.…”