Partograph chart use among obstetric caregivers in public
Partograph chart use among obstetric caregivers in public health institutions of West Showa Zone, Oromia Regional State, Ethiopia Wakeshi Willi, Mitike Molla
Introduction § Obstructed labor accounted for (8%) of maternal deaths globally. § This is related to the three delays (at home, on the way and at facility) § Structurally, health centers are the first contact point for delivery § Health centers do not have the capacity to mange complicated labor § Understanding this the Mo. H introduced tools that could help to identify critical time for action during labor § One of the tools to this end is partograph § A partograph is a pre-printed paper that provides a visual display of recorded observations carried out on a laboring woman and fetus 2
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Objectives General objective To assess the magnitude of partograph use and factors that affect its utilization among obstetric caregivers in public health institutions of West Showa Zone. Specific objectives: ØTo identify the extent use of partograph use by obstetric staff working in maternity units of public health institutions of WSZ ØTo identify factors influencing the use of partograph in maternity units of public health institutions of WSZ 4
Methods Study Area: The study was conducted in public health institution West Shoa Zone of Oromia Region (Ambo, Toke kutaye and Chelia districts). Study Design and Period A mixed method research (quantitative and qualitative), institution Sample size determination: Quantitative study: ØSingle population proportion formula was used P= 57% (AA study) D=0. 05 , CL=95% Using population correction SS=266 formula and 10% contingency 5
Methods… Sampling procedure • Two hospitals and five PHCUs were selected among three hospitals and 89 PHCUs in the study zone • The PHCUs were selected purposively based on client flow • The number of participants were allocated proportionate to size and each participant was selected randomly Qualitative study: In-depth interview were conducted among purposely selected 14 key informants. Data collectors: Five nurses who were working at Ambo University • Supervised by principal investigator and one health officer. Qualitative data: Interviews were conducted by the principal 6
Methods… Data processing and Analysis • Data were coded, entered and cleaned by using Epi info. and analyzed using SPSS version 16. Descriptive statistic & multivariate logistic regression analysis was conducted Measurement: • Partograph use: was measured based on routine use of the tool for all laboring women • Knowledge: those who scored above mean score= good knowledge; below the mean = poor knowledge • Attitudes: Obstetric care providers whose attitude score towards partograph use is above the mean value= positive attitude. 7
Results and discussions Socio-demographic characteristics of obstetric care providers in West Shoa Zone, Oromia Ethiopia, 2015 (n=259) Variable Number Percent Male 96 37. 1 Female 163 62. 9 Sex Age category of the respondent 20 -24 140 54. 1 25 -29 76 29. 3 30 -34 37 14. 3 35 -39 2 0. 8 >40 4 1. 5 Respondent place of work Hospital Heath Center 101 158 39. 0 61. 0 8
Result and discussion … Partograph use: • Majority 219 (84. 6%) of obstetric care providers were using partograph chart to follow a laboring women • Practice: 44 clients were observed directly in the sampled health institutions, only five out of fifteen parameters on the partograph chart were completed • Knowledge: Majority 194 (74. 9%) knew when to start plotting according to WHO partograph use. 9
Factors associated with partograph utilization of obstetric care giver in public health institution in west Showa, Oromia, Ethiopia; 2015 Variables Partograph Use Crude OR (95%CI) AOR (95%CI) Yes No No (%) <5 year 186(71. 8) 15 (5. 8) 7(2. 5 -19. 5) 6(1. 8 -19. 9)* 5 -10 years 19 (7. 3) 17(6. 6) 0. 6(0. 22 -1. 9) 0. 6(0. 17 -2. 4) >10 year 8(3. 1) 14(5. 4) 1. 00 Midwifery 138((53. 3) 38(14. 7) 11(2. 6 -47. 5) 18 (2. 9 -113)* Others** 81(31. 3) 2(0. 8) 1. 00 Hospital 70(27) 31(12) 4(1. 4 -11. 3) 0. 09(0. 03 -0. 26)* PHCU 149(57. 5) 9(3. 5) 1. 00 192(74. 1) 27(10. 4) 3. 4(1. 59 -7. 4) 8. 8(2. 8 -27. 6)* 27(10. 4) 13(5) 1. 00 Yes 158(61) 61(23. 6) 0. 98(0. 46 -2. 0) 0. 33(0. 7 -1. 6) No 29(11. 2) 11(4. 2) 1. 00 Services year Profession Work place Availability of partograph Yes No Training 10
Result and discussion… • In multivariate analysis, profession of obstetric care provider was one of the factors for partograph use, Midwives and nurses (AOR=18, CI=2. 9 -113), . were using partograph than general practitioner and health officers. • Health provider who served less than 5 yrs were 6 times more likely to use partograph (AOR=6 (1. 8 -19. 9) • Availability of the partograpgh (AOR=8. 8, CI: 2. 8 -27. 6) also associated with the tool utilization. • 11
Results… Attitude of respondent toward partograph use Ø More than half of the respondent strongly agree that partograph use: Ø Is beneficial to identify problems and recognize complications Ø It alerts obstetric care givers of any deviation from normal and Ø Enables to perform essential basic interventions Ø On the other hand 142(54. 8%) and 139(53. 7%) agreed that partograph use is not useful as its the estimate is exaggerated, and misleads management of the progress of labor. . While the condition of both mother and fetus are in normal, the chart reachs the alert line 12
Conclusion v. This study found out that, labor follow-up is incomplete as only some items were filled. v. This will affect proper identification of the action line which will farther affect maternal and fetal outcome. v. Questioning the accuracy of the measurement by HPs is a huge concern that needs further work Strength and limitation of the study • Strength: Method triangulation using both qualitative and quantitative • Limitation: : Small sample size hampers the precision of some associations 13
Recommendation Ø To West Shoa Zonal health Bureau – The WHO standards for recording in the partograph should be accessible to all institutions. Ø To stakeholders – Monitoring and supervision of obstetric staff to ensure appropriate use of the partograph should be given highest priority. – A provision of on-job training on partograph use is mandatory. Ø To obstetric care providers – The partograph should be used for every woman in labor. – There is a need for commitment by the obstetric care providers’ team to the use of the partograph. Ø Research - Further study is recommended to see the accuracy of measurements among Ethiopians 14
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