Utilization of Partograph among Nurses and Midwives in Selected Facilities, Makueni County, Kenya
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Date
2022
Authors
Muthusi, Urbanus Mutiso
Journal Title
Journal ISSN
Volume Title
Publisher
Kenyatta University
Abstract
The partograph, a graphic recording of progress of labor and salient conditions of the mother and fetus, has been used since 1970 to detect labor that is not progressing normally, to indicate when augmentation of labor is appropriate and to recognize cephalopelvic disproportion long before labor becomes obstructed. Early detection of abnormal progress of labor and the prevention of prolonged labor would significantly reduce the risk of postpartum hemorrhage and sepsis, and eliminate obstructed labor, uterine rupture and its sequelae. In comparison to high-income countries, maternal mortality is a severe health issue in low-income countries. This primarily affects low-income nations in Sub-Saharan Africa and Southeast Asia, where maternal mortality account for nearly all of the deaths. The use of partograph in labor management is recommended by the World Health Organization (WHO). This allows for quicker decision-making and life-saving measures. Factors that influence partograph use in Makueni County are unknown. The purpose of this study was to determine the level of partograph usage in the selected facilities in Makueni County. This was a descriptive cross-sectional study that used quantitative and qualitative methods. A data abstraction tool was utilized to obtain data from partographs retrospectively for the quantitative investigation. Individual interviews with 46 nurses and midwives working in the maternity wing were used to gather qualitative data. SPSS version 20.0 was used to analyze the data. To summarize the data and indicate the scope of partograph use, frequency tables were employed. The Chi-square test was used to determine the relationship between the independent and outcome variables. The significance level was set to 0.05. The Phi and Cramer's V tests were used to determine the strength of the relationship. The analysis of qualitative data was done in grouped themes. The interviews were verbatim transcribed and examined with content analysis. From the findings of the study both fetal and maternal outcomes were linked to partograph use. The study found that method of birth had a significant association with fetal monitoring (fetal heart rate (p=.000), liquor (p=.002), and moulding p=.021)), labor progress monitoring (descent (p=.001), contractions (p=.000) and cervical dilatation (p=.001)) and referral monitoring at α = 0.05. The study also found significant association between fetal outcome and contraction (p=.014), gravidity (p=.000), parity (p=.000), fetal heart rate and moulding (p=.021) at α = 0.05. Most midwives partially filled the partograph. The study further concluded that there exists a significant association between maternal, fetal outcomes and labor progress with partograph completeness in Makueni County. The study therefore recommends increased support supervision to ensure proper partograph use. The number of midwifery care-providers should also be increased to improve efficiency in maternal and child care. Regular and structured ongoing trainings on partograph use should be part of the policy framework to build capacity of the midwives and improve maternal and fetal outcomes.
Description
A Research Thesis Submitted in Partial Fulfilment of the Requirements for the Award of the Degree of Master of Public Health (Reproductive Health) in the School of Public Health and Applied Human Sciences of Kenyatta University, April, 2022
Keywords
Utilization, Partograph, Nurses, Midwives, Selected Facilities, Makueni County, Kenya