FACTORS ASSOCIATED WITH COMPLETENESS AND ACCURACY ON

DOCUMENTATION OF PARTOGRAPH DURING LABOUR IN LEVEL 4 AND

3B FACILITIES DAGORETTI SUB-COUNTY, NAIROBI COUNTY, KENYA

BY Carolyne Atieno Ogalo.

ADM NO:H153/P/6179/23.
COURSE: MASTERS IN EPIDEMIOLOGY&BIOSTATISTICS.
BACKGROUND OF THE STUDY
• Partograph is a graphical tool presentation used for monitoring the progress of
labor .
• The parameters like fetal heart rate, cervical dilatation, uterine contractions,
pulse rate and blood pressure are plotted on a graph.
• Partograph enables the clinical staff to identify and can reduce the risks of
maternal and fetal mortality through facilitating early detection of complication
for quick response to the problem caused by prolong labor and for preparation
for early referral for further better management.
• In many settings most documented partographs have not met the standards and
some of the studies have shown that, partographs are in accurately and
incompletely documented and due to that may not reflect the condition of the
mother and baby being monitored.
 The table below show the distribution gaps identified in the previous studies conducted in the
documentation of the partograph in monitoring 1st phase of labor.

REGIONS PREVALENCE GAP IDENTIFIED. Citations

Kenya(KNH) No estimate. No documentation on Rotich et al..2011

partograph at all.
South west - 58.8% Had no recording on blood Kushwa B et all..2013.
Zone pressure, no temperature and
fetal heart rate.
Ghana 25.5% No fetal condition Gans_Lartey et al..2013
documented ,maternal and labor
progress.
Malawi 39% Had no fetal heart rate, cervical Khan et al..2018.
dilatation.
Uganda 61% Less documentation on fetal Mukisa et al..2019
heart and cervical dilatation.
Statement of the problem.
• The documentation of the partograph is still not fully emphasized in various health
institutions which has contributed to the increase of maternal and neonatal mortality rate.
• According to recent global estimates, about 289,000 women die annually from pregnancy
related complications and most of these deaths are in the developing countries.
• In Kenya, currently reported to have maternal mortality rate of 414/100000 live birth and
neonatal mortality of 31/1000 live birth,(DHS 2017).

• A study conducted at KNH reported that the maternal death was high and that in some
cases partographs were either not completely or accurately documented or not used at all.
(Rotich et al..2011)
• These deaths can be reduced if partographs are accurately and completely documented
and used during monitoring of mothers experiencing labor. (WHO,2019).
• There is also need to understand the problem and provide the correct solutions to
address them in order to improve pregnancy outcome and capacity building need for
better intervention.
OBJECTIVES
BROAD OBJECTIVE.
To determine the factors associated with completeness and accuracy on
documentation of partograph during labor in selected hospitals in level 3B and 4
Dagoretti subcounty,Nairobi county in Kenya
SPECIFIC OBJECTIVES.
1. To assess the performance of documentation on partograph in a selected
public and private hospital.
2. To determine the clinical staff-related factors associated with completeness
and accuracy in documentation on partograph.
3. To determine the predictors of completeness and accuracy of documentation
on partograph.
RESEARCH QUESTIONS

1. What is the performance of documentation on partograph in a selected public

and private hospitals?
2. What are the clinical staff-related factors associated with completeness and
accuracy of documentation on partograph?
3. What are the predictors of completeness and accuracy of documentation on
partograph?
 JUSTIFICATION .
• Partograph triggers early detection of complication for quick response to the
problem caused by prolonged labor and its consequences for preparation of early
referral of the expectant mother to the next higher level of the facility for further
better management.
• According to Lavenda (2013), partograph provides a pictorial labor summary that will
warn the birth attendant to the abnormalities in labor progress .
• Promotes perinatal maternal and fetal safety (WHO,2012).
• It also aids in clinical audit of progress of labor and outcomes to identify where
improvement support is required.
SIGNIFICANTS OF THE STUDY.

• The results from the study may inform clinical staff on how completeness and
accuracy of documentation on partograph can be enhanced for improvement of
maternal and fetal outcome.
• The results will also inform policymakers on areas where training strategies can
be facilitated to increase good management practices in healthcare services in
order to improve quality of care in labor and early detection of prolong or
obstructed labor complications.
• Clinical staff may be more equipped with knowledge which can improve in
monitoring the expectant mothers during delivery.
• Similarly, the findings will provide a baseline for further studies on the
completeness and accuracy of documentation on partograph and recommend to
the appropriate authorities on measures likely to improve on effective
documentation on partograph in order to reduce child mortality and improve
maternal health.
 CONCEPTUAL FRAMEWORK.

Independent variables

Staff demographic and

Dependent variables
Interpersonal factors:
• Age.
• Gender.
• Attitude and Perceptions
Completeness;
• Team Composition.
accuracy on
documentation of
partograph.
Capacity for Documentation.
• Staff Burnout.
• Staff Skills and Competence Intervening Variables.
• Staff Availability On-going capacity building.
• Availability of Stationary/supplies Support supervision and Training.
and commodities. Availability of EMR
• Availability of Equipment for Leadership and Governance
Patient Assessment.
METHODOLOGY

Study settings.

The study will be conducted in selected public and private

hospitals in level 4 and 3B i.e.; at Mutuini sub county
hospital ,waithaka, uthiru, muteithania ,Coptic hospital and
Maria immaculate hospitals in Dagoretti sub county.

Study population. Its will only be comprises of clinical staff

who are providing maternity services in these selected hospitals .
STUDY DESIGN
• The study will employ a descriptive cross sectional design with a mixed method
approach .
• The quantitative component will include a retrospective descriptive analysis of
medical records to assess the performance of completeness, accuracy of
documentation on partograph.
• The qualitative component will involve use of semi-structured questionnaires with
open-ended or explanatory responses whereby nurses providing maternity services
during the study period and responsible for recording the partograph will be invited
to participate in interview.
• The use of questionnaire is appropriate because the opinion obtain is always correct
and its relatively faster to collect processed data in large portion from a population.
(Harris and Brown,2010).
Sample size determination.
.Frackel and Wallen (2007) describe a sample in research as the group on
which information is obtained.
.This “sample” is usually just a fraction of the population being
studied. .This study will use a saturated sample of 30 respondents for the
research out of a population of 90.
.The sample elements for the research will consist of 20 nurses/midwives,
5 clinicians and 5 Health records officers based in Dagoretti sub county,
Nairobi county in Kenya
. Sampling procedure.
• Purposive sampling will be use to select the clinical staff who will be willing to participate
during the study. The nurses working in shifts will be given an opportunity to participate at
their own free time.
Inclusion criteria.
• Only nurses and midwives who will have work in those facilities for a minimum of 3
months, mostly involve in maternity services and will be willing to take part in the study
participation.
• Partographs for all expectant women with established labor
• Partographs for all methods of deliveries..

Exclusion criteria.
• Expectant mothers who have delivered before arrival:
• Obstetric emergencies for example, Antepartum haemorrhage
• Those who are eligible to participate but decline to participate
Data collection tools.
• The tool will be design based on specific objectives of the study.
• Semi-structured questionaires will be applied .
• Likert scale will be used to assess perceptions and attitudes.
• The abstraction tool to assess completeness and accuracy

Method of data collection.

• The data collection tool will be self-administered.
.Validity of data collection tool.
• The questionnaires will be validated through discussions by the HRIOs and clinical staff
based on the WHO requirements
• Pilot testing of the tool to assess both internal consistency and content appropriateness
• Test for reliability will be based on Cronbach correlation(≥ 0.7)
Data management and Analysis.
1. Data entry will be done using a statistical software (SPSS version 20.0 IBM).
2. Descriptive statistics will be computed to assess performance of documentation status
on partograph in order to get the measures of central tendency for objective 1.
3. The investigator will also employ t-test for continuous variables while categorical
variables will be compared using the chi –square test whereby a P-Value less than 0.05
will be considered statistically significant on clinical staffs related factors associated
with completeness and accuracy in documentation on partograph for objective 2.
4. Finally, inferential analysis by use of logistic regression will be use to determine the
predictors of completeness and accuracy of documentation on partograph for
objective 3.
Ethical Consideration.

• Undergo ethical review and approval by the JOOUST ethics committee and
NACOSTI.

• Permission to conduct this study to be obtained from the hospital management

of the selected facilities.

• Confidentiality of the collected information.

• Informed consent form to be obtain from each study participant.

References.

• WHO Partograph in management of labor. WHO maternal health and safe

motherhood lancet(1994).
• WHO .(2016). Health workforce requirements for universal health care coverage
and sustainable development goals.
• Asibongu at al…(2014).The use of partograph in labor monitoring.
• Lavender at al..(2013).students experiences of using the partograph in Kenya
labor wards.
• African journal of midwifery and women‘s health,2011.
• WHO. Analysis of cause of maternal death: systematic review. Lancet 2006.