title: Quality of partogram monitoring at a primary health centre in Zambia.
abstract: BACKGROUND
  The World Health Organization (WHO) recommends using a partogram to reduce maternal and neonatal mortality, especially in developing countries. Some previous studies conducted in African countries suggested that appropriate use of a partogram with standardised monitoring was associated with good labour outcomes. However, the compliance rates of recording differed among the monitoring items on the partogram and the quality of monitoring has not been examined adequately.
  
  
  OBJECTIVE
  to examine the compliance for each monitoring item on the WHO partogram and the quality of the monitoring.
  
  
  METHODS
  a retrospective and observation study.
  
  
  METHODS
  a retrospective review of partograms (n=200) was undertaken in a health centre in Lusaka, Zambia. We excluded referral cases, admission with full dilatation, birth before arrival, childbirth within 30 minutes, and false labour. Finally, 125 partograms were examined to assess the recording compliance for each monitoring item. An observation study in the delivery room and interviews with midwives were also conducted to examine the quality of monitoring for labour. The research ethics committee of the Division of Health Sciences, Osaka University Graduate School of Medicine and the Biomedical Research Ethics Committee of the University of Zambia approved the study.
  
  
  RESULTS
  the lowest recording rate of the frequency of uterine contractions at the time of admission was 69.6%. The highest compliance rates in the active phase were found for the descent of the fetal head and cervix dilatation at 97.6% and 97.3%, respectively. The lowest rate was found for the mother's pulse rate at 25.5%, whereas 27.1% of the women admitted in the latent phase were diagnosed as entering the active phase in the acceleration phase. In addition, the methods of abdominal palpation for assessing uterine contractions and intermittent fetal heart rate monitoring were not appropriate.
  
  
  CONCLUSIONS
  Zambian midwives have acquired sufficient understanding regarding the usefulness of the WHO partogram. However, there were differences in the compliance rates for each monitoring item due to a lack of medical devices and inappropriate monitoring skill. To improve labour outcomes with the WHO partogram, it is necessary to improve the recording and compliance rates for each monitoring item, as well as to upgrade the quality of monitoring.
authors.affiliation: Hokkaido University, Faculty of Health Sciences, Kita 12 Nishi 5, Kita-ku, Sapporo, Hokkaido 060-0812, Japan. Electronic address: w_fujita@hs.hokudai.ac.jp.
authors.forename: Wakako
authors.initials: W
authors.lastname: Fujita
authors.affiliation: Railway Hospital, Lusaka, c/o Ms. Anayawa Siamianze, Palliatice Care Alliance Zambia, P.O. Box 31566, Lusaka, Zambia. Electronic address: lmukumbuta@yahoo.com.
authors.forename: Lubinda
authors.initials: L
authors.lastname: Mukumbuta
authors.affiliation: University Teaching Hospital Zambia, P.O. Box 50479, Lusaka, Zambia. Electronic address: rchavuma@gmail.com.
authors.forename: Roy
authors.initials: R
authors.lastname: Chavuma
authors.affiliation: Osaka University Graduate School of Medicine, 1-7, Yamadaoka, Suita City, Osaka 565-0871, Japan. Electronic address: ohashi@sahs.med.osaka-u.ac.jp.
authors.forename: Kazutomo
authors.initials: K
authors.lastname: Ohashi
mesh_terms: D000328:Adult; D005260:Female; D006340:Heart Rate, Fetal; D006801:Humans; D007747:Labor Stage, First; D008499:Medical Records / Q000592:standards*; D008991:Monitoring, Physiologic / Q000379:methods* / Q000592:standards*; D007744:Obstetric Labor Complications / Q000517:prevention & control*; D036801:Parturition; D011247:Pregnancy; D012189:Retrospective Studies; D013997:Time Factors; D015024:Zambia
keywords: Compliance; Monitoring of labour; Partogram; Quality; Zambia