Background
About 295,000 women died in 2017 as a result of a preventable cause of maternal mortality (MM). The majority of these deaths (94 %) occurred in low and middle-income countries; Subsaharan Africa (SSA) and Southeast Asia (SEA) combined accounted for 86 % of these deaths, and SSA alone accounting for nearly 66 %. Although the maternal mortality rate (MMR) has declined by 60 % in SEA from 2000 to 2017, in SSR, it was reduced by 40 % only [
1,
2]. According to the 2016 Ethiopian Demographic and Health Survey (EDHS), Ethiopia’s MMR was 412/100,000 live births, with a Neonatal Mortality rate of about 30 deaths per 1000 live births [
3].
Maternal death may occur at any time during pregnancy, childbirth, or the postpartum period. MM may be caused by pre-eclampsia and eclampsia during pregnancy, labour complications, bleeding during and during delivery, infection after childbirth, and abortion [
1,
4].
To reduce the catastrophe of maternal death, feasible intervention are available such as the utilization of partograph. Partograph is a preprinted paper, which is used to monitor the progress of labor and the change observed on mother and fetus during labor. It was first used in 1950; its use became an international standard method in 1987 in Nairobi, Kenya, and in 1994, the World Health Organization declared its essential use in all seating for enhancing labor management and lowering maternal and foetal mortality [
1,
2]. It was, also demonstrated that in labor monitored by parthograph prolonged labour was reduced from 6.4 to 3.4 %, augmentation was reduced from 20.7 to 9.1 %, emergency caesarean section was reduced from 9.9 to 8.3 %, and stillbirths were reduced from 0.5 to 0.3 % [
2].
Despite the WHO recommendations, the utilization of partograph was not consistent in every setting. For example, in Bangladesh Partographs were used for 98 % of women in labor [
5]. But, in Africa the magnitude of partograph utilization was less than 50 % [
6‐
8].
According to different studies done in Ethiopia the magnitude of the utilization of partograph shown to have a wide variation from region to region and across zones of the same region [
9‐
18]. Studies from the Central and Eastern zone of Tigray regional state reported the highest level of utilization from around 70 to 83 % [
10,
13]. While a study from the west shoa zone of Oromiya regional state reported the lowest utilization of partograph which was 31 % [
9]. The magnitude of utilization of partograph in others region such as East Gojam Amhara Region, was 53 % [
19], in SNNPRE Hadiya zone 54 %, and Wolayita Zone 71 % [
12,
17]. In Addis Ababa, 57 to 69 % of obstetric caregivers utilized partograph routinely [
11,
16]. The largest diference in the utilization of partograph is seen in different zones of Oromia region ranging from 31, to 71 % [
9].
Regarding the determinants of partograph utilization, studies had showing an association with different variable. These variable were socio-demographic characteristics of obstetric caregivers (age, gender, profession, qualification, service year, and types of health institution), knowledge regarding partograph and receiving training regarding partograph [
5‐
21].
Eventhough, similar studies were performed in various parts of the world, including Ethiopia, the results were not generalizable due to geographic and socioeconomic heterogeneity, and also such information was lacking in southwest Ethiopia. Therefore, this study investigated the magnitude of utilization of partograph among obstetric care givers in public health institutions of southwest Ethiopia.
Methods
Study setting and period
The research was carried out in public health institutions in four zones in South West Ethiopia: Bench-Shako, Kafa, West-omo, and Shaka. These areas had a total population of about 3,291,083. Regarding the health infrastructure in the study area there are six hospitals (1 university teaching hospital, two zonal hospitals, and three primary level hospitals) and over 80 health centres. This study was condacted from March 1st to June 30th, 2018.
Study design and population
Institution based cross-sectional study design was conducted to assess the magnitude of partograph utilization and associated factors among obsetetrci care givers. The source population of this study were all health professionals who were working in the obstetric unit of public health institutions of Kaffa, Bench-shako, West-Omo and Sheka Zones. The study population were all randomly selected health professionals who were working in the randomly selected public health institutions of Kaffa, Bench-shako, West-Omo and sheka zones.
Inclusion and exclusion criteria
The study included health professionals who had worked in the obstetric ward for the last six months, such as nurses, midwives, and health officers. The study excluded professionals who did not work in the obstetric ward for less than six months.
Sample size determination
The sample size was calculated using the single population proportion formula, with a 95 % confidence interval (CI), a 5 % margin of error, and a 50 % utilization rate of partograph. The calculated sample size was 384, and the final sample size was 423 after accounting for the 10 % non-response rate.
$$ n=\frac{{\underset{\overline{2}}{\left({\mathrm{Z}}_{\partial}\right)}}^2\mathrm{P}\left(1\hbox{-} \mathrm{P}\right)}{{\mathrm{d}}^2}\kern2em n=\frac{(1.96)^20.5\left(1-0.5\right)}{(0.05)^2} $$
Sampling procedure
The study participants were selected by using simple random sampling method, after proportional allocation of the sample size to each randomly selected institution based on the number of caregivers working in the health institution.
Data collection procedures and quality control
To collect the data a structured questionnaire was used, which was adopted from similar work [
6,
20,
21]. The questionnaire has three parts the first part was about the socio-demographic characteristics of the participants including age, sex, profession, qualification, and experience. The second part was about the utilization of partograph and the third part was about other determinants of partograph utilization such as training regarding partograph, knowledge regarding partograph and types of public health institution where obstetric caregivers work. To ensure the data quality the questionnaire was pre-tested, the data collectors were given training on the objective and purpose of the study and all stages of the data collection were supervised.
Data processing and analysis
The data were entered into Epi Info Version 3.5.1 and double-checked for accuracy, and transported to the statistical software package for social science (SPSS) version 22 for analysis. Bivariate and a multivariate logistic regression was performed to identify factors that are associated with utilization of partograph. Finally, the adjusted odds ratio (AOR) and its 95 % confidence interval (CI) were reported. A cut-off point for statistical significance is a P-value of less than 0.05.
Conclusion and recommendations
The utilization of a Partograph among obstetric caregivers in the study area is low. Being a nurse or health officer and being a degree level qualifications were negatively associated partograph utilization, while receiving training, good Knowledge regarding the partograph and working in health center types of institution were positively associated with it. Utilization of partograph can be improved by assigning midwives in the delivery ward, offering on-the-job training, and improving the knowledge of obstetric caregivers. Inaddition, qualitative study my help to dig out the barriers of partograph utilization among obstetric caregivers who have higher qualification and those who were woring in hospital level institutions.
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