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      Knowledge and attitudes of midwives on the use of the partogram: a study among midwives in the Tamale Metropolis

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          Abstract

          Background

          The partogram is the most effective tool to use to monitor the progress of labour and complications associated with labour.

          The main objective of this study was to assess the knowledge level of midwives on the effective use of the partogram in monitoring the progress of labour in the Tamale Metropolis of Ghana.

          Methods

          This study was a cross-sectional descriptive study conducted on 140 midwives selected using random sampling technique from March to July, 2011.

          Results

          The study revealed that all respondents had knowledge of the supposed use of the partogram. However, the study also identified inadequate knowledge on the proper use of the tool (as observation showed that some of the partogram sheets were inadequately filled). Inadequate knowledge, inadequate staffing (1.0 % of respondents) and extra workload on the few midwives (2.6 %) were some of the factors that militated against the effective use of the partogram. There were enough partogram sheets in the health facilities under study as 91.4 % of respondents had access to the partogram.

          Conclusion

          Midwives in Ghana know about the supposed use of partogram as a monitoring tool for labour; however inadequate knowledge on the proper use of the tool and inadequate staffing militated against effective use. We recommended constant refresher training on the use of the partogram and also training of more midwives to enhance effective utilisation of the partogram.

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          Most cited references9

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          World Health Organization partograph in management of labour. World Health Organization Maternal Health and Safe Motherhood Programme.

          (1994)
          As part of the Safe Motherhood Initiative, launched in 1987, the World Health Organization have produced and promoted a partograph with a view to improving labour management and reducing maternal and fetal morbidity and mortality. This partograph has been tested in a multicentre trial in south east Asia involving 35,484 women. Introduction of the partograph with an agreed labour-management protocol reduced both prolonged labour (from 6.4% to 3.4% of labours) and the proportion of labours requiring augmentation (from 20.7% to 9.1%). Emergency caesarean sections fell from 9.9% to 8.3%, and intrapartum stillbirths from 0.5% to 0.3%. Among singleton pregnancies with no complicating factors, the improved outcome was even more marked, with caesarean sections falling from 6.2% to 4.5%. The improvements took place among both nulliparous and multiparous women. The World Health Organisation partograph clearly differentiates normal from abnormal progress in labour and identifies those women likely to require intervention. Its use in all labour wards is recommended.
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            Reduction of maternal mortality: A joint WHO/UNFPA/ UNICEF/World Bank Statement

            (1999)
              Bookmark
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              • Article: not found

              Rapid assessment of partograph utilisation in selected maternity units in Kenya.

              Prolonged labour causes maternal and perinatal morbidity and mortality. Its sequela include obstructed labour, uterine rupture, maternal exhaustion, postpartum haemorrhage, puerperal sepsis, obstetric fistula, stillbirths, birth asphyxia and neonatal sepsis. These complications can be reduced by using the partograph to assess the progress of labour. The Ministry of Health, Kenya has adopted this tool for labour management in the country and the standardised partograph is recommended for use in all delivery units. To determine the utilisation of the partograph in the management of labour in selected health facilities in Kenya. A descriptive cross sectional study. Nine health facilities -ranging from a tertiary hospital to health centre, including public private and faith based facilities in four provinces in Kenya. All facilities apart from Pumwani Maternity Hospital and one health centre were using the partograph. The correct use was low, the knowledge on the use of the tool was average and there was minimal formal training being provided. Staff shortage was listed as the most common cause of not using the tool. Contractions were recorded 30-80%, foetal heart rate 53-90% and cervical dilatation 70-97%. Documentation of state of the liquor, moulding and descent as well as maternal parameters such as pulse, and blood pressure and urinalysis were minimally recorded. Supplies for monitoring labour such as fetoscopes and blood pressure machines were in short supply and sometimes not functional. Overall, the poor usage was contributed to staff shortages, lack of knowledge especially on interpretation of findings, negative attitudes, conflict between providers as to their roles in filling the partograph, and senior staff themselves not acting as role models with regards to the use, advocacy and implementation of the partograph. The partograph was available in most units. However, accurate recording of parameters to monitor the foetus, the mother and progress of labour as recommended was mostly not done. Shortage of staff, lack of knowledge, lack of team work, lack of supplies and negative attitude among healthcare providers were some of the obstacles noted to hamper partograph use.
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                Author and article information

                Contributors
                dkkonlan@yahoo.com
                jmkombat@yahoo.co.uk
                gwuffele@yahoo.com
                aarahmilli@yahoo.com
                Journal
                Matern Health Neonatol Perinatol
                Matern Health Neonatol Perinatol
                Maternal Health, Neonatology and Perinatology
                BioMed Central (London )
                2054-958X
                25 April 2016
                25 April 2016
                2016
                : 2
                : 2
                Affiliations
                [ ]Tamale Teaching Hospital, Tamale, Ghana
                [ ]Department of Paediatrics, University for Development Studies, School of Allied Health Sciences, Tamale, Ghana
                [ ]Department of Midwifery, University for Development Studies, School of Allied Health Sciences, Tamale, Ghana
                [ ]Department of Nursing, University for Development Studies, School of Allied Health Sciences, Tamale, Ghana
                Article
                30
                10.1186/s40748-016-0030-0
                4843203
                27114825
                f1f05624-a63f-4f12-b00a-e91cd1a57193
                © Konlan et al. 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 25 November 2015
                : 21 March 2016
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2016

                partogram: a graphical tool that is used to assess the progress of labour and to identify when interventions are necessary,labour: the processes in a woman (37 weeks gestation) for successful expulsion of the product of conception,maternal complications: any untoward event, scenario or process that occurs to the mother with before, during and immediately after birth

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