Feasibility and effectiveness of electronic vs. paper partograph on improving birth outcomes: A prospective crossover study design


Autoři: Aminur Rahman aff001;  Tahmina Begum aff001;  Fatema Ashraf aff002;  Sadika Akhter aff001;  Dewan Md. Emdadul Hoque aff003;  Tarun Kanti Ghosh aff004;  Monjur Rahman aff001;  Jelle Stekelenburg aff005;  Sumon Kumar Das aff007;  Parveen Fatima aff008;  Iqbal Anwar aff001
Působiště autorů: Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh aff001;  Department of Obstetrics and Gynaecology, Shaheed Suhrawardi Medical College & Hospital, Dhaka, Bangladesh aff002;  Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh aff003;  Department of Obstetrics and Gynaecology, Kushtia Medical College & Hospital, Kushtia, Bangladesh aff004;  Department of Health Sciences, Global Health, University Medical Centre/University of Groningen, Groningen, The Netherlands aff005;  Department of Obstetrics and Gynaecology, Leeuwarden Medical Centre, Leeuwarden, The Netherlands aff006;  Clinical and Nutrition Sciences Division, icddr,b, Dhaka, Bangladesh aff007;  Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh aff008
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0222314

Souhrn

Background

The partograph has been endorsed by World Health Organization (WHO) since 1994 which presents an algorithm for assessing maternal and foetal conditions and labor progression. Monitoring labour with a partograph can reduce adverse pregnancy outcomes such as prolonged labor, emergency C-sections, birth asphyxia and stillbirths. However, partograph use is still very low, particularly in low and middle income countries (LMICs). In Bangladesh the reported partograph user rate varies from 1.4% to 33.0%. Recently, an electronic version of the partograph, with the provision of online data entry and user aid for emergency clinical support, has been tested successfully in different settings. With this proven evidence, we conducted and operations research to test the feasibility and effectiveness of implementing an e-partograph, for the first time, in 2 public hospitals in Bangladesh

Methods

We followed a prospective crossover design. Two secondary level referral hospitals, Jessore and Kushtia District Hospital (DH) were the study sites. All pregnant women who delivered in the study hospitals were the study participants. All nurse-midwives working in the labor ward of study hospitals were trained on appropriate use of both types of partograph along with standard labour management guidelines. Collected quantitative data was analyzed using SPSS 23 statistical software. Discrete variables were expressed as percentages and presented as frequency distribution and cross tabulations. Chi square tests were employed to test the association between exposure and outcome variables. Potential confounding factors were adjusted using multivariate binary logistic regression methods. Ethical approval was obtained from the institutional review board of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b).

Findings

In total 2918 deliveries were conducted at Jessore DH and 2312 at Kushtia DH during one-year study period. Of them, 1012 (506 in each facility) deliveries were monitored using partograph (paper or electronic). The trends of facility based C-section rates was downwards in both the hospitals; 43% to 37% in Jessore and from 36% to 25% in Kushtia Hospital. There was a significant reduction of prolonged labour with e-partograph use. In Kushtia DH, the prolonged labour rate was 42% during phase 1 with the paper version which came down to 29% during phase-2 with the e-partograph use. The similar result was observed in Jessore DH where the prolonged labour rate reduced to 7% with paper partograph from the reported 30% prolonged labour with e-partograph. The e-partograph user rate was higher than the paper partograph during both phases (phase 1: 3.31, CI: 2.04–5.38, p < .001 and in phase 2: 15.20 CI: 6.36–36.33, p < .001) after adjusting for maternal age, parity, gestational age, religion, mother’s education, husband’s education, and fetal sex

Conclusion

The partograph user rate has significantly improved with the e- partograph and was associated with an overall reduction in cesarean births. Use of the e-partograph was also associated with reduced rates of prolonged labour. This study has added to the growing body of evidence on the positive impact of e-partograph use. We recommend implementing e-partograph intervention at scale in both public and private hospitals in Bangladesh.

Trial registration

ClinicalTrials.gov NCT03509103.

Klíčová slova:

Asphyxia – Bangladesh – Cesarean section – Hospitals – Labor and delivery – Obstetrics and gynecology – Pregnancy – Religion


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