Use and completeness of partograph and associated factors in Mwanza region, Tanzania

Abstract

Background: There is scientific evidence that proper use of the partograph reduces maternal and foetal morbidity and mortality. In 2015 the use of partograph in selected regions in Tanzania was approximately 50%. In Mwanza and lake zone as a whole there is reported high maternal mortality but there is inadequate information on the use and completeness of partograph. Therefore, this study aimed to determine use and completeness of partograph and associated factors in Mwanza region. Methodology: A cross-sectional study was conducted in all public/designated hospitals in Mwanza region from January to March 2019All the deliveries which occurred in this hospitals in December 2018 were assessed for their corresponding partographs to determine partograph use. A random sample of Partographs for deliveries which occurred in these hospitals in December 2018 were reviewed to assess completeness using a standard checklist. Characteristics of midwives who conducted the deliveries was obtained by using a pretested structured questionnaire. Data was entered and cleaned using Epi info v7.2.2, and analyzed using Stata v13. Measures of central tendency and dispersion were used to summarize continuous variables while frequency distributions were used for categorical variables. Logistic regression was used to calculate Odds ratios and their associated 95% confidence intervals as a measure of association between Partograph completeness and the independent variables. . Results: Of the 3103 deliveries that were conducted in these hospitals in December 2018, 2408 (77.6%) had partograph filled. 853 partographs were randomly selected to be reviewed. Three hundred seventy three (43.5%) were completely filled. One hundred and fifty midwives were involved in the study and of them 134 (89.3%) had good knowledge on partograph. Significant difference was found with regards to completeness of partograph between regional/zonal and district/designated hospitals. Factors associated with partograph completeness included level of education of health workers with degree level having higher odds [aOR 7.49 (95% CI)2.10-26.66] compared to those with lower levels of education, experience in labour ward where by midwives with long experience were more likely to complete partography [aOR 3.93( 95% CI)1.62-9.51] compared to those with few years of experience, sex of provider [aOR8.38(95%CI)6.46-31.99)], Training on Emergency Obstetric care [aOR1.36(95%CI)0.81-2.29] and, Knowledge on partograph [aOR2.37(95%CI)1.39-4.04)]. Providers who responded to have partographs forms, guidelines and policy to use partograph in their hospitals had 470(63%) and 478(61%) respectively of partograph completeness. Conclusion: There is inadequate use of partograph, and completeness of vital parameters in the Partographs is low especially in the districts/ designated hospitals. There is need for regular mentorship and onjob training to newly employed health providers.