Partograph completion levels. a comparison of rural-urban health facilities in Jinja district in 2023

Abstract

Introduction: Maternal and neonatal mortality rates in Uganda remain a significant public health concern, with maternal deaths attributed to postpartum hemorrhage, sepsis, and delivery-related complications, while neonatal deaths are linked to birth asphyxia and infections. This study aimed to evaluate partograph completion levels, challenges and enablers to partograph completion, and the relationship between partograph completion and neonatal outcomes. Methods: This cross-sectional study was conducted in Jinja District, Uganda, reviewing patient delivery folders from Buwenge HCIV (rural setting) and Mpumudde HCIV (urban setting). A total of 352 out of 866 folders were sampled from Buwenge HCIV, and 352 out of 1148 from Mpumudde HCIV. A checklist was used to measure neonatal labor outcomes and partograph completion. Key informant interviews explored contextual challenges and enablers of partograph completion. The primary overall outcome was dichotomized into completion/non-completion. Univariate, bivariate, and multivariable analyses were conducted, with findings presented in tables, pie charts, bar graphs, and narrative format. Results: The majority were mothers aged 20-24 (260/704), homemakers (227/704), married (368/704), and residing in rural areas (447/704), with most being multigravida (507/704) and in their 37th week of gestation or beyond (624/704). Out of 704 partographs, only 68 were fully completed, with 29/352 at Buwenge HCIV and 39/352 at Mpumudde HCIV. Cervical dilation was the most recorded parameter. Partographs for asphyxiated neonates had a completion level of 11.3%, compared to 9.3% for those without asphyxia, but this difference was not statistically significant (aOR: 0.76, p=0.626). Challenges in the urban context included high patient volumes, work overload for healthcare staff and inconsistent supportive supervision. Enablers included access to training and patient education and awareness. Challenges in the rural context included, planned absenteeism among staff, patient hesitance to be monitoring and influence of native medicine on patient care. Enablers included, mentorship from senior midwives and awareness of the pantographs’ importance. Conclusion: The study highlights that urban health facilities in Jinja, Uganda, have higher partograph completion rates than rural facilities due to better staffing and resources, while emphasizing the need for targeted interventions to address the unique challenges faced by rural settings