1. Completion of the modified World Health Organization (WHO) partograph during labour in public health institutions of Addis Ababa, Ethiopia By
Engida Yisma
School of Allied Health Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia

2. Background Partograph is a single sheet of paper;
Includes information about the foetus’ heart rate, uterine contractions, cervical dilation and other important factors.
The modified WHO partograph defines the beginning of the active phase at 4 cm cervical dilatation [1].
A study conducted in Addis Ababa showed that over half (57.3%) of the obstetric care givers reported use of the modified WHO partograph to monitor mothers in labour [2].

3. Modified WHO partograph

4. Objectives General objective
To assess completion of the modified WHO partographs for mothers in labour in public health institutions of Addis Ababa, Ethiopia from December 2011—February 2012.
Specific objectives
To describe extent to which each parameters were recorded on the partographs
To assess correct completion of the partographs

5. Methods February 28 to March 30, 2012 in Addis Ababa, Ethiopia
Study Period & Area
February 28 to March 30, 2012 in Addis Ababa, Ethiopia
Study Design
A descriptive study based on a retrospective document review
Population
The source population comprised all the modified WHO partographs that had been used to monitor labour in public health institutions of Addis Ababa from December 2011—February 2012.
Study subjects were comprised of a random sample of the modified WHO partographs.

6. Inclusion & exclusion criteria
Included all the modified WHO partographs having complete or partially complete information
And excluded those modified WHO partographs which had records of mothers who were admitted in second stage of labour.

7. Sampling method Sample size determination
P is the estimate of the proportion of the modified WHO partographs (assumed to be 24% as obtained from a previous study) [3].
Due to multistage nature of the study, a design effect 1.5 was considered.
And accordingly, the final sample size was 420 modified WHO partographs.

9. Data collection A pre-tested and structured checklist
Standard protocols which were defined based on the time inter­val as follows were used [4]:-
Cervical dilatation, moulding, descent of head and BP monitored every four hours;
Foetal heart rate, maternal pulse and uterine contractions monitored every 30 minutes;
Condition of the baby after birth should always be recorded on the card.

10. Data collection cont…
Records not meeting any one of the protocol standards or with parts misplaced/missing or inadequate for each parameter of the partograph were judged as substandard,
Or not recorded if no information was documented on each parameters of the partograph
And standard if all the criteria are met for each parameter on the partograph.

11. Data analysis
Data was entered using the software Epi Info version and then exported to SPSS version 16 for further analysis.
Frequency distributions, cross-tabulations and a graph were used to describe the variables of the study.
Ethical clearance
Conducted after obtaining ethical clearance from the ethical review committee of the Department of Nursing and Midwifery of Addis Ababa University

12. Results and discussion
420 of the modified WHO partographs that had been used for labour management in 5 health facilities during the period of this study were reviewed.

13. Table 1: Recording of parameters of feotal and maternal wellbeing, public health institutions of Addis Ababa, December 2011—February 2012

15. Figure 2 Proportions of partographs on which parameters were recorded to standard, public health institutions of Addis Ababa, December 2011—February 2012.

16. Results and discussion cont…
In this study only 32.9%, 30.70% and 20.70% of the foetal heart rate, cervical dilation and uterine contraction respectively were recorded according to the standard protocol.
These findings are similar with studies done in Tanzania, Uganda and Benin [4-6]
This necessitates the need for regular pre-service and on-job training of obstetric care givers & mandatory health facility policy on the completion of the partograph

17. Conclusions
The present 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.

18. Recommendations
Pre-service and periodic on-job training of health workers on the completion of the partograph;
Regular supportive supervision;
Provision of guidelines;
And mandatory health facility policy are recommended.

19. Acknowledgments
WHO, Ethiopia
Hirut Gemeda
Mohammed Seid

20. Disclaimer
This PowerPoint presentation is produced based on a published research article; “Yisma E, Dessalegn B, Astatkie A, Fesseha N: Completion of the modified World Health Organization (WHO) partograph during labour in public health institutions of Addis Ababa, Ethiopia. Reproductive Health :23.” ( journal.com/content/10/1/23).
The authors declare that they have no competing interests.

21. References
Levin K, Kabagema Jd A: Use of the partograph: effectiveness, training, modifications, and barriers—a literature review. New York: Engender Health/Fistula Care; 2011
Yisma E, Dessalegn B, Astatkie A, Fesseha N: Knowledge and utilization of partograph among obstetric care givers in public health institutions of Addis Ababa, Ethiopia. BMC Pregnancy Childbirth 2013,13:17.
Mugerwa KY, Namagembe I., OnongeS.,OmoniG.,MwuivaM.,WasicheJ., Masbayi V, (2008) “unpublished observations”
Nyamtema AS, Urassa DP, Massawe S, Massawe A, Lindmark G, Van Roosmalen J:Partogram use in the Dares Salaam perinatal care study. Int J Gynaecolgy Obstetrics 2008,100:37–40
Ogwang S, Karyabakabo Z, Rutebemberwa E: Assessment of partogram use during labour in rujumbura health Sub district, Rukungiri district, Uganda. Afr Health Sci 2009, 9 (Suppl1):27–34.
Azandegbe N, Testa J, Makoutode M: Assessment of partogram utilization in Benin [article in French]. Sante 2004,14:251–255.