title: Feasibility of using partograph by practitioners of Indian system of medicine (AYUSH): An exploratory observation.
abstract: OBJECTIVE
  to understand the use of the partograph by Skilled Birth Attendance/Basic Emergency Obstetric Care (SBA/BEmOC) trained practitioners from Indian systems of medicine called AYUSH practitioners (APs).
  
  
  METHODS
  mixed method observational study, including an exploration of the views of APs, programme managers and SBA trainers on the necessity, feasibility and barriers to the use of partograph.
  
  
  METHODS
  primary and community health centres in two purposively selected districts in each of the three states (Rajasthan, Maharashtra and Odisha) in India where SBA/BEmOC trained APs are deployed to provide SBA services. In-depth interviews with state, district and block level programme managers were held at their respective headquarters.
  
  
  METHODS
  83 APs plotted the simplified partograph based on a given labour case scenario. In-depth interviews were conducted with 36 programme managers and 37 APs (24 Ayurvedic and 13 Homoeopathic).
  
  
  RESULTS
  the completed simplified partograph was analysed according to a previously devised scoring system with a score of 70% or more indicating competency. APs in Rajasthan and Maharashtra demonstrated good partograph plotting skills (72.1% and 82% respectively) obtaining a competency score of more than 70%. However, overall performance of APs in Odisha was poor (11.1%) and except correct recording of fetal condition, the APs did not score well in the plotting of the other partograph components. Errors occurred mainly in the recording of cervical dilatation and uterine contractions. The in-depth interviews revealed that most APs demonstrated a good understanding of the tool in the context of decision making regarding timely referral in case of prolonged labour or fetal distress. There was a high perception of the need for more hands-on training in the SBA training curriculum. The programme managers also expressed the need for appropriate training and supervision to ensure good plotting of partograph. The barriers for partograph use included increased workload, insufficient training, unavailability of partograph forms and its non-utility for women coming late in labour.
  
  
  CONCLUSIONS
  knowledge of plotting and correct interpretation of partograph were generally good in two states but more practice is needed to improve providers׳ skills. Identified barriers could be addressed with further training and local managerial support. An analysis of the causes for the poor performance of APs in Odisha should be carried out. Pre-service and periodic in-service training of APs on the completion of the partograph, regular supportive supervision, implementation of programme guidelines on mandatory completion of partograph and an environment that supports its correct and consistent use are recommended.
  
  
  CONCLUSIONS
  with appropriate training, it is feasible for AYUSH practitioners to use partograph for monitoring progress of labour.
authors.affiliation: Indian Council of Medical Research, Ansari Nagar, New Delhi 110029, India. Electronic address: n_chandhiok@hotmail.com.
authors.forename: Nomita
authors.initials: N
authors.lastname: Chandhiok
authors.affiliation: 40/1a, Karve Road, Pune 411004, India. Electronic address: shrotriaparna@gmail.com.
authors.forename: Aparna
authors.initials: A
authors.lastname: Shrotri
authors.affiliation: 2160 B Sadashiv Peth, 605 C Swami Puram, Pune 411030, India. Electronic address: joglekarneelam@gmail.com.
authors.forename: Neelam Sanjay
authors.initials: NS
authors.lastname: Joglekar
authors.affiliation: Population Services International, C-445, C. R. Park, New Delhi 110019, India. Electronic address: nayanjeetc@gmail.com.
authors.forename: Nayanjeet
authors.initials: N
authors.lastname: Chaudhury
authors.affiliation: M-2753, Netaji Nagar, New Delhi 110023, India. Electronic address: pannachoudhury@gmail.com.
authors.forename: Panna
authors.initials: P
authors.lastname: Choudhury
authors.affiliation: Indian Council of Medical Research, Ansari Nagar, New Delhi 110029, India. Electronic address: shalinisingh.icmr@gmail.com.
authors.forename: Shalini
authors.initials: S
authors.lastname: Singh
mesh_terms: D002983:Clinical Competence; D003695:Delivery of Health Care; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007194:India; D007407:Interviews as Topic; D007743:Labor, Obstetric; D000068101:Maternal-Child Health Services; D008880:Midwifery; D018743:Perinatal Care / Q000458:organization & administration* / Q000592:standards; D011247:Pregnancy; D018590:Uterine Monitoring
keywords: Labour; Partograph; Skilled birth attendant; Task shifting