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 Medical Group

Archives of Community Medicine and

Public Health
DOI: http://dx.doi.org/10.17352/acmph ISSN: 2455-5479 CC By

Fobellah N Nyiawung1, Elvis T

Amin2*, Johnson A Fondungallah3, Research Article
Thomas O Egbe4
The Partogram: Knowledge, Attitude
1
Muyuka District hospital, Southwest
Region,Cameroon; Ministry of Public Health,
Cameroon
and Use by Healthcare Providers at
2
CMA Mbangasina, Centre Region, Cameroon;
Ministry of Public Health, Cameroon Two Hospitals in the South West
3
CMA Buea Town, Southwest Region, Cameroon;
Ministry of Public Health, Cameroon
4
Faculty of Health Sciences, University Of Buea,
Region of Cameroon
Cameroon

Received: 08 August, 2018

Accepted: 26 October, 2018
Abstract
Published: 27 October, 2018
Background: The use of the partogram is critical in preventing maternal and perinatal morbidity and
*Corresponding author: Elvis T Amin, CMA Mbanga-
mortality. Our main objective was to assess the use of the partogram among healthcare providers at the
sina, Centre Region, Cameroon. Tel: (237)675603194;
E-mail: Limbe Regional (L.R) and Bota District (B.D) hospitals. Specifically, we sought to determine the knowledge
on the partogram among healthcare providers, determine the prevalence of use of the partogram, and
Keywords: Knowledge; Attitude; Partogram; Health- compare the knowledge, attitudes and practices among healthcare providers on the partogram in Limbe.
care providers; Utilization; Cameroon
Methods: This was a descriptive cross- sectional study involving 80 healthcare providers who were
https://www.peertechz.com
recruited through convenient sampling method. The study was carried out from December 2013 to March
2014. We checked already filled partograms and observed use of the partogram by healthcare providers.
Data were collected with the use of a structured questionnaire and analyzed using Epi-info version 7.0
statistical software (CDC, Atlanta, GA, USA).

Results: Partograms were used in 35% of labour cases during the study period. Just 46.3% of
healthcare providers had a fair knowledge on the use of the partogram. A comparison between the two
hospitals showed that 50% of healthcare providers had a good knowledge on the partogram from B.D.H as
against 7.7% at L.R.H. Majority of healthcare providers (97.5%) knew that the partogram was a useful tool.
At the B.D.H, the partogram was frequently used when compared to L.R.H due to lack of supervision and
follow up. In our study, 71.4% of the partograms were incompletely filled in both institutions.

Conclusion: Partograms are used only in 35 % of deliveries. More than two thirds of them have
incomplete information. This has been due to lack of capacity building of healthcare providers on the use
of the program, which if organised, will play a mojor role in improving labour and delivery care practices
in this region.

Introduction The partogram is an instrument which is used to monitor

labour. It is used in decision making in obstetrics. It contains
Although normal labour accounts for 80% of all deliveries, various components that look at the progress of labour as
there might be some complications of labour [1]. It’s worth well as maternal and fetal parameters. Some of the maternal
noting that some of the maternal deaths are attributable to parameters are: blood pressure, uterine contractions, drugs,
complications related to labour [2]. Some of these complications heart rate, urinalysis and temperature while some of the fetal
are obstructed labour which is responsible for 8% of maternal parameters are fetal heart rate, state of the membranes and
deaths [3] and postpartum haemorrhage which accounts for colour of liquor [6]. A number of common partogram designs
10- 60% of maternal deaths worldwide [4]. In order to prevent incorporate an alert and action line [7].
prolonged labour and its complications, a tool was needed
The partogram was first developed by Hugh Philpott [8],
which could identify the abnormal progress of labour. Hence
but first provided by Friedman [9]. This was to enable clinicians
early detection and referral will not only reduce but prevent the
(midwives and doctors) plot examination findings from their
occurrence of these complications. It was on this basis that the assessments on labour. The belief that use of the partogram
partogram was introduced [5]. could be applicable in developed and developing countries led

073

Citation: Nyiawung FN, Amin ET, Fondungallah JA, Egbe TO (2018) The Partogram: Knowledge, Attitude and Use by Healthcare Providers at Two Hospitals in the South
West Region of Cameroon. Arch Community Med Public Health 4(2): 073-077. DOI: http://dx.doi.org/10.17352/2455-5479.000041
to its introduction globally [10]. The use of the partogram is labour and conducting deliveries were excluded from the
critical in preventing maternal and perinatal morbidity and study. The minimum sample sizes for the health care providers
mortality [11]. recruited and the number of partograms analysed, were
calculated using the formula of Finite population correction
In our milieu, there are multiple potential reasons why for proportions and the formular for single proportions to be
the partogram is not used. Some health care providers have
76 health care providers and 42 partograms respectively. This
been trained on how to use the partogram but don’t use it
calculations were done on the assumptions that about 50% of
in health facilities where they work. Moreover, other trained
the study population didn’t have adequate knowledge on the
healthcare providers believe the use of the partogram is time
use of partogram. A total 80 health care providers who met
consuming and might not be necessary since the outcomes of
the inclusion criteria as well as 42 partogram were however
normal labour remains unchanged. In some cases, some health
recruited.
professionals don’t actually know how to use it, or have just a
few ideas about its use. Also, it’s not known whether the nature Study procedure
of the hospital (i.e. either the district or regional) has gotten
influence on the knowledge, attitude and practice among After obtaining ethical approval from the Faculty of Health
healthcare providers (HCP). Our study sought to describe the Sciences Institutional Review Board, and administrative
demographic and professional profiles of healthcare providers clearance from the Regional Delegate of Public Health, we made
in the Limbe Regional and Bota District hospitals, to determine contact with the hospital authorities, discussed with them
the knowledge on the partogram among healthcare providers, and had authorization to carry out our study. Also, copies of
to determine the prevalence of use of the partogram and the protocol were distributed to the above personalities. Semi
to compare the knowledge, attitudes and practice in both structured pre tested questionnaires were used to abstract four
institutions. categories of data namely: the demographic and professional
profiles of healthcare providers, knowledge of HCP, common
Materials and Methods attitudes and practices by healthcare providers concerning the
partogram. Most healthcare providers responded insitu to the
Study design and Setting
questionnaire while some took theirs home to return with the
The study was a descriptive cross- sectional study among following day. Also, in the maternity, delivery records with
healthcare providers carried out in the Bota district hospital partograms were analyzed based on the grid
(BDH) and Limbe regional hospital (LRH) of the South West
Data management and analysis
Region of Cameroon. The study was carried out from December
2013 to March 2014. The Limbe Regional Hospital is a secondary At the end of each day, the data collected were carefully
health facility in the South West Region. It is located in Limbe cross- checked and safeguarded in preparation for entry over
around the coast of the Atlantic Ocean and has all the services the weekends. Data were analyzed with use of Epi-info version
and units of a secondary health centre (Administrative, 7.0 statistical software (CDC, Atlanta, GA, USA) and Microsoft
medical, laboratory, surgical, maternity, paediatrics etc). Excel 2007.
The LRH maternity is made up of the ward charge’s office, a
nursing station, two labour and delivery rooms, an antenatal To assess knowledge, we designed a composite test. It was
care hall, a ward for nursing mothers and an observation room. scored on a total of 10. Opened ended questions (10) were used
The maternity unit has averagely nine healthcare providers to avoid guessing. A score of less than 4 was graded as poor;
and two gynaecologists. There is an average of four labour 5-7 was graded moderate and more than 7 as a good mastery
cases daily. The LRH is easily accessible. Besides, being the of the partogram. This score was used previously in a study
regional hospital, it serves as one of the referral centres for carried out in Buea.
the South West Region. Therefore so many deliveries are being
followed-up and effected in this hospital. On the other hand, For comparison between the two hospitals, the predictor
BDH is also located in Limbe town. The maternity ward is a T- variable was the type of health facility while some of the
shaped building made up of the ward charge’s office, a nursing outcome variables were: not always available, takes too much
station and a labour room (with one labour bed). This unit is time to fill, limited knowledge and work load.
headed by the ward charge. It consists of midwives, nurses,
The prevalence was analyzed with Microsoft Excel 2007
medical students. It has no gynaecologist. It has an average of
and presented on a pie chart. The proportion of labour cases
2 labour cases a day.
monitored with a partogram to the total number of cases were
Study population and Sampling obtained and tabulated each week.

The study population included all healthcare providers with Descriptive statistics such as frequencies and proportions
age greater than 21, who were working in the maternities of were used for the analysis of the quantitative data. Cross
the LRH and BDH and are usually involved in the monitoring tabulations of variables were done, and chi-squared test (x2)
of labour with the use of a partogram. All health care providers was used to determine the statistical significance of differences
who were not willing to participate in the study and had not of relative frequencies. A p-value of less than 0.05 was
undergone any training in midwifery or in monitoring of considered significant.

074

Citation: Nyiawung FN, Amin ET, Fondungallah JA, Egbe TO (2018) The Partogram: Knowledge, Attitude and Use by Healthcare Providers at Two Hospitals in the South
West Region of Cameroon. Arch Community Med Public Health 4(2): 073-077. DOI: http://dx.doi.org/10.17352/2455-5479.000041
 Table 1: Socio- demographic data of Healthcare providers by gender
Results
Frequency (%)
Socio- demographic characteristic of healthcare provi- N= 80

ders Age

21- 25 29(36.3)
Of the 80 questionnaire respondents, there were 46 females
26- 30 22(27.5)
(57.5%) and 34 males (42.5%). The ages ranged from 21 to 44
31- 35 19(23.8)
with a mean of 28.9 and a standard deviation of 2.4 years. The
predominant age group was 21-25 years, representing 36.3% of 36- 40 8(10.0)
the study sample. A plurality of the healthcare providers (43%) 41- 45 2(2.5)
had the Ordinary level as their highest level of education. See Sex
table 1.
Male 34 (42.5)

Prevalence of partogram usage female 46 (57.5)

Level of Education
Out of the 120 deliveries during the study period, partograms
Postgraduate diploma or masters 7 (8.8)
were used in just 42 of them giving a prevalence of 35% while
Medical Doctor 7 (8.8)
majority of the deliveries (65%) where where conducted
without use of partogram. Bacherlors in Nursing 8(10.0)

Higher National Diploma in Nursing 15 (18.7)

Knowledge on the partogram among healthcare provi-
GCE ordinary level Certificate 34(42.5)
ders
GCE advance level Cerificate 9 (11.2)
The most responded question was the quotation on cervical Duration of practice
dilatation (89.7%) while the least was that on the definition of 0-2 (years) 37(46.3)
the partogram (40.0%). This is shown on table 2. As shown on
>2 – 4 (years) 5 (6.3)
table 3 the composite test was used to evaluate the knowledge
>4- 6 (years) 29(36.3)
among healthcare providers. As many as 46.3 % of H.C.P had a
moderate score. >6- 8 (years) 6 (7.5)

>8- 10 (years) 2 (2.5)

Comparing the knowledge, attitudes and practices on
>10- 12 (years) 1 (1.3)
the partogram use among healthcare providers in the
Type of facility
LRH and BDH
Regional hospital 54(67.5)
A greater percentage of healthcare providers from the Bota District hospital 26(32.5)
hospital had a good score 14 (50.0%) compared to the Limbe
Regional hospital 4(7.7%) as shown on the table 4. As many as
Table 2: Responses by H.C.P to questions of the composite test
34.6% of healthcare providers mentioned that they had little
or no knowledge of the use of the partogram. Also, among the Correct response Incorrect reponse
Questions
(%) (%)
80 healthcare providers, 24.4 % mentioned that it took much
What is the partogram? 32 (40) 48 (60)
time to fill the partogram. This is shown on table 5. As many
as 96% of healthcare providers frm B.D.H correctly opened What is it used for? 54 (67.5) 26 (32.5)
the partogram as shown on table 6. This partogram is usually At what cervical dilatation do you open it? 70 (89.7) 10 (10.3)
opened at 4cm cervical dilation. How often do you record FHR 45 (57.7) 35 (42.3)

How often do you record maternal BP? 36 (43.6) 44 (56.4)

Discussion
How often do you record temperature? 34 (41.0) 46 (59.0)
The predorminant age group in the study was 21- 25 How often do you do vaginal examinations? 50 (61.5) 30 (38.5)
representing 36.3% of healthcare providers with a mean age
For how long do you palpate for number of
of 30 years. It is similar to those from other studies in Buea of 39 (48.8) 41 (51.2)
contractions?
20- 30 [12] and in Africa of less than 30 years in Cairo, Egypt How long (hours) is the action line from the
[13]. This age group was the youngest age group and it’s the 35 (42.3) 45 (57.7)
alert line?
working population. It was lower than that reported by Archa How do you know labour is not progressing
35 (42.3) 45 (57.7)
et al who found 30- 39 years and higher than that reported by normally?
Engida et al who found 19- 25 years as the predorminant age
group. Most of the healthcare providers were state reistered
levels or the BAC examination. This explains why most of the
nurses (23.8%) and majority of the healthcare providers had the
healthcare providers had ordinary levels. Rather in other studies
Ordinary level as their highest level of education representing
done in Nigeria and Ethiopia, most of the healthcare providers
43% of them. It is similar to a study carried out in Mangalore
[14]. In Cameroon, entry into school of state registered nurses were staff nurse midwives (57.7%) [16] and midwives (45.1%)
demands the General Certificate of Examination ordinary [15], respectively. This is obvious for the common reason

075

Citation: Nyiawung FN, Amin ET, Fondungallah JA, Egbe TO (2018) The Partogram: Knowledge, Attitude and Use by Healthcare Providers at Two Hospitals in the South
West Region of Cameroon. Arch Community Med Public Health 4(2): 073-077. DOI: http://dx.doi.org/10.17352/2455-5479.000041
 that midwives are trained to deal with labour cases. As many Table 6: Opening of the partogram

as 37 healthcare providers representing 46.3% of the study TOTAL P value

Type of health facility No (%) Yes (%)
population had a moderate score (5-7) using the composite N= 80 Fisher exact
test. It is contradictory from a study done in Buea where 36% Limbe Regional hospital 10(18.1) 45(81.8) 55 0.09
of healthcare providers had a poor knowledge, and of 55.5% in Bota district hospital 1 (4.0) 24(96.0) 25
Nigeria having moderate knowledge. The poor knowledge was
TOTAL 8(10.4) 69(89.6) 80
attributable to the lack of training, lack of refresher courses on
the partogram and also due to inexperience on its use.
of (9.8%) [17] and lower than that obtained by Ogwang S et
The prevalence of partogram usage was 35%. Our al of (69.9%) [18]. The low prevalence could be attributed
prevalence was higher than those reported by Oladapo et al to little or no knowledge on partogram, and increased work
load among healthcare providers. On the other hand, the high
Table 3: Knowledge on the Partogram Among Healthcare Providers
prevalence rate is attributed to good knowledge on partogram,
availability of partograms, better supervision and positive
Score Frequency Percent
attitudes towards its use. With respect to practical issues, 64.4
0-4 26 32.5%
% of healthcare providers from B.D.H compared to 55.8% could
5-7 37 46.3% easily detect on the partogram when labour was more likely to
8-10 17 21.3% end in C/S. This is similar to a study done in Ethiopia [15]. The
Total 80 100.0% unavailability of obstetricians and doctors who could handle
C/S was responsible for the higher detective rate in B.D.H.

Table 4: Comparism of knowledge on the partogram in the two hospitals

Given that there was just a fair knowledge as well as a low
P value prevalence of partogram use in our study, we call on frequent
Total
Type of health facility Poor (%) Moderate (%) Good (%) (Fisher
N= 80 refresher trainings of midwives and other healthcare providers
Exact test)
working in marternities on standard delivery care practices
Limbe Regional
23 (44.2) 25 (48.1) 4 (7.7) 52 0.00001 and the importance of partogram use in monitoring labour.
hospital
Also, increase availability of this labour monitoring tool
Bota district hospital 2 (7.2) 12 (42.8) 14 (50.0) 28
in maternities willl go a long way in increasing its usage at
various health institutions
Table 5: Attitude among healthcare providers in both hospitals
Yes (%) No (%) Total Conclusion
Attitudes Hospital P value
N= 80
The prevalence of use of the partogram was low. Morever,
Limited knowledge
a considerable amount of healthcare providers had a fair
Limbe Regional hospital 19 (35.2) 35 (64.8) 54
knowledge and had a positive attitude towards its usage.
Bota district hospital 8 (30.8) 18 (69.2) 26 0.61 Therefore, organising capacity building of healthcare providers
Total 27 (34.6) 53 (65.4) 80 on the use of the program will play a major role improving
Work load labour and delivery care practices in this region.

Limbe Regional hospital 12 (23.1) 42 (76.9) 54

Acknowledgements
Bota district hospital 6 (23.1) 20 (76.9) 26 0.62
The authors wish to thank all who made this study possible.
Total 18 (23.1) 62 (76.9 80

Leads to increase C/S Author contributions

Limbe Regional hospital 8 (15.4) 46(84.6) 54
FNN protocol development, project development, data
Bota district hospital 4 (15.4) 22 (84.6) 26 0.74
collection, and manuscript writing/editing.
Total 12 (15.4) 66 (84.6) 80

Not always available ETA protocol development, project development and

manuscript editing.
Limbe Regional hospital 8 (15.4) 46(84.6) 54 0.22

Bota district hospital 7 (26.9) 19 (73.1) 26 JAF data collection. Manuscript editing
Total 15 (19.2) 65 (80.8) 80
TOE protocol development, general supervision, manuscript
Takes too much time to fill
editing
Limbe Regional hospital 11 (21.2) 43 (78.8) 54 0.35

Bota district hospital 8 (30.8) 18 (69.2) 26 Compliance with ethical standards.

Total 19 (24.4) 61 (75.6) 80

Appendix 1
Difficult to fill

Limbe Regional hospital 12 (23.1) 40 (76.9) 54 0.43 References

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Citation: Nyiawung FN, Amin ET, Fondungallah JA, Egbe TO (2018) The Partogram: Knowledge, Attitude and Use by Healthcare Providers at Two Hospitals in the South
West Region of Cameroon. Arch Community Med Public Health 4(2): 073-077. DOI: http://dx.doi.org/10.17352/2455-5479.000041
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Copyright: © 2018 Nyiawung FN, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and source are credited.

077

Citation: Nyiawung FN, Amin ET, Fondungallah JA, Egbe TO (2018) The Partogram: Knowledge, Attitude and Use by Healthcare Providers at Two Hospitals in the South
West Region of Cameroon. Arch Community Med Public Health 4(2): 073-077. DOI: http://dx.doi.org/10.17352/2455-5479.000041

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