Bridging the Gap: Leveraging Partograph Utilization Insights to Facilitate the Smooth Implementation of the Labour Care Guide at Mbale Regional Referral Hospital, Eastern, Uganda
Authors: KIBUUKA RONALD , Apoya Jill , Nsubuga Allan. G. , Kagoya Enid Kawala , Atuhairwe Irene , Nakattudde Prossy , Jesca Atugonza , Okibure Ambrose , betty Nakawuka , Namaganda Agnes , Mugabe Kenneth , Auma Patience , Olaki Olga Ariga , Adokon Barbara Rachael , Wandera Ernest , Okello Francis , Nakawuki Ashley , Nekaka Rebecca , Arach Lawrence , Musaba Milton , Waako Paul , wandabwa julius 
Published: December 2023

Abstract
Introduction: Maternal and newborn care has seen significant advancements through evidence-based guidelines, including the labour care guide introduced by the World Health Organization (WHO). However, the successful implementation of these guidelines relies on analysing the level of effective utilization of tools such as the partogram. In this study, we aim to assess the effects of a QI project aimed at improving the utilization of the partogram, and the current level of its utilization at Mbale Regional Referral Hospital, Uganda, and identify the possible challenges in its use and design effective procedures in rolling out of the labour care guide into existing clinical practices.
Methodology: A retrospective study combining quantitative and qualitative approaches was conducted. In March 2021 200 files were randomly sampled and checked for presence or absence of a partograph and this formed the baseline data before starting a QI project to improve utilization of a partograph to improve partograph utilization. In March 2023, 1120 patient files were reviewed from deliveries that happened between April to December 2022, these were analyzed to determine the presence or absence of a partogram in the file and the level of utilization. 6 key informant interviews were also conducted with healthcare workers to explore factors influencing partograph utilization and recommendations.
Results: While certain mothers’ particulars were well-documented, critical information such as LNMP, EDD, and risk factors displayed higher rates of missing data. Monitoring rates decreased with subsequent times with an average level of partograph utilization of 39%. The presence of a partograph in patients’ files improved from 3% in March 2021 to 80% from April to December 2022. Key informant interviews revealed challenges related to heavy workload, inadequate human resources, poor attitudes towards partograph utilization, knowledge gaps, and policy-related issues.
Conclusions: The level of partograph utilization at Mbale Regional Referral Hospital remains suboptimal (<50%), Which could hinder the successful rolling out of the LCG. Addressing the identified challenges is essential for improving maternal and newborn care practices. With the above insights in mind and with support from Seed Global Health, the team is set to effectively change its goal from improving the level of utilization, which improved from 3% to 80%, towards rolling out the LCG.
Recommendations: To enhance partograph utilization and facilitate the smooth implementation of the labour care guide, we recommend increasing human resources, providing targeted training and education, improving hospital infrastructure, fostering positive attitudes among healthcare workers, and implementing continuous quality improvement programs.