Assessment of health worker’s knowledge and utilization of partograph to diagnose fetal distress during labor at Bwaila Hospital, in Lilongwe Malawi
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Date
2022-03-01
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Abstract
World Health Organization recommended the partograph in management of women during labor to improve maternal and neonatal outcomes. Despite gains made in reducing maternal health, neonatal deaths from complications of labor and delivery persists. Quality of care and the use of the partograph in labor can help to avert deaths from labor complications. The way health workers use that partograph to diagnose fetal distress during labor needs to be investigated.
This facility based cross-sectional study was conducted at Bwaila hospital using both qualitative and quantitative methods. A total of 911 partographs of births at Bwaila for the month of April and May 2020 were reviewed. Fifteen (15) midwives in the maternity ward were interviewed. Descriptive statistics and logistic regression were used to analyze quantitative data. Thematic analysis was applied to analyze data from in-depth interviews.
Midwives had good knowledge about the partograph. Utilization of partographs and diagnosis of fetal distress was poor. Meconium-stained liquor (AOR=2.33; 95% CI =1.51-3.59, p<0.001), vacuum extraction (AOR=4.64; 95% CI= 1.61-13.58, p=0.004), Crossing alert line (AOR=1.70; 95% CI =1.09-2.66, p=0.020)., Male sex (AOR=1.75; 95% CI=1.17-2.62, p=0.006) and Birth Weight (AOR= 0.9992234; 95% CI= 0.9988441 - 0.9995922, p <0.001) were factors associated with birth asphyxia.
Improving staffing levels, consistent supportive supervision, availability of equipment and supplies, in-service trainings on labor management and partograph, introduction of incentives, improving inter-professional collaboration, are necessary to improve quality. Partograph needs to be reviewed and modified to meet context needs. Electronic fetal monitoring should be used in busy setting.