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A cross-sectional study of partograph utilization as a decision making tool for referral of abnormal labour in primary health care facilities of Bangladesh

Journal Article
(Published September, 2018)
Khan, ANS (Author),
Billah, SM (Author),
Mannan, I. (Author),
Mannan, II (Author),
Begum, T. (Author),
Khan, MA (Author),
Ahasan, AMN (Author),
Rahman, JN (Author),
George, J (Author),
Arifeen, SE (Author)
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In Bangladesh, female paramedics known as Family Welfare Visitors (FWVs), conduct normal deliveries in first-level primary care facilities, or Union Health and Family Welfare Centres (UH&FWC). Utilization of partographs allow for early identification of abnormal labour and referral for advanced care to Emergency Obstetric Care (EmOC) facilities. A systematic assessment of the quality of partograph utilization in clinical-decision making will contribute to understanding the use of the tool by health workers.

METHODS: In 2013-2014, the USAID supported MaMoni HSS project, led in country by Save the Children with Icddrb and Jhpiego, trained FWVs on the use of partographs in five UH&FWCs in Habiganj district. 

RESULTS: A total of 1,198 deliveries were managed at the study sites, of which 663 presented with cervical dilatation of 8 cm or less. Partographs were initiated in 98% of these cases. Indication of abnormal labour was found in 71 partographs (11%) and among them, only 1 was referred to a higher-level facility. Foetal heart rate and cervical dilatation were appropriately recorded in 61% and 70% of the partographs, respectively. Interviews with health workers revealed poor interpretation of referral indications from the partographs. Limited accessibility to the nearest EmOC facility, inadequate time for referral, and non-compliance to referral by clients were identified by the interviewed health workers as the key barriers for referral decision making.

CONCLUSIONS: Supporting the health workers at first-level primary care facilities to better interpret and act on partograph data in a timely manner, and strengthening the referral systems are needed to ensure that women in labour receive the prompt quality care they and their babies require to survive.

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Citation: 
Khan ANS, Billah SM, Mannan I, Mannan, II, Begum T, Khan MA, Rahman JN, et al. A cross-sectional study of partograph utilization as a decision making tool for referral of abnormal labour in primary health care facilities of Bangladesh. PloS one. 2018;13(9):e0203617