Partograph Completion: A Comparison Between Faith-Based Mission Hospitals and County Public Teaching and Referral Hospitals in Upper Eastern, Kenya

Abstract

Ninety-nine per cent of global maternal deaths, partly caused by obstructed labor, occur in sub-Saharan Africa. The World Health Organization recommends that all mothers in labor be monitored correctly in labor to detect complications early. The partograph, when used properly to monitor labor, can avert maternal and fetal health complications. The rate and quality of completion in public hospitals is known. However, not much is known on how the rate of completion of the partograph compares among the faith based hospitals (FBH) and CRH, yet FBHs form a significant part of the health system globally. This study aims at comparing completion rates of the WHO modified partograph between FBH and CRH in upper Eastern, Kenya. This was a cross-sectional descriptive study involving retrospective records review. The sample size was 365 partographs from Faith based hospitals and County hospitals (83 and 282 respectively). Quantitative data was collected using a standard protocol checklist and analyzed descriptively using means, percentages, standard deviations, and the independent-samples t-test. Qualitative data was collected using key informant interview. Frequency tables, bar graphs and charts were used to present data and relevant verbatim from Key Informant Interviews included.Based on fetal, labor and maternal monitoring, 54.9% [95% (CI: 34.95, 74.92) of all the partographs were completed to standard. The average rate of completion to standard was lower in FBH (43.1,SD=23.19.) than in CRH (58.3; SD=19.16, p = 0001. Only 39.0% of births had fetal monitoringcompleted to standard in FBH compared to CRH (60.5%). Patient’s name (86.75%), parity (82.75%)and gravidity (82.75%) were the most commonly recorded socio- demographics. On the other hand, labor was the most monitored parameter to standard in FBH and CRH (67% and 73.8%respectively). Overall, maternal monitoring was either substandard or not recorded at all in 59.3%and 76.7% births in CRH and FBH respectively. Lower completion in FBH was associated with high staff turn-over, staff shortages and inadequate experience. Facilitating factors in CRH include trainings, meetings to audit progress, and presence of nurse-trainees. The quality and rate of completion of the partograph in our study setting is sub-optimal giving a significant difference between partograph completion in FBH and CRH. FBH and CRH should engage in more collaborations and further research to establish ways of improving quality of partograph completion in order to reduce maternal mortality and morbidity in line with sustainable development goal three.