Knowledge and Utilization of the Partograph among obstetric care givers in South West Nigeria 1Fawole AO, 2Hunyinbo KI, 3Adekanle DA ABSTRACT This cross-sectional study assessed knowledge and utilization of the partograph among health care workers in south- western Nigeria. Respondents were selected by multi-stage sampling method from primary, secondary and tertiary levels of care. 719 respondents comprising of CHEWS - 110 (15.3%), Auxiliary Nurses - 148 (20.6%), Nurse/Midwives - 365 (50.6%), Physicians ��� 96 (13.4%) were selected from primary (38.2%), secondary (39.1%) and tertiary levels (22.7%). Only 32.3% used the partograph to monitor women in labour. Partograph use was reported significantly more frequently by respondents in tertiary level compared with respondents from primary/secondary levels of care (82.4% vs. 19.3% X2 = 214.6, p 0.0001). Only 37.3% of respondents who were predominantly from the tertiary level of care could correctly mention at least one component of the partograph (X2 = 139.1, p 0.0001). The partograph is utilized mainly in tertiary health facilities knowledge about the partograph is poor. Though affordable, the partograph is commonly not used to monitor the Nigerian woman in labour. (Afr Reprod Health 2008 12[1]:22-29). R��SUM�� Connaissance et utilisation du partographe chez les dispensateurs des soin obst��triques au sud-ouest du Nigeria. Cette ��tude transvasale a ��valu�� la connaissance et l���utilisation du partographe parmi les membres du personnel soignant au sud-ouest du Nig��ria. Les personnes interrog��es ont ��t�� s��lectionn��es �� l���aide d���une m��thode d�����chantillon �� plusieurs ��tapes �� partir des niveaux de soin primaire, secondaire et tertiaire. Au total 719 personnes ont ��t�� interrog��es, y compris les travailleurs communautaires pour l���extension des services de sant�� 110 (15,3%), des infirmi��res auxillaires ��� 148 (20,6%), les infirmi��res / sages���femmes ��� 365 (50,6%), les m��decins ��� 96 (13,4%) ont ��t�� s��lectionn��es �� partir des niveaux primaire (38,2%), secondaire (39,1%) et tertiaire (22,7%). Seuls 32,3% se sont servis du partographe pour surveiller les femmes au travail. L���utilisation du partographe a ��t�� plus fr��quent chez les interrog��s qui appartiennent au niveau tertiaire par rapport aux int��rrog��s des niveaux primaire et secondaire de soin (82,4% vs 19,3% X2 = 214,6 p 0,0001). Seules 37,3% des int��rrog��s qui appartenaient en majorit�� au niveau tertiaire de soin pouvaient mentionner au juste au moins un constituent du partographe (X2 = 139, p 0,0001). Le partographe est utilis�� surtout dans les ��tablissement de sant�� tertiaire la connaissance du partographe est faible. Bien qu���il soit abordable, le partographe n���est pas commun��ment utilis�� pour surveiller la femme nig��riane au travail. (Rev Afr Sant�� Reprod 2008 12[1]:22-29). KEY WORDS: partograph, healthcare providers, knowledge, utilization Knowledge and Utilization of the Partograph among obstetric care givers in South West Nigeria 1Department of Obstetrics & Gynaecology, University College Hospital, Ibadan 2Department of Obstetrics & Gynaecology, Federal Medical Centre, Abeokuta 3Dept. of Obstetrics & Gynaecology, College of Health Sciences, LAUTECH, Osogbo Correspondence: Dr. Fawole AO Department of Obstetrics & Gynaecology, University College Hospital, Ibadan, Nigeria. E-mail: fawoleo@yahoo.co.uk

23 African Journal of Reproductive Health Vol. 12 No.1 April, 2008 Introduction Maternal mortality ratio continues to be the major index of the widening discrepancy in the level of care and the outcome of reproductive health between the advanced and developing countries.1, 2 This observation is supported by the global maternal mortality pattern in which annual losses of more than 515 000 maternal deaths from complications of pregnancy and childbirth, occur in developing countries3. Among those who survive childbirth, at least 8 million develop serious morbidities and a further 50 million suffer minor complications4. The tragedy of maternal mortality in Nigeria is that despite the recognition of maternal mortality as a major public health issue, maternal mortality figures continue to rise, inspite of the apparent commitment by stake- holders.5 The majority of the deaths and compli- cations could be prevented by cost-effective and affordable health interventions like the partograph6 and indeed the same measures that would prevent maternal deaths would also prevent morbidity and improve neonatal outcome.7 The partograph is an effective tool for monitoring labour, and when used effectively, will prevent prolonged or obstructed labour, which accounts for about 8% of maternal deaths.8,9 The partograph thus serves as an ���early warning system��� and assists in early decision on transfer, intervention decisions in hospitals and ongoing evaluation of the effect of interventions. The partograph as a tool for intra-partum management is a mandatory component of care in all health facilities providing maternity services in the new Women and Children Friendly Services (WCFHS) Initiative from the Federal Ministry of Health in Nigeria and UNICEF.10 This study, designed in the broad context of understanding why the problem of maternal mortality persists in Nigeria, was undertaken to assess the level of utilization of the partograph to monitor labour, and the attitude and knowledge of the partograph by health care workers providing maternity services in south- western Nigeria. Recognizing the value of the partograph as a cheap, affordable and effective tool, the study explored the question of its use in the management of the parturient woman. Methodology The study was conducted among health care providers in selected health facilities providing maternity services in Ogun, Oyo and Osun States all in south-western Nigeria. Health care delivery in the region is provided at the primary, secondary and tertiary levels. The state capitals, Abeokuta, Ibadan and Osogbo are municipalities with between two and five local governments each respectively. Each city has a rich network of health facilities comprising of primary health centres (including privately-owned maternities and hospitals), secondary health facilities and at least one tertiary hospital providing maternity service. The study was conducted as a collaborative effort between researchers at the Department of Obstetrics & Gynaecology, University College Hospital, Ibadan, the Department of Obstetrics & Gynaecology, Federal Medical Centre, Abeokuta, and the Department of Obstetrics & Gynaecology, Ladoke Akintola University of Technology (LAUTECH) Teaching Hospital, Oshogbo. It was designed as a descriptive cross sectional study amongst health care providers in health care facilities at all levels of the health care system in the three states, utilizing a multi-stage sampling method. In each state, two local government areas were selected. The local government in the capital city in which the seat of the state government was based was selected. A second local government located in a rural area was randomly selected. This measure was to accommodate potential urban-rural disparities in health infrastructure and personnel distribution. Using a sampling frame derived from the list of health care facilities in each level of care obtained from the Ministry of Health in each state, a systematic random sampling was done to select 5 primary health care centres, 10 private health Knowledge and Utilization of the Partograph among obstetric care givers in South West Nigeria