Utilization Of Partograph In Management Of Women In Labor Among Nurses/Midwives Working In Machakos County, Kenya

ABSTRACT

A partogram is a graphical representation of the fetal status, maternal status and progress of labor. Its proper interpretation assists in early identification of complications which may lead to morbidity and mortality. Health records from selected hospitals in Machakos County in regards to partograph utilization revealed that 60% of the records had a partograph attached with only 40% of them used correctly up to delivery. The study determined the utilization of the partograph in management of women in labor in Machakos County. The objectives of the study were to determine the level of utilization of the partograph, nurses related factors and health facility related factors influencing the utilization of the partograph. A cross-sectional study design was used. The study was conducted in selected hospitals within Machakos County. The study population comprised of 124 nurses working in maternity wards. Purposive sampling technique was used to choose study participants from selected health facilities. Structured questionnaires were used to collect quantitative data while focused group discussions were conducted and key informants interviewed. Data collected was organized and entered into computer software and analyzed using SPSS Version 24 and presented by use of tables, figures, bar charts and narration. Logistic regression was used to assess the possible association and strength of association was measured using 95% confidence interval. From the study, level of utilization of the partograph among midwives was at 44.5%, nurses related factors influencing utilization of the partograph were negative attitude (p=0.001), and lack of training on partograph use (p=0.001). Majority (55.5%) of the files reviewed were not completed while monitoring labor, 63.7% of nurses said that use of partograph was time consuming, 80.9% needed supervision, 62.7% of the nurses working in maternity ward had not attended any workshop on partograph use. Health related factors that were found to influence partograph use were number of deliveries in labor ward (p=0.001) and institutional policies on partograph use (p=0.001), 53.6% of nurses conducted more than 5 deliveries per shift, 52.7% indicated that partographs were not available in labor wards while 68.2% said that institutional policies on partograph use were not implemented. The study concludes that utilization of partograph was poor which can be associated with negative attitude among nurses, lack of seminars and on job training, understaffing among nurses working in labor wards and lack of policies on partograph use in maternity department. The study recommends nurse managers in the health facilities to arrange for seminars and continuous medical education on partograph use, maternity in charges to offer supportive supervision and ensure regular supply of partograph papers and hospital managers to make a proposal to the County ministry of health to employ more nurses thereby addressing the issue of shortage in order to improve utilization of partograph among nurses working in maternity wards in Machakos County.