Use and documentation of Partograph in urban hospitals in Lilongwe - Malawi : health workers perspective : A cross sectional study on use and documentation of partograph and factors that prevent optimal utilization of the partograph : perspectives of health workers at Bwaila and Ethel Mutharika Maternity Units in Lilongwe - Malawi

Abstract

Background: A partograph is a pre-printed paper that provides a visual display of recorded observations carried out on mother and foetus during labour. It is universally used as part of Safe motherhood initiative for improving labour management and reducing maternal and foetal morbidity and mortality. The partograph is used to identify abnormal labours which are the cause of problems that lead to morbidity and mortality. However, most parameters on the partograph are not monitored and most health care workers do not document their findings on the partograph after reviewing a woman in labour. Hence the progress of labour may not be closely monitored or labour monitoring may not translate into actions required when need arise. In Malawi, factors that influence partograph use at Ethel Mutharika and Bwaila Maternity Units in Lilongwe, Malawi were not known. Aim: The aim was to assess the use of the partograph and its effects on the maternal and foetal outcomes. Materials and Method: A cross sectional study which used a ‘mixed methods’ approach. The quantitative study used a structured questionnaire to collect data from the partographs retrospectively. The qualitative study consisted of 20 interviews with clinicians and nurse midwives and 4 focus group discussions with nurse midwives Findings: The analysis of the quantitative data showed that the partograph was improperly utilized. Only 3.9% of 464 partographs were correctly filled in. A strong association was found between monitoring FHR and method of delivery but also between FHR and foetal outcomes (p<0.01). We also found a strong association between monitoring descent and method of delivery but also between descent and foetal outcomes (p<0.01). The odds of foetal deaths were reduced by 59.6% if FHR was monitored. The qualitative component demonstrated that the barriers to use of the partograph included shortage of staff with high workload, negligence, inadequate supervision and lack of motivation. Conclusion and recommendation: The partograph was not optimally used, evidenced by incomplete documentation with only 3.9% partographs correctly documented and less than 5% on all parameters on partograph being properly filled in. There was no difference in performance in the two units. Time spent in labour by the women did not influence the amount to which they were observed. The study shows that there is a strong association between monitoring foetal heart rate, descent and method of delivery; and between monitoring foetal heart rate, descent and foetal outcomes. Monitoring of foetal heart rate also reduced the odds of death in the foetus as well as monitoring of descent. The findings indicate the foetal heart rate and descent are the common but also most important parameters influencing the labour outcomes. Further study is required to assess the complexity of the atmosphere where the partograph is used and documented by the method of participant observation. Key words: partograph, partograph utilization, labor management tool, progress of labor, birth complications, maternal and perinatal morbidity and mortality, Malawi.