By
Engida Yisma
School of Allied Health Sciences, College of Health
Sciences, Addis Ababa University, Addis Ababa,
Ethiopia
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Background
 Partograph is a single sheet of paper;
 Includes information about the foetus’ heart rate, uterine
contractions, cervical dilation and other important factors.
 The modified WHO partograph defines the beginning of the
active phase at 4 cm cervical dilatation [1].
 A study conducted in Addis Ababa showed that over half
(57.3%) of the obstetric care givers reported use of the
modified WHO partograph to monitor mothers in labour [2].
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Modified WHO partograph
Objectives
General objective
 To assess completion of the modified WHO partographs for
mothers in labour in public health institutions of Addis Ababa,
Ethiopia from December 2011—February 2012.
Specific objectives
 To describe extent to which each parameters were recorded on
the partographs
 To assess correct completion of the partographs
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Methods
Study Period & Area
• February 28 to March 30, 2012 in Addis Ababa, Ethiopia
Study Design
 A descriptive study based on a retrospective document review
Population
 The source population comprised all the modified WHO partographs
that had been used to monitor labour in public health institutions of
Addis Ababa from December 2011—February 2012.
 Study subjects were comprised of a random sample of the modified
WHO partographs.
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Inclusion & exclusion criteria
 Included all the modified WHO partographs having complete
or partially complete information
 And excluded those modified WHO partographs which had
records of mothers who were admitted in second stage of
labour.
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Sampling method
 Sample size determination
 P is the estimate of the proportion of the modified WHO
partographs (assumed to be 24% as obtained from a previous
study) [3].
 Due to multistage nature of the study, a design effect 1.5 was
considered.
 And accordingly, the final sample size was 420 modified
WHO partographs.
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Public health institutions in Addis
Ababa, Ethiopia
Gandhi
Memorial
hospital
Yekatit 12
hospital
234
114
partograph
s
partographs
Lideta
health
centre
17
partographs
Kotebe
health
centre
Gulele
health
centre
28
27
partographs
s
partographs
420 Modified WHO
partographs
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Data collection
 A pre-tested and structured checklist
 Standard protocols which were defined based on the time
interval as follows were used [4]:1) Cervical dilatation, moulding, descent of head and BP
monitored every four hours;
2) Foetal heart rate, maternal pulse and uterine contractions
monitored every 30 minutes;
3) Condition of the baby after birth should always be recorded
on the card.
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Data collection cont…
 Records not meeting any one of the protocol standards or with
parts misplaced/missing or inadequate for each parameter of
the partograph were judged as substandard,
 Or not recorded if no information was documented on each
parameters of the partograph
 And standard if all the criteria are met for each parameter on
the partograph.
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Data analysis
 Data was entered using the software Epi Info version 3.5.1 and
then exported to SPSS version 16 for further analysis.
 Frequency distributions, cross-tabulations and a graph were
used to describe the variables of the study.
Ethical clearance
 Conducted after obtaining ethical clearance from the ethical
review committee of the Department of Nursing and Midwifery
of Addis Ababa University
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Results and discussion
 420 of the modified WHO partographs that had been used for
labour management in 5 health facilities during the period of
this study were reviewed.
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Table 1: Recording of parameters of feotal and maternal
wellbeing, public health institutions of Addis Ababa, December
2011—February 2012
Parameters of labour
Frequency (n=420)
%
Feotal heart rate
Not recorded
174
41.4
Substandard
117
27.9
Monitored to Standard
129
30.7
Not recorded
364
86.7
Substandard
26
6.2
Monitored to Standard
30
7.1
Yes
113
26.9
No
307
73.1
Moulding
Was the status of membranes recorded?
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Parameters of labour
Frequency (n=420)
%
Not recorded
353
84.0
Substandard
38
9.0
Monitored to Standard
29
6.9
Not recorded
172
41.0
Substandard
110
26.2
Monitored to Standard
138
32.9
189
45.0
Substandard
144
34.3
Monitored to Standard
87
20.7
Yes
15
10.9
No
123
89.1
Not recorded
203
48.3
Substandard
139
33.1
Monitored to Standard
78
18.6
17
4.0
Good (Apgar score 7- 10)
333
79.3
Not good (Apgar score 1-6)
57
13.6
Still birth
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3.1
Descent of foetal head
Cervical dilatation
Uterine contraction
Not recorded
Action line crossed (n=138)
Blood pressure
Condition of the baby after birth
Not recorded
Recorded
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Figure 2 Proportions of partographs on which parameters were recorded to standard, public health
institutions of Addis Ababa, December 2011—February 2012.
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Results and discussion cont…
 In this study only 32.9%, 30.70% and 20.70% of the foetal
heart rate, cervical dilation and uterine contraction respectively
were recorded according to the standard protocol.
 These findings are similar with studies done in Tanzania,
Uganda and Benin [4-6]
 This necessitates the need for regular pre-service and on-job
training of obstetric care givers & mandatory health facility
policy on the completion of the partograph
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Conclusions
 The present study showed a poor completion of the modified
WHO partographs during labour in public health institutions of
Addis Ababa, Ethiopia.
 The findings may reflect poor management of labour or simply
inappropriate completion of the instrument.
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Recommendations
 Pre-service and periodic on-job training of health workers on
the completion of the partograph;
 Regular supportive supervision;
 Provision of guidelines;
 And mandatory health facility policy are recommended.
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Acknowledgments
 WHO, Ethiopia
 Hirut Gemeda
 Mohammed Seid
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Disclaimer
 This PowerPoint presentation is produced based on a published
research article; “Yisma E, Dessalegn B, Astatkie A, Fesseha
N: Completion of the modified World Health Organization
(WHO) partograph during labour in public health
institutions of Addis Ababa, Ethiopia. Reproductive Health
2013 10:23.” (http://www.reproductive-health
journal.com/content/10/1/23).
 The authors declare that they have no competing interests.
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References
1.
2.
3.
4.
5.
6.
Levin K, Kabagema Jd A: Use of the partograph: effectiveness, training,
modifications, and barriers—a literature review. New York: Engender
Health/Fistula Care; 2011
Yisma E, Dessalegn B, Astatkie A, Fesseha N: Knowledge and utilization of
partograph among obstetric care givers in public health institutions of
Addis Ababa, Ethiopia. BMC Pregnancy Childbirth 2013,13:17.
Mugerwa KY, Namagembe I., OnongeS.,OmoniG.,MwuivaM.,WasicheJ.,
Masbayi V, (2008) “unpublished observations”
Nyamtema AS, Urassa DP, Massawe S, Massawe A, Lindmark G, Van
Roosmalen J:Partogram use in the Dares Salaam perinatal care study. Int J
Gynaecolgy Obstetrics 2008,100:37–40
Ogwang S, Karyabakabo Z, Rutebemberwa E: Assessment of partogram use
during labour in rujumbura health Sub district, Rukungiri district,
Uganda. Afr Health Sci 2009, 9 (Suppl1):27–34.
Azandegbe N, Testa J, Makoutode M: Assessment of partogram utilization in
Benin [article in French]. Sante 2004,14:251–255.
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