MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES

MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES.SCHOOL OF NURSING.

DEPERTMENT OF COMMUNITY NURSING.

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TITTLE: KNOWLEDGE OF PARTOGRAPH UTILIZATION AMONG THIRD YEAR MIDWIFERY UNDERGRADUATE STUDENTS AT MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES IN DAR ES SALAAM.

NAME OF THE AUTHOR: KASHINDYE MAZIKU
REGISTRATION NO: 2015-04-08669
DEGREE PROGRAMME: BACHELOR OF SCIENCE IN MIDWIFERY
SUPERVISOR: MASUNGA ISESELO.

COORDINATOR: Dr.LILIAN T. MSELLE

Background:
A partograph is a graphical presentation of a woman’s progress of labour. Once the woman has true signs of labour, the midwife initiates the use of the partograph to record her findings. The partograph was endorsed and modified by the World Health Organisation (WHO) between 1990 and 2000 to monitor the fetal and maternal wellbeing during the active stage of labour. Monitoring help the midwives and the mother in achieving spontaneous vaginal delivery with low risk of both morbidity and mortality. Furthermore, accurate partograph recordkeeping enables an effective communication between healthcare professionals who manage women in labour.ADDIN CSL_CITATION {“citationItems”:{“id”:”ITEM-1″,”itemData”:{“DOI”:”10.5897/IJNM2013.0115″,”ISSN”:”2141-2456″,”abstract”:”A partograph is a graphical presentation of a woman’s progress of labour. Once the woman has true signs of labour, the midwife initiates the use of the partograph to record her findings. The partograph was endorsed and modified by the World Health Organisation (WHO) between 1990 and 2000 to monitor the fetal and maternal wellbeing during the active stage of labour. Monitoring help the midwives and the mother in achieving spontaneous vaginal delivery with low risk of both morbidity and mortality. Furthermore, accurate partograph recordkeeping enables an effective communication between healthcare professionals who manage women in labour. Documentation and recordkeeping have always been integral to midwifery practice and continue to be so. The aim of the study was to establish the perception of the use of the partograph by midwives, and to establish and describe the factors that contribute to the underutilization of the partograph by midwives during the management of labour. The context of the study was an Academic Hospital and a Midwifery seminar, Gauteng Province, South Africa. A cross-sectional descriptive quantitative study was conducted. Sampling was purposeful. A self-administered questionnaire was used to collect data. The findings revealed that midwives understood the importance of the use of the partograph but do not effectively use it due to a number of factors.”,”author”:{“dropping-particle”:””,”family”:”M”,”given”:”Mathibe-Neke J”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”L”,”given”:”Lebeko F”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},”id”:”ITEM-1″,”issue”:”8″,”issued”:{“date-parts”:”2013″},”page”:”145-153″,”title”:”International Journal of Nursing and Midwifery The partograph: A labour management tool or a midwifery record?”,”type”:”article-journal”,”volume”:”5″},”uris”:”http://www.mendeley.com/documents/?uuid=2288dcd6-be93-39b2-bab4-2c150e23e0f7″},”mendeley”:{“formattedCitation”:”(M & L, 2013)”,”plainTextFormattedCitation”:”(M & L, 2013)”,”previouslyFormattedCitation”:”(M & L, 2013)”},”properties”:{“noteIndex”:0},”schema”:”https://github.com/citation-style-language/schema/raw/master/csl-citation.json”}(M ; L, 2013). . Studies in Tanzania shows poor utilization of partograph among nurses and midwives and other health practitioners associated with poor knowledge and training skills, limited staffs, complexity of composite WHO partograph and poor health facility policies (Maaløe et al., 2017). Although different studies show that factors influencing partograph utilization are professional qualified staff, knowledge about partograph, favorable attitude towards partograph, on job training and previous training but little is known about factors influencing partograph utilization among students at Muhimbili University of health and allied sciences. Therefore this study aim is going to focus on identifying the percentage contributed by previous training by evaluating knowledge and perception on partograph utilization among the students at Muhimbili University of health and allied sciences those has been exposed to the program and are in clinical practice.

Problem statement
Globally, there was an estimated number of 287,000 maternal deaths in 2010. Eighty five percent (245,000) of these deaths occurred in Sub-Saharan Africa and Southern Asia. Among the causes of these deaths were obstructed and prolonged labour which could be prevented by cost effective and affordable health interventions like the use of the partograph. The Use of the partograph is a well-known best practice for quality monitoring of labour and subsequent prevention of obstructed and prolonged labour. However, a number of cases of obstructed labour do happen in health facilities due to poor quality of intrapartum care.ADDIN CSL_CITATION {“citationItems”:{“id”:”ITEM-1″,”itemData”:{“DOI”:”10.1186/1471-2393-13-17″,”ISBN”:”1471-2393″,”ISSN”:”1471-2393″,”PMID”:”23331626″,”abstract”:”BACKGROUND: Globally, there was an estimated number of 287,000 maternal deaths in 2010. Eighty five percent (245,000) of these deaths occurred in Sub-Saharan Africa and Southern Asia. Among the causes of these deaths were obstructed and prolonged labour which could be prevented by cost effective and affordable health interventions like the use of the partograph. The Use of the partograph is a well-known best practice for quality monitoring of labour and subsequent prevention of obstructed and prolonged labour. However, a number of cases of obstructed labour do happen in health facilities due to poor quality of intrapartum care. METHODS: A cross-sectional quantitative study assessed knowledge and utilization of partograph among obstetric care givers in public health institutions of Addis Ababa, Ethiopia using a structured interviewer administered questionnaire. The collected data was analyzed using SPSS version 16.0. Logistic regression analysis was used to identify factors associated with knowledge and use of partograph among obstetric care givers. RESULTS: Knowledge about the partograph was fair: 189 (96.6%) of all the respondents correctly mentioned at least one component of the partograph, 104 (53.3%) correctly explained the function of alert line and 161 (82.6%) correctly explained the function of action line. The study showed that 112 (57.3%) of the obstetric care givers at public health institutions reportedly utilized partograph to monitor mothers in labour. The utilization of the partograph was significantly higher among obstetric care givers working in health centres (67.9%) compared to those working in hospitals (34.4%) Adjusted OR = 3.63(95%CI: 1.81, 7.28). CONCLUSIONS: A significant percentage of obstetric care givers had fair knowledge of the partograph and why it is necessary to use it in the management of labour and over half of obstetric care givers reported use of the partograph to monitor mothers in labour. Pre-service and on-job training of obstetric care givers on the use of the partograph should be given emphasis. Mandatory health facility policy is also recommended to ensure safety of women in labour in public health facilities in Addis Ababa, Ethiopia.”,”author”:{“dropping-particle”:””,”family”:”Yisma”,”given”:”E”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Dessalegn”,”given”:”B”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Astatkie”,”given”:”A”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Fesseha”,”given”:”N”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},”container-title”:”BMC Pregnancy Childbirth”,”id”:”ITEM-1″,”issued”:{“date-parts”:”2013″},”page”:”17″,”title”:”Knowledge and utilization of partograph among obstetric care givers in public health institutions of Addis Ababa, Ethiopia”,”type”:”article-journal”,”volume”:”13″},”uris”:”http://www.mendeley.com/documents/?uuid=523f6001-6fa4-4a33-a47c-74a8b64c25ac”},”mendeley”:{“formattedCitation”:”(Yisma, Dessalegn, Astatkie, & Fesseha, 2013)”,”plainTextFormattedCitation”:”(Yisma, Dessalegn, Astatkie, & Fesseha, 2013)”,”previouslyFormattedCitation”:”(Yisma, Dessalegn, Astatkie, & Fesseha, 2013)”},”properties”:{“noteIndex”:0},”schema”:”https://github.com/citation-style-language/schema/raw/master/csl-citation.json”}(Yisma, Dessalegn, Astatkie, ; Fesseha, 2013). Developing countries including Tanzania maternal and neonatal mortality rate is still high. Maternal mortality rate has remained high for the last 10 years without showing any decline despite of the trained personal for specialty of care and currently estimated to be 398 per 100,000live births. While significantly progress has reduce child mortality in Tanzania, the neonatal mortality remains high at 25 per 1000 live births and infant mortality rate which is estimated at 39.9 per 1000 live births. It is recommended by WHO to use partograph in monitoring labour and delivery, with the objective of improving health care and reduce maternal and fetal morbidity and death. Only 63% of all birth in Tanzania occurs at health facilities and 64% of all births are assisted by a skilled health worker. While 37% occurs at
home. (TDHS, 2015). As partograph as the monitoring tool during intrapartum period and is influenced by training in the university. The studies are most focusing to obstetric care giver other than to focus on the training center where the obstetric care giver are produced. Therefore there is a need to determine knowledge of partograph utilization among third year midwifery undergraduate students at Muhimbili University of Health and Allied Sciences.

Broad objective:
To explore the knowledge of partograph utilization among students at Muhimbili University of health and allied sciences
Specific objective:
To assess knowledge of partograph utilization among students at muhimbili university of health and allied sciences.

To assess practice of use of partograph among students at muhimbili university of health an allied sciences.

Research question:
1. What is partograph.2. When do partograph initiated during labour.

3. Is partograph useful in care of the mother who is in labourConceptual framework
Knowledge of partograph utilization among third year midwifery undergraduate student at Muhimbili University of Health and Allied Sciences can be influenced by many factors in my study the illustrated factors in the conceptual framework bellow will be concern to be assessed.

The result of the study will help to assess the knowledge acquired by students in theoretical teaching on partograph utilization, and evaluate the strength and weakness of students at muhimbili university of health and allied sciences. It will be helpful the other students who will be trained thereafter for the coming academic years.
Literature review:
A study done in Malawi to assess use of documentation of partograph in urban hospital at Lilongwe aimed to identify its effect to maternal and fetal outcome, they defined partograph as 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 result was only 3.9 percent of 464 partograph were correctly filled in.ADDIN CSL_CITATION {“citationItems”:{“id”:”ITEM-1″,”itemData”:{“abstract”:”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 – Malaw”,”author”:{“dropping-particle”:””,”family”:”Khonje”,”given”:”M.”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},”id”:”ITEM-1″,”issue”:”May”,”issued”:{“date-parts”:”2012″},”page”:”1 – 155″,”title”:”Use and Documentation of Partograph in Urban Hospitals in Lilongwe- Malawi: Health Workers’ Perspective”,”type”:”article-journal”},”uris”:”http://www.mendeley.com/documents/?uuid=96862fda-0d1d-3740-bf4c-b55b8e360aba”},”mendeley”:{“formattedCitation”:”(Khonje, 2012)”,”plainTextFormattedCitation”:”(Khonje, 2012)”,”previouslyFormattedCitation”:”(Khonje, 2012)”},”properties”:{“noteIndex”:0},”schema”:”https://github.com/citation-style-language/schema/raw/master/csl-citation.json”}(Khonje, 2012)
A study done in Addis Ababa Ethiopia aimed to assess partograph utilization among obstetric care giver in public health institution of observation of increased maternal mortality ratio 287,000 per 100000 live births in 2010 of these deaths occurred in Sub-Saharan Africa and Southern Asia. The result showed half of obstetric care giver have knowledge of partograph utilizationADDIN CSL_CITATION {“citationItems”:{“id”:”ITEM-1″,”itemData”:{“DOI”:”10.1186/1471-2393-13-17″,”ISBN”:”1471-2393″,”ISSN”:”1471-2393″,”PMID”:”23331626″,”abstract”:”BACKGROUND: Globally, there was an estimated number of 287,000 maternal deaths in 2010. Eighty five percent (245,000) of these deaths occurred in Sub-Saharan Africa and Southern Asia. Among the causes of these deaths were obstructed and prolonged labour which could be prevented by cost effective and affordable health interventions like the use of the partograph. The Use of the partograph is a well-known best practice for quality monitoring of labour and subsequent prevention of obstructed and prolonged labour. However, a number of cases of obstructed labour do happen in health facilities due to poor quality of intrapartum care. METHODS: A cross-sectional quantitative study assessed knowledge and utilization of partograph among obstetric care givers in public health institutions of Addis Ababa, Ethiopia using a structured interviewer administered questionnaire. The collected data was analyzed using SPSS version 16.0. Logistic regression analysis was used to identify factors associated with knowledge and use of partograph among obstetric care givers. RESULTS: Knowledge about the partograph was fair: 189 (96.6%) of all the respondents correctly mentioned at least one component of the partograph, 104 (53.3%) correctly explained the function of alert line and 161 (82.6%) correctly explained the function of action line. The study showed that 112 (57.3%) of the obstetric care givers at public health institutions reportedly utilized partograph to monitor mothers in labour. The utilization of the partograph was significantly higher among obstetric care givers working in health centres (67.9%) compared to those working in hospitals (34.4%) Adjusted OR = 3.63(95%CI: 1.81, 7.28). CONCLUSIONS: A significant percentage of obstetric care givers had fair knowledge of the partograph and why it is necessary to use it in the management of labour and over half of obstetric care givers reported use of the partograph to monitor mothers in labour. Pre-service and on-job training of obstetric care givers on the use of the partograph should be given emphasis. Mandatory health facility policy is also recommended to ensure safety of women in labour in public health facilities in Addis Ababa, Ethiopia.”,”author”:{“dropping-particle”:””,”family”:”Yisma”,”given”:”E”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Dessalegn”,”given”:”B”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Astatkie”,”given”:”A”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Fesseha”,”given”:”N”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},”container-title”:”BMC Pregnancy Childbirth”,”id”:”ITEM-1″,”issued”:{“date-parts”:”2013″},”page”:”17″,”title”:”Knowledge and utilization of partograph among obstetric care givers in public health institutions of Addis Ababa, Ethiopia”,”type”:”article-journal”,”volume”:”13″},”uris”:”http://www.mendeley.com/documents/?uuid=523f6001-6fa4-4a33-a47c-74a8b64c25ac”},”mendeley”:{“formattedCitation”:”(Yisma et al., 2013)”,”plainTextFormattedCitation”:”(Yisma et al., 2013)”,”previouslyFormattedCitation”:”(Yisma et al., 2013)”},”properties”:{“noteIndex”:0},”schema”:”https://github.com/citation-style-language/schema/raw/master/csl-citation.json”}(Yisma et al., 2013).As knowledge can change some ones attitude likewise impacted knowledge of partograph among students at muhimbili university of health and allied sciences will help to evaluate the outcome for future use in training.
The study was done in central Ethiopia to assess the factor associated with partograph utilization among obstetric care provider they came up with the following factors to be the major contributing factors; profession, on job training, knowledge and attitude of obstetric care providers towards partograph were significantly associated with partograph utilization. Knowledgeable were 4 times likely to utilize partograph than those who had no knowledge of partograph.ADDIN CSL_CITATION {“citationItems”:{“id”:”ITEM-1″,”itemData”:{“DOI”:”10.4314/ahs.v15i2.30″,”ISBN”:”1680-6905″,”ISSN”:”16806905″,”PMID”:”26124802″,”abstract”:”BACKGROUND: Globally, prolonged and obstructed labor contributed to 8% of maternal deaths which can be reduced by proper utilization of partograph during labor.\n\nMETHODS: An Institution based cross-sectional study was conducted in June, 2013 on 403 obstetric care providers. A pre-tested and structured questionnaire was used to collect data. Data was entered to EpiInfo version 3.5.1 statistical package and exported to SPSS version 20.0 for further analysis. Logistic regression analyses were used to see the association of different variables.\n\nRESULTS: Out of 403 obstetric care providers, 40.2% utilized partograph during labor.Those who were midwives by profession were about 8 times more likely to have a consistent utilization of the partograph than general practitioners (AOR=8. 13, 95% CI: 2.67, 24.78). Similarly, getting on job training (AOR=2. 86, 95% CI: 1.69, 4.86), being knowledgeable on partograph (AOR=3. 79, 95% CI: 2.05, 7.03) and having favorable attitude towards partograph (AOR=2. 35, 95% CI: 1.14, 4.87) were positively associated with partograph utilization.\n\nCONCLUSION: Partograph utilization in labor monitoring was found to be low. Being a midwife by profession, on job training, knowledge and attitude of obstetric care providers were factors affecting partograph utilization. Providing on job training for providers would improve partograph utilization.”,”author”:{“dropping-particle”:””,”family”:”Wakgari”,”given”:”Negash”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Amano”,”given”:”Abdella”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Berta”,”given”:”Marta”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},{“dropping-particle”:””,”family”:”Tessema”,”given”:”Gizachew Assefa”,”non-dropping-particle”:””,”parse-names”:false,”suffix”:””},”container-title”:”African Health Sciences”,”id”:”ITEM-1″,”issue”:”2″,”issued”:{“date-parts”:”2015″},”page”:”552-559″,”title”:”Partograph utilization and associated factors among obstetric care providers in north shoa zone, central ethiopia: A cross sectional study”,”type”:”article-journal”,”volume”:”15″},”uris”:”http://www.mendeley.com/documents/?uuid=949531bd-170b-328c-b007-e990b1a6bfa2″},”mendeley”:{“formattedCitation”:”(Wakgari, Amano, Berta, & Tessema, 2015)”,”plainTextFormattedCitation”:”(Wakgari, Amano, Berta, & Tessema, 2015)”,”previouslyFormattedCitation”:”(Wakgari, Amano, Berta, & Tessema, 2015)”},”properties”:{“noteIndex”:0},”schema”:”https://github.com/citation-style-language/schema/raw/master/csl-citation.json”}(Wakgari, Amano, Berta, ; Tessema, 2015).knowledge of partograph utilization in the study show to be the second factor which influence partograph utilization.
From literature review factors which will influence students at muhimbili university of health and allied sciences on partograph utilization is training,knowledge and perception .After the study conducted the result will be helpful in improving teaching strategies on partograph utilization at muhimbili university of health and allied sciences.
Reference
ADDIN Mendeley Bibliography CSL_BIBLIOGRAPHY
ADDIN Mendeley Bibliography CSL_BIBLIOGRAPHY Asibong, U., Okokon, I. B., Agan, T. U., Oku, A., Opiah, M., Essien, E. J., ; Monjok, E. (2014). The use of the partograph in labor monitoring: a cross-sectional study among obstetric caregivers in General Hospital, Calabar, Cross River State, Nigeria. International Journal of Women’s Health, 6, 873–880. https://doi.org/10.2147/IJWH.S49188
Khonje, M. (2012). Use and Documentation of Partograph in Urban Hospitals in Lilongwe- Malawi: Health Workers’ Perspective, (May), 1–155. Retrieved from https://www.duo.uio.no/browse?order=ASC;rpp=20…by…

M, M.-N. J., ; L, L. F. (2013). International Journal of Nursing and Midwifery The partograph: A labour management tool or a midwifery record?, 5(8), 145–153. https://doi.org/10.5897/IJNM2013.0115
Opiah, M. M., Ofi, A. B., Essien, E. J., ; Monjok, E. (2012). Knowledge and Utilization of the Partograph among Midwives in the Niger Delta Region of Nigeria. Utilization of the Partograph in Niger Delta African Journal of Reproductive Health March, 16(161). Retrieved from http://www.bioline.org.br/pdf?rh12014
Wakgari, N., Amano, A., Berta, M., ; Tessema, G. A. (2015). Partograph utilization and associated factors among obstetric care providers in north shoa zone, central ethiopia: A cross sectional study. African Health Sciences, 15(2), 552–559. https://doi.org/10.4314/ahs.v15i2.30
Yisma, E., Dessalegn, B., Astatkie, A., ; Fesseha, N. (2013). Knowledge and utilization of partograph among obstetric care givers in public health institutions of Addis Ababa, Ethiopia. BMC Pregnancy Childbirth, 13, 17. https://doi.org/10.1186/1471-2393-13-17