Background:
The World Health Organization (WHO) recommends using the partograph to follow labour and
delivery, with the objective to improve health care and reduce maternal and foetal morbidity and death. The
partograph consists of a graphic representation of labour and is an excellent visual resource to analyze cervix,
uterine contraction and foetal presentation in relation to time. However, poor utilization of the partograph was
found in the public health institutions which reflect poor monitoring of mothers in labour and/or poor pregnancy
outcome.
Methods:
A retrospective document review was undertaken to assess the completion of the modified WHO
partograph during labour in public health institutions of Addis Ababa, Ethiopia. A total of 420 of the modified WHO
partographs used to monitor mothers in labour from five public health institutions that provide maternity care
were reviewed. A structured checklist was used to gather the required data. The collected data were analyzed using
SPSS version 16.0. Frequency distributions, cross-tabulations and a graph were used to describe the results of the
study.
Results:
All facilities were using the modified WHO partograph. The correct completion of the partograph was very
low. From 420 partographs reviewed across all the five health facilities, foetal heart rate was recorded into the
recommended standard in 129(30.7%) of the partographs, while 138 (32.9%) of cervical dilatation and 87 (20.70%)
of uterine contractions were recorded to the recommended standard. The study did not document descent of the
presenting part in 353 (84%). Moulding in 364 (86.7%) of the partographs reviewed was not recorded.
Documentation of state of the liquor was 113(26.9%), while the maternal blood pressure was recorded to standard
only in 78(18.6%) of the partographs reviewed.
Conclusions:
This study showed a poor completion of the modified WHO partographs during labour in public
health institutions of Addis Ababa, Ethiopia. The findings may reflect poor management of labour or simply
inappropriate completion of the instrument and indicate the need for pre-service and periodic on-job training of
health workers on the proper completion of the partograph. Regular supportive supervision, provision of guidelines
and mandatory health facility policy are also needed in support of a collaborative effort to reduce maternal and
perinatal deaths.