The WHO partograph has been adopted by ministries of health throughout sub-Saharan Africa to monitor labor progress. The purpose of this study is to understand the scope of its use in Rwanda.METHODS:
Completion of the WHO partograph was assessed by trained observers in three Rwandan maternity wards: urban tertiary referral hospital, rural health center, and rural district hospital. Data was recorded at multiple points during patients' labor and after delivery to assess degree of partograph completion. Demographic and labor characteristics data were collected. Descriptive statistics and chi-square analyses were performed to assess for associations with partograph completion. Statistical analysis was performed using STATA version 12.0. An alpha level less than 0.05 denoted statistical significance.RESULTS:
Thirty providers consented to be observed. Data was collected on 58 women. Eighty-nine percent of partographs were not complete when patients were completely dilated; 84% were not complete when patients started pushing. Ninety-four percent of partographs were complete within one hour of delivery. Having at least one co-morbidity was associated with a complete partograph by the time the patient was pushing (P=.05). None of the following were associated with partograph completion: day/night shift (P=.22), weekday/weekend shift (P=.58), induction/augmentation medications (P=.64), and parity (P=.53).CONCLUSION:
Despite being a validated tool proven to reduce maternal morbidity and neonatal morbidity and mortality, partographs are not routinely completed and thus not routinely used to manage labor in some Rwandan maternity wards. Patient co-morbidities may lead to more frequent use. Additional determinants of use and barriers to completion need to be assessed.