Implementation of partograph and outcome of labour at Chipata general hospital

Abstract

Worldwide use of the partograph in monitoring of labour has been proven to reduce maternal and infant morbidity and mortality. Zambia has one of the highest maternal mortality in the world. The eastern Province of Zambia, particularly Chipata District had the highest levels accounting for 76% of the maternal deaths in the province in a research done in 1998. The purpose of this study was to provide baseline data on the implementation of the partograph and outcome of labour at Chipata General Hospital with a view to reducing maternal deaths. A prospective and descriptive study, with both, qualitative and quantitative research components, was conducted in maternity ward at the hospital from May to August 2005. A review of 246 partographs of women who had delivered at Chipata General Hospital was conducted with the aid of a checklist. In addition, a focus group discussion with ten midwives working in maternity ward was conducted. In this study, high monitoring of labour means that observations were carried out and partograph was filled in consistently,while medium monitoring means inconsistent observation and low monitoring refered to inconsistent or no observation having been carried out. Similarly, poor outcome meant that the woman had complication(s) during labour or within the first twenty-four hours of delivery. Good outcome means that labour progressed without complications.The study revealed that low monitoring was associated with poor outcome of labour. About 50% of the women had low monitoring of the maternal condition during labour and 30.4% of them had moderate monitoring while only 23.7% had consistent monitoring. Further, 10.9% of the women with low monitoring of maternal conditions had poor outcome of labour, while 6.0% of them with moderate monitoring also had poor outcome. Age in relation to maternal outcome showed that poor outcome was high among women aged 20 -29 years.The study has also revealed that outcomes of labour at Chipata General Hospital do not correlate with partograph use. Monitoring of the fetal condition was low and 8.9% of the babies had severe asphyxia while 11.8% of them had moderate asphyxia. During the study period there were a total of 729 deliveries, 126 caesarean sections, three maternal deaths, one ruptured uterus and 24 fresh stillbirths..Although the partograph is being used at the hospital, this study has demonstrated that it is not being used properly given the poor outcomes of labour during the study period. The equipment and resources needed to implement the use of partograph were usually not available. These included the partographs, gloves, thermometers, and sphygmomanometers. This situation had made it difficult for midwives to use the partograph according to expectations. There was also critical shortage of midwives and a few of those available were observed to have a negative attitude towards the use of partograph. If the implementation of the partograph has to be effective at the hospital, the midwives should use it correctly everyday. As the study shows, there are a number o f negative attitudes not withstanding shortages and the lack of equipment. The authorities should thus provide adequate supportive supervision to the staff working in the maternity ward and they should also ensure at all times that there is adequate staffing, equipment and reliable source of supplies in the maternity ward. Monitoring of women with the partograph should not be selective. In addition it is necessary for the hospital to develop management protocols that should accompany partograph use. There is also need to have a maternal death audit considering the number of deaths (3) in such a short period of the study.