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Background: The period around childbirth and the first 24 hours postpartum remains a perilous time for both mother and newborn. Health care providers’ compliance to the World Health Organization modified partogram across the active first stage of labor is a graphic representation of a mother’s condition that is used as a guide in providing quality obstetrics care. However, little evidence is documented on the health providers’ adherence to the use of the partograph in Ethiopia, which limits health care providers’ ability to improve quality care services. Therefore, this study assessed the adherence of partograph use and associated factors in Ethiopia. Methods: Data from the Ethiopian 2016 National Emergency Obstetric and Newborn Care survey of 3,804 health facilities that provided maternity services were used. We extracted 2611 partograph charts over a 12 months period prior to the survey to review the proper recording of each component. Data analyses were performed using SPSS version 22.0 software. A logistic regression analyses was used to identify the association of explanatory variables with the outcome variable. A p-value of <0.05 was considered as cut off point to declare the significance association in the multivariable analysis. Results: Of the total 2611 partographs reviewed, 561(21.5%) of them were fully recorded as per the WHO guideline. Particularly, molding in 50%, color of liquor in 70.5%, fetal heart beat in 93.3%, cervical dilation in 89.6%, descent in 63.2%, uterine contraction in 94.5%, blood pressure in 80.5%, pulse rate in 70.5%, and temperature in 53% were accurately recorded. The odds of adherence to partograph use were 1.4 in rural health facilities when compared to their counterparts (AOR=1.44; 95% CI: 1.15, 1.80, P- 0.002). Conclusion: This study revealed a poor level of adherence in partograph use in Ethiopia. Molding, maternal temperature and decent were the least recorded parameters of the partograph. The odds of completion of partograph were high in rural facilities. Strong supporting supervision and mentoring the health workers to better record and use of partograph are needed mainly in urban health facilities. Moreover in the future, interventional research should be conducted to improve the current rate of adherence.
We used data from the EmONC assessment that was conducted in 2016 [28]. The EmONC assessment was a national cross-sectional census of health facilities, both at public and private health facilities that provided maternal and newborn health services. A total of 3804 facilities (293 hospitals, 3,459 health centers and 52 clinics) encompassing both government and private health facilities that offered delivery services throughout all regions of the country were assessed. Data from registers and birth records for the last 12 months prior to the survey were also extracted. In each facility, two latest charts of partograph were reviewed however two of them were not always completed. Therefore, for the purpose of this analysis we chose the partograph category with high frequency for the first dilation in active phase charted on the alert line correctly to represent the facilities. Thus, after a thorough exclusion criteria a total of 2,611 charts were assessed with regard to the completion of all components of the partograph and associated factors (Fig. 1). As eligibility criteria, partographs with first dilatation charted correctly on alert line were included in the final analysis. Flow diagram that shows partograph selection criteria for analysis, EmONC, 2016 Ethiopia Our primary outcome of interest was full adherence to standard partograph recording, using nine parameters/components of the partograph. It had a binary outcome: Adhered or not adhered to the standard recording. Therefore, a partograph was considered adherent to the standard if the nine parameters of the partograph were recorded completely as per the WHO standard. If at least one component was not recorded as per the WHO partograph, the partograph was considered non adherent. Provider-level characteristics: socio-demographic variables, qualification, level of training and work experience and facility characteristics: facility type, location and managing authority were the explanatory variables were included in this study. The analysis was performed using SPSS version 22™ software. Descriptive analysis such as frequency, percent, mean/median, and standard deviation were computed and the results were presented using text, tables and figures. Logistic regression model was used to assess the association between the predictor and outcome variable. Variables with p-value of < 0.25 were considered for inclusion in the multivariable logistic regression model. Finally, variables with p-value of < 0.05 in the multivariable analysis were considered to declare statistical significance. Odds ratio along with 95% confidence interval was computed to ascertain the strength of association between independent and dependent variables. The primary researchers of the 2016 Ethiopia EmONC survey obtained ethical clearance from Ethiopian Public Health Institute (EPHI) and letter of permission from Federal Ministry of Health (FMOH). Therefore, there was no need for ethical clearance for this secondary analysis. However, permission to access the data was obtained from FMOH of Ethiopia.
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