Knowledge and Utilization of the Partograph among obstetric care givers in South West Nigeria

This cross-sectional study assessed knowledge and utilization of the partograph among health care workers in southwestern 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).Cette étude transvasale a évalué la connaissance et l\'utilisation du partographe parmi les membres du personnel soignant au sud-ouest du Nigéria. Les personnes interrogées ont été sélectionnées à l\'aide d\'une méthode d\'échantillon à plusieurs étapes à partir des niveaux de soin primaire, secondaire et tertiaire. Au total 719 personnes ont été interrogées, y compris les travailleurs communautaires pour l\'extension des services de santé 110 (15,3%), des infirmières auxillaires – 148 (20,6%), les infirmières / sages–femmes – 365 (50,6%), les médecins – 96 (13,4%) ont été sélectionnées à 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 été plus fréquent chez les interrogés qui appartiennent au niveau tertiaire par rapport aux intérrogés des niveaux primaire et secondaire de soin (82,4% vs 19,3% ; X2 = 214,6 p < 0,0001). Seules 37,3% des intérrogés qui appartenaient en majorité au niveau tertiaire de soin pouvaient mentionner au juste au moins un constituent du partographe (X2 = 139, p < 0,0001). Le partographe est utilisé surtout dans les établissement de santé tertiaire ; la connaissance du partographe est faible. Bien qu\'il soit abordable, le partographe n\'est pas communément utilisé pour surveiller la femme nigériane au travail.Keywords: partograph, healthcare providers, knowledge, utilization Knowledge and Utilization of the Partograph among obstetric care givers in South West NigeriaAfrican Journal of Reproductive Health Vol. 12 (1) 2008: pp. 22-2

Utilization of the partograph in primary health care facilities in Southwestern Nigeria

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Maternal death and obstetric care audits in Nigeria: A systematic review of barriers and enabling factors in the provision of emergency care.

Acknowledgements We would like to thank Yutaka Osakabe for co-ordinating the retrieval of full text articles. The John D. and Catherine T. MacArthur Foundation supported this study, grant number 12-100074-000-INPPeer reviewedPublisher PD

Maternal and child health interventions in Nigeria: a systematic review of published studies from 1990 to 2014

BACKGROUND: Poor maternal and child health indicators have been reported in Nigeria since the 1990s. Many interventions have been instituted to reverse the trend and ensure that Nigeria is on track to achieve the Millennium Development Goals. This systematic review aims at describing and indirectly measuring the effect of the Maternal, Newborn, and Child Health (MNCH) interventions implemented in Nigeria from 1990 to 2014. METHODS: PubMed and ISI Web of Knowledge were searched from 1990 to April 2014 whereas POPLINE® was searched until 16 February 2015 to identify reports of interventions targeting Maternal, Newborn, and Child Health in Nigeria. Narrative and graphical synthesis was done by integrating the results of extracted studies with trends of maternal mortality ratio (MMR) and under five mortality (U5MR) derived from a joint point regression analysis using Nigeria Demographic and Health Survey data (1990-2013). This was supplemented by document analysis of policies, guidelines and strategies of the Federal Ministry of Health developed for Nigeria during the same period. RESULTS: We identified 66 eligible studies from 2,662 studies. Three interventions were deployed nationwide and the remainder at the regional level. Multiple study designs were employed in the enrolled studies: pre- and post-intervention or quasi-experimental (n = 40; 61%); clinical trials (n = 6;9%); cohort study or longitudinal evaluation (n = 3;5%); process/output/outcome evaluation (n = 17;26%). The national MMR shows a consistent reduction (Annual Percentage Change (APC) = -3.10%, 95% CI: -5.20 to -1.00 %) with marked decrease in the slope observed in the period with a cluster of published studies (2004-2014). Fifteen intervention studies specifically targeting under-five children were published during the 24 years of observation. A statistically insignificant downward trend in the U5MR was observed (APC = -1.25%, 95% CI: -4.70 to 2.40%) coinciding with publication of most of the studies and development of MNCH policies. CONCLUSIONS: The development of MNCH policies, implementation and publication of interventions corresponds with the downward trend of maternal and child mortality in Nigeria. This systematic review has also shown that more MNCH intervention research and publications of findings is required to generate local and relevant evidence

Evaluation of Criteria-Based Clinical Audit in Improving Quality of Obstetric Care in a Developing Country Hospital

Study evaluated criteria–based clinical audit in measuring and improving quality of obstetric care for five life-threatening obstetric complications: obstetric haemorrhage, eclampsia, genital tract infections, obstructed labor and uterine rupture. Clinical management of 65 patients was audited using a ‘before (Phase I) and after (Phase II)’ audit cycle design using standard criteria. Following Phase I, areas inneed of improvement were identified; mechanisms for improving quality of care were identified and implemented. Overall care of the complications improved significantly in obstetric haemorrhage (61 to81%, p = 0.000), eclampsia (54.3 to 90%, p=0.00), obstructed labour (81.7 to 93.5%,

Improved quality of management of eclampsia patients through criteria based audit at Muhimbili National Hospital, Dar es Salaam, Tanzania : Bridging the quality gap

Background: Criteria-based audits (CBA) have been used to improve clinical management in developed countries, but have only recently been introduced in the developing world. This study discusses the use of a CBA to improve quality of care among eclampsia patients admitted at a University teaching hospital in Dar es Salaam Tanzania. Objective: The prevalence of eclampsia in MNH is high (approximate to 6%) with the majority of cases arriving after start of convulsions. In 2004-2005 the case-fatality rate in eclampsia was 5.1% of all pregnant women admitted for delivery (MNH obstetric data base). A criteria-based audit (CBA) was used to evaluate the quality of care for eclamptic mothers admitted at Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania after implementation of recommendations of a previous audit. Methods: A CBA of eclampsia cases was conducted at MNH. Management practices were evaluated using evidence-based criteria for appropriate care. The Ministry of Health (MOH) guidelines, local management guidelines, the WHO manual supplemented by the WHO Reproductive Health Library, standard textbooks, the Cochrane database and reviews in peer reviewed journals were adopted. At the initial audit in 2006, 389 case notes were assessed and compared with the standards, gaps were identified, recommendations made followed by implementation. A re-audit of 88 cases was conducted in 2009 and compared with the initial audit. Results: There was significant improvement in quality of patient management and outcome between the initial and re-audit: Review of management plan by senior staff (76% vs. 99%; P=0.001), urine for albumin test (61% vs. 99%; P=0.001), proper use of partogram to monitor labour (75% vs. 95%; P=0.003), treatment with steroids for lung maturity (2.0% vs. 24%; P=0.001), Caesarean section within 2 hours of decision (33% vs. 61%; P=0.005), full blood count (28% vs. 93%; P=0.001), serum urea and creatinine (44% vs. 86%; P=0.001), liver enzymes (4.0% vs. 86%; P=0.001), and specialist review within 2 hours of admission (25% vs. 39%; P=0.018). However, there was no significant change in terms of delivery within 24 hours of admission (69% vs. 63%; P=0.33). There was significant reduction of maternal deaths (7.7% vs. 0%; P=0.001). Conclusion: CBA is applicable in low resource setting and can help to improve quality of care in obstetrics including management of pre-eclampsia and eclampsia