Opportunities and challenges of partograph utilization for labor monitoring in Sub- Saharan Africa: A systematic review
Authors: Mugyenyi RG , Tumuhimbise W , Ntayi JM , Yarine TF , Byamugisha J , Atukunda EC 
Published: October 2023

Background
Despite decades of healthcare provider training and investment, rates of utilization and capacity to appropriately plot the partograph and use it to make critical decisions remain sub-optimal in Sub-Saharan Africa.
Objective
To synthesize the evidence of the existing gaps, challenges and opportunities of partograph utilization in labor monitoring in Sub-Saharan Africa from the existing literature.
Methods
PUBMED, Cochrane Library of Trials, Google Scholar, and ScienceDirect databases published between 1st January 2013 and July 2023 for studies reporting the opportunities and challenges/gaps of utilizing the partograph in labor monitoring in Sub-Saharan Africa were searched. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided the identification of the eligible studies for inclusion. We utilized the Consolidated Framework for Implementation Research to interpret the gaps, challenges and opportunities of labor monitoring using the partograph in Sub-Saharan Africa, and inform wider interest groups on future or ongoing implementation approaches to introduction or utilizing similar long-term interventions in similar low resource settings. The review protocol was registered with PROSPERO (CRD42023452882)
Results
Twenty-eight high quality studies met the inclusion criteria and were analysed for this review. Opportunities identified by this review include; the ppartograph’s uncontested potential to reduce the risk of maternal and foetal mortality and morbidity, with good support supervision, formal and ongoing on-job training, active mentorships, plus availability of policy and standard protocols for guidance on use and reporting. The partographs’ availability in health facilities was also reported to facilitate information transfer among midwives when handing over shifts of duty On the other hand, the lack of or little training, the complexity of the partograph, time consumption due to too much detail required to fill the non-stand-alone partograph, availability of different and or supplementary monitoring tools other than the partograph often fatigued and biased users, and all these, coupled with a lack of motivation, feedback on use, unavailability of the partograph in some health facilities, shortage of staff in busy facilities, lack of support supervision, protocols, encouragement, praise nor reward for consistent users seemed to lead to lack of commitment, negative attitude, negligence, careless partograph completion or non-use among obstetric care workers during labor monitoring in Sub-Saharan Africa
Conclusion
Rethinking the partograph utilization, given its gaps and shortcomings should be given ardent attention. The adoption of the alternatively recommended mechanisms such as the labor care guide may revolutionize and motivate labor monitoring in Sub-Saharan Africa. Keen attention should be paid to a clearly thought-out implementation strategy to avoid similar mistakes hindering partograph’s optimal use.