Research Tittle: Factors associated with completeness and accuracy

on documentation of partograph in first phase of labor progress in

selected hospital in level 4 and 3B dagoretti subcounty,Nairobi
county in Kenya.

Name: 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 midwives 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
most 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

South west -Zone 58.8% Had no recording on Kushwa B et all..2013.

blood pressure, no
temperature and fetal
heart rate.
Malawi 39% Had no fetal heart rate, Khan et al..2018.
cervical dilatation.
Ghana 25.5% No fetal condition Gans_Lartey et al..2013
documented ,maternal
and labor progress.
Uganda 61% Less documentation on Mukisa et al..2019
fetal heart and cervical
dilatation.
Kenya(KNH) No estimate. No documentation on Rotich et al..2011
partograph at all.
Statement of the problem.

• The documentation of the partograph still not fully emphasize in various health
institutions which has contributed to the increased of maternal and neonatal
mortality rate in Kenya.
• Dagoretti sub county is among institutions identify not embracing full
documentation on completeness and accuracy of the partograph.
• The reasons why midwives are still not documenting the partograph, maybe assume
to be due to high workload, lack of skills competency, shortage of number of nurses
working at the maternity and that’s why there is need to conduct the research
pertaining the related issues leading to incomplete documentation of partograph in
monitoring 1st phase of labor .
• 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 in first phase of labor progress in selected hospital in
level 4 and 3B dagoretti subcounty,Nairobi county in Kenya

SPECIFIC OBJECTIVES.
• To determine the nurses related factors associated with quality of completeness
and accuracy in documentation on partograph.
• To assess the performance of the completeness and accuracy of documentation on
partograph in a selected public and private hospital.
• To determine the factors associated with the completeness, accuracy of
documentation on partograph.
RESEARCH QUESTIONS

• What are the staff related factors associated with quality of completeness,
accuracy of documentation on partograph?
• What are the relationship in comparing the completeness, accuracy of
documentation on partograph in a selected public and private hospital?
• What are the predictions associated with the completeness, accuracy of
documentation on partograph?
 JUSTIFICATION .
• It triggers early detection of complication for quick response to the problem caused
by prolong 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 provide a pictorial labor summary that will
warn the birth attendant to the abnormalities in labor progress .
• Provides fetal safety hence aiming at improving healthcare and reduction of maternal,
fetal morbidity or death (WHO,2012).
• Its aid in assessment on the maternity services to identify where need necessary
support.
SIGNIFICANTS OF THE STUDY .
• The results from the study may inform nurses 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 teaching 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.
• Nurses may be more equipped with knowledge which can improve in monitoring the expectant
mothers during delivery.
• Similarly, the findings will provide 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

Nurses related factor.

• Age. Dependent variables
• Gender.
Completeness and
• Attitude
accuracy on
• Knowledge gap
documentation of
• training.
partograph.
• Team work.

Factors associated with

documentation. Intervening Variables.
• Workload. Vertical program support.
• Staffing On going capacity building.
• Resources. Support supervision.
• Equipment's.
STUDY DESIGN
• The study will employ a descriptive cross sectional 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 and the
qualitative analysis will involve a descriptive cross sectional study whereby nurses providing
maternity services will be interviewed.

• Then the logistic regression will be used in testing statistical outcome on nurses related factors in
relationship to factors associated with completeness and accuracy of documentation on partograph.
Study settings.
The study will be conducted in a selected public and private hospitals in level 4 and 3B at Mutuini sub county
hospital ,waithaka, uthiru, muteithania ,Ray of hope and Maria immaculate hospitals in Dagoretti sub county.
Study population. Its will only be comprises of nurses and midwives who are providing maternity services in the selected
hospitals.
Inclusion criteria. Only nurses and midwives who will have work in those facilities for more than 3 months, mostly involve
in maternity services and will be willing to take part in the study participation.

Exclusion criteria. Only nurses who has been working in those facilities for less than 3 months and mostly not involved in
maternity services.
Sampling procedure.
The investigator will be using random sampling method by applying stratified techniques in order to obtain sample element.
.
Sample determination.
A statistical formulae (fisher’s formulae) will be use to calculate the size of the sample.
n=Z²pq/ d²
Where n=desire, Z=standard deviation of required confidence level (1.96) at confidence level 0f 95% ;P=Proportional of the target population
as 0.5,Q=1-p,thereforeQ=1-0.5=0.5, d=maximum tolerance error =0.05
n=(1.96)² *0.5*0.5/(0.05)² =384 since the study population calculated using fisher’s less than 10000, apply Reduction factor.
nf=n/1+(n/N). Where nf=desired sample size. ,n=sample size of the population.

So the finding value will act as the number of the respondents.

Data collection tools.
• Structure questions will be applied .The tool will be design based on specific objectives of the study.
Method of data collection.
• The data collection tool will be a self-administered questionnaire‘s design on the basis of research questions. 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).
Data management and Analysis.
• Data entry will be done using a statistical software (SPSS version 20.0 IBM).
• The descriptive statistics will be computed in order to get the measures of central tendency on nurses related factors
that are associated with the completeness and accuracy in documentation of the partograph.
• cross tabulation will also be use in getting general factors associated with documentation of partograph
• In addition to that, the inferential analysis where logistic regression will also be use for assessing the performance
on documentation of the partograph in a selected hospitals.
Validity of data collection tool.
• The questionnaires will be presented to the internal supervisor to make the correction before use.
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.