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Public Health

journal homepage: www.elsevier.com/puhe

Original Research

Knowledge and utilization of partograph among

health care professionals in public health
institutions of Bale zone, Southeast Ethiopia

D. Markos a,*, D. Bogale b,1

a
Department of Nursing, College of Medicine and Health Sciences, Madawalabu University, Bale Goba, Ethiopia
b
Department of Public Health, College of Medicine and Health Sciences, Madawalabu University, Bale Goba, Ethiopia

article info abstract

Article history: Background: Partograph has been shown to be an efficacious tool for monitoring labor and
Received 22 December 2014 identifying women in need of an obstetric intervention. Therefore, the aim of this study
Received in revised form was to assess knowledge and utilization of partograph among health care professionals in
28 December 2015 public health institutions of Bale zone, Southeast Ethiopia.
Accepted 28 February 2016 Study design: A facility-based cross-sectional study was conducted from February 1st to
Available online 31 March 2016 March 30, 2014.
Methods: Single population proportion sample size determination formula was used to
Keywords: calculate the sample size and it was 401. Simple random sampling was employed to select
Partograph both the health facilities as well as study subjects. Data were collected using pretested
Knowledge structured questionnaire. It was analyzed by SPSS for windows version 16.0. Descriptive,
Utilization binary and multivariable logistic regression analyses were conducted. Statistically signifi-
Bale zone cant tests were declared at a level of significance of P value <0.05.
Ethiopia Results: One hundred and forty (38.5%) and 224 (61.5%) study subjects have a poor and good
level of knowledge about partograph, respectively. The magnitude of partograph utilization
was 70.2%. Variables having statistically significant association with good level of knowl-
edge about partograph were being midwives (AOR ¼ 7.70, 95% CI ¼ 2.38, 24.94), being nurses
(AOR ¼ 0.40, 95% CI ¼ 0.19, 0.85) and being graduated from governmental higher institution
(AOR ¼ 2.04, 95% CI ¼ 1.22, 3.42). Additionally, being female health professionals
(AOR ¼ 2.39, 95% CI ¼ 1.17, 4.89), being hospital staff (AOR ¼ 17.78, 95% CI ¼ 2.32, 135.98)
and receiving training about partograph (AOR ¼ 2.94, 95% CI ¼ 1.15, 7.54) have statistically
significant association with partograph utilization.
Conclusions: More than half of the respondents have a good level of knowledge about par-
tograph. A significant number of study subjects reported use of partograph to monitor
women in labour. It is recommended to provide periodic on-job training on partograph to
all obstetric caregivers especially for nurses and public health officers to improve their
knowledge.
© 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

* Corresponding author. P. O. Box 302, Bale Goba, Ethiopia. Tel.: þ251 912057720 (mobile).
E-mail addresses: desalegnmarkos@yahoo.com (D. Markos), dbogale386@gmail.com (D. Bogale).
1
P. O. Box 302, Bale Goba, Ethiopia. Tel.: þ251 912 818117 (mobile).
http://dx.doi.org/10.1016/j.puhe.2016.02.026
0033-3506/© 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

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 p u b l i c h e a l t h 1 3 7 ( 2 0 1 6 ) 1 6 2 e1 6 8 163

asked to use the tool. Non-availability of preprinted parto-

Introduction graphs has also been reported as a cause for non-utilization.13
Because partograph serves as a simple and inexpensive
Worldwide, there are an estimated 289,000 maternal deaths tool to monitor labor in a cost-effective way, it is a suitable
yielding maternal mortality ratio (MMR) of 210 maternal method to use in low income countries to improve the ma-
deaths per 100,000 live births in 2013. Developing countries ternity care.14 Despite this fact, in Ethiopia particularly in Bale
account for 99% (286,000) of the global maternal deaths with zone, the proportion of health care workers who have good
the Sub-Saharan Africa region alone accounting for 62% knowledge using the partograph, as well as what factors affect
(179,000).1 In Ethiopia, the MMR was 676 per 100,000 live births their knowledge and utilization are not yet studied very well.
for the seven year period preceding the demographic and Generally, when some of these issues are studied in the
health survey.2 Following hemorrhage, infection and pre- country, it is mainly restricted in a very urban area of the
eclampsia/eclampsia; prolonged labor is a significant cause country.3,4,15,16 Besides, no previous studies were accessed in
of maternal mortality in our population.3 The majority of the current study area. On the other hand, understanding
maternal deaths and complications attributable to obstructed health care professional knowledge and utilization of parto-
and prolonged labor could be prevented by cost effective and graph will be important to inform health facilities mangers as
affordable health interventions like the use of partograph.4 well as local and national policy makers to design appropriate
Partograph is a Greek word meaning ‘Labor Curve’. It is intervention strategies to provide quality maternity care.
considered as a very effective tool to monitor labor and pre- Therefore, the aim of this study was to assess knowledge and
vent prolonged and obstructed labor. Besides, it provides utilization of partograph among health care professionals in
timely information regarding further intervention in the form public health institutions of Bale zone, Southeast Ethiopia.
of referral to a higher level facility, labor augmentation, and
caesarean section depending on the availability of resources.5
The observations in partograph consist of fetal condition,
maternal condition, progress of labor and therapeutics mea- Methods
sure in the course of the labor. The chart often contains an
alert line (a signal of alert to deviations in labor progress) and Study area and period
an action line, which is the mandatory time to commence
actions to correct the deviations in labor progress.6 The study was conducted in public health institutions of Bale
Partograph has also transformed the subjective evaluation zone from February 1st to March 30, 2014. Bale zone is one of
and management of labor into a more objective exercise with the zones among 18 rural zones of Oromia regional state
predictive ability.7 located 430 km away from the capital town of Ethiopia; Addis
A multicenter trial conducted by the World Health Orga- Ababa. It is the second largest zone in the region with an area
nization (WHO) showed that the use of partograph reduced of 67,329.6 km2. There are a total of 715 health institutions in
the number of prolonged labors, need for augmentation of Bale zone which was composed of four hospitals, 76 health
labor with oxytocin, rates of cesarean section, and the inci- centers (H/C), 351 health posts, 179 private clinics, one None
dence of infection. As a result of this, WHO recommended that Governmental Organization (NGO) clinic, four other public
partograph should be used in monitoring all labors to help clinics, 95 pharmacy/drug shops, one NGO drug shop and four
identify abnormal progress as well as women who might need medical drug stores. From these institutions, all health cen-
further interventions.8 ters and hospitals provide obstetric services [Bale Zone Health
Another multicenter trial done by the WHO to evaluate the Department: Annual Health report, unpublished].
impact of WHO partograph on labor management and
outcome also demonstrated that use of the partograph led to a Study design
reduction in duration of labor from 6.4% to 3.4%, augmenta-
tion of labor from 20.7% to 9.1%, emergency caesarean sec- A facility-based cross-sectional study was conducted. The
tions from 9.9% to 8.3%, and intrapartum stillbirths from 0.5% study was undertaken among midwives, health officers and
to 0.3%.9 nurses working in public health facilities. They were enrolled
The use of partographs is most common in hospitals in to the study after getting their confirmation for working in
(rather than clinics or homes) in low resource settings. Beyond delivery units either on regular basis, rotation or in night duty.
hospitals, a study of health extension workers and midwives Health professionals who do not attend labor cases in selected
in peripheral delivery units in Nigeria found that only 10% of hospitals and health centers were excluded from the study.
caregivers consistently used partograph, and even fewer used
it correctly. Correct use may be limited by training, time, and Sample size and sampling procedure
caregiver skill level.10 On the other hand, the estimated pro-
portion partograph utilization in Rukungiri District, Uganda Sample size determination
was 30%. This was thought to be due to poor attitude of health The study employed single population proportion sample size
workers, lack of confidence and skills in its use.11 determination formula with the assumption of the proportion
Similarly, a study from Nigeria reported that only 25% to (p) of health professionals who had good level of knowledge
33% of caregivers used partograph for routine monitoring.12 about partograph was 53.4%,3 with 95% confidence interval
They may resist using the tool if they have insufficient (CI), and 5% marginal error. Then, adding 5% contingency for
knowledge and do not fully understand why they have been non-respondents, the final total sample size was 401.

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Sampling procedure Utilization of partograph: this was considered if respon-

Since there were about 80 public health institutions (four dent replay saying ‘yes’ for the question that ask whether they
hospitals and 76 functional health centers) that provide ob- have been using partograph or not (based on yes or no
stetric care in the zone, first simple random sampling method question).
was employed to select health institutions. To obtain
adequate sample size, a total of 44 public health institutions Data collection tool and procedure
were included. Then simple random sampling method was
employed after proportional allocation of health professionals A pre-tested and structured, interviewer-administered ques-
found on each health institutions. To employ simple random tionnaire that was adapted from a previous study3,4 and other
sampling on each institution, sampling frame was prepared relevant literature was used. The questionnaire contained a
by listing the name of health professionals after dealing with combination of open-ended and closed-ended questions. It
head nurse and/or medical directors of the selected institu- was designed to obtain information on the professional
tion. Then, lottery method was used to select the respondents. background characteristics, knowledge of the partograph,
Health professionals from all departments in the sampled source of information about partograph and their utilization.
health centers were studied by taking into account that they Fourteen nurses were involved in the data collection and four
are always rotated among departments including the delivery MPH/MSc holder health professionals supervised the data
unit every two to three months. In addition, when health collection process.
center staffs are assigned at night duty, they provide all types
of services including delivery care. Data quality control
In hospitals, providers only from delivery, Antenatal care
(ANC), Post Natal Care (PNC), Family Planning (F/P) and Gy- The quality of the data were assured by using a validated
necology units were included as the trend of rotation of pro- questionnaire, doing pre-tests, providing training for data
viders among other departments such as medical, surgical, collectors and supervisors, and conducting intensive super-
and pediatric ward was not practical. This was done after vision during data collection. The questionnaire was pre-
getting information about the trend of rotation from the tested on five percent of the total sample size in a health
medical director of each hospital. institution other than the place where actual data collections
In cases where the study participants were not be able to be were conducted. After the pre-test, Cronbach's Alpha was
interviewed for some reason (e.g. absenteeism), three attempt calculated to test internal consistency (reliability) of the item
a were made to interview the respondent and after all they and its value for item that assessed professionals' knowledge
were considered as a non-respondents. of partograph was 0.78. Besides, content validity was cross
checked by another maternal health experts. Supervisors and
investigators supervised and checked the collected data for its
Operational definitions completeness.

Knowledge of partograph: based on the overall knowledge Ethical consideration

scores, the respondents' levels of knowledge of partograph
were rated as having a minimum score of 0 and a maximum The proposal was approved by the Ethical Review Committee
score of 30. Scores between 0 and 20 were considered as poor of Madawalabu University. Furthermore, a letter of permis-
level of knowledge and 21e30 as good level of knowledge.4 The sion was obtained from Bale Zone Health Department and
criteria for scoring knowledge are displayed on the table each woreda (the smallest administrative classification of an
(Table 1). area next to zone) health office. Furthermore, on each
selected study site, the head of the health center and medical
directors of the hospital were contacted for permission. After
Table 1 e Criteria for the partograph knowledge score. explaining the study objectives and procedures, verbal con-
Parameters Response sent was obtained from the study subjects and their rights to
No Yes refuse not to participate in the study at any time they want
was assured.
Awareness of partograph 0 2
Correct definition of the partograph 0 3
Knows the benefit of the partograph to parturient 0 2 Data processing and analysis
Knowledge of observations on component of partograph
Cervical dilatation 0 3 The data were checked for its completeness and consis-
Foetal heart rate 0 2 tencies. Then, it was cleaned, coded and entered in to com-
Uterine contraction 0 2
puter using SPSS windows version 16.0 (SPSS Inc, Chicago, IL,
Descent of the presenting part 0 2
USA). Descriptive statistics were computed to describe the
Maternal blood pressure 0 2
Maternal pulse 0 2 status of knowledge about partograph and magnitude of
Color of liquor 0 2 partograph utilization. Additionally, binary and multivariable
Maternal temperature 0 2 logistic regression analyses were constructed to examine the
Oxytocin regimen 0 2 existence of a relationship between selected independent
Intravenous fluids & drugs 0 2 variables and respondents' knowledge and utilization of par-
Urine test results 0 2
tograph. A P value <0.05 on a binary logistic regression was

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 p u b l i c h e a l t h 1 3 7 ( 2 0 1 6 ) 1 6 2 e1 6 8 165

considered to select candidate variable for multivariable lo-

gistic regression analysis as well as to declare a statistically
significant variable.

Results

Out of the total 401 respondents planned for the study, 364
were successfully interviewed yielding the response rate of
91.0%.

Background characteristics of the respondents

Out of the total study subjects, 317 (87.1%) worked in Health Fig. 1 e Source of information about partograph among
Centers. One hundred and ninety-one (52.5%) study subjects respondents in public health institution of Bale zone,
were male. Regarding their educational status, 287 (78.8%) Oromia region, Southeast Ethiopia, 2014.
study subjects were diploma holders. Two hundred and
twenty-one (60.7%) respondents were nurses followed by
midwives (27.2%). About 242 (66.2%) respondents had gradu-
Knowledge on partograph
ated from governmental higher institutions (Table 2).
Two hundred and forty-eight (68.1%) respondents reported
Source of information about partograph that they knew about partograph. Of them, 202 (81.1%) study
subject correctly defined partograph. Among component of
A majority of respondents (78.2%) reported that university/ partograph, fetal heart rate was identified by the majority of
college was their primary source of information about parto- respondents (83.5%), followed by cervical dilatation (83.1%).
graph followed by in-service training episode (23.4%) (Fig. 1). Color of liquor was the least (23.0%) mentioned section of
partograph (Table 3). Generally, 140 (38.5%) and 224 (61.5%) of
them have a poor and good level of knowledge about parto-
Table 2 e Background characteristics of the respondents graph, respectively.
in public health institutions of Bale Zone, Oromia region,
Southeast Ethiopia, 2014.
Utilization of partograph
Variable Frequency Percentage
Sex Among those respondents who were aware of partograph
Male 191 52.5
(248), about 174 (70.2%) reported that they used partograph
Female 173 47.5
while attending labor. Of which, 76 (43.7%) respondents re-
Age in years
20e29 297 81.6 ported that they used it routinely, 70 (40.2%) sometimes and 28
30e39 42 11.5 (16.1%) rarely. The most common reasons forwarded for non-
40þ 25 6.9 utilization were little knowledge (44.9%), followed by it is
Mean (±SD) 27.5 (6.5) much detail to fill (30.4%) (Fig. 2).
Marital status
Single 152 41.8
Married 212 58.2
Professional qualification
Table 3 e The proportion of health care professionals who
Midwife (Diploma þ BSc) 99 27.2
correctly identified the components partograph in labor
Public Health Officer 44 12.1
assessment in public health institutions of Bale zone,
Nurse (Diploma þ BSc) 221 60.7
Oromia region, Southeast Ethiopia, 2014.
Level of education Knowledge of partograph Frequency Percentage
Diploma 287 78.8 components (n ¼ 364)
Bachelor of science 77 21.2
Cervical dilatation 202 83.1
From where did you graduate?
Fetal heart rate 203 83.5
Private 122 33.5
Uterine contraction 175 72.0
Government 242 66.5
Descent of presenting part 110 45.3
Work place
Maternal blood pressure 187 77.0
Health center 47 12.9
Maternal pulse 151 62.1
Hospital 317 87.1
Color of liquor 56 23.0
Professional tenure
Maternal temperature 115 47.3
<5 year 244 67.0
Oxytocin regimen 71 29.2
10e10 year 85 23.4
Intravenous fluids and drugs 59 24.3
11e20 year 17 4.7
Urine test results 59 24.3
>20 year 18 4.9
Range 37 N.B this cannot be sum up to hundred percent because of the
Median (±variance) 3 (±42.8) possibility of multiple response.

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compared to public health officers. The odds of good level of

knowledge on partograph were two times (AOR ¼ 2.04, 95%
CI ¼ 1.22, 3.42) higher among respondents who graduated
from governmental higher institutions when compared to
private higher institution graduates (Table 4).

Factors associated with utilization of partograph

On binary logistic regression analysis, sex of the respondents,

age of the respondents, professional qualification, type of
institution where they are currently working and institution
where they graduated from have a statistical significant
association.
Multivariable logistic regressions were also computed. The
odds of partograph utilization were two times (AOR ¼ 2.39,
Fig. 2 e Reasons for not using partograph among Health 95% CI ¼ 1.17, 4.89) higher among female health professionals
care professional in public health institution in Bale Zone, when compared to males. Additionally, the odds of parto-
Oromia region, Southeast Ethiopia, 2014. graph utilization were 17 times (AOR ¼ 17.78, 95% CI ¼ 2.32,
135.98) higher among Hospital staff than Health Center staffs.
Furthermore, the odds of partograph utilization were about
two times (AOR ¼ 2.94, 95% CI ¼ 1.15, 7.54) higher among
Factors associated with knowledge on partograph participants who received training on partograph than those
who did not (Table 5).
On binary logistic regression analysis, sex of the respondents,
professional qualification, and institution where they gradu-
ated from have a statistically significant association with re- Discussion
spondents' good level of knowledge on partograph.
The odds of good level of knowledge on partograph among One hundred and forty (38.5%) and 224 (61.5%) study sub-
midwives were seven times (AOR ¼ 7.70, 95% CI ¼ 2.38, 24.94) jects have a poor and good level of knowledge on parto-
higher than public health officers. On the other hand, the odds graph, respectively. It is nearly consistent with the finding
of good level of knowledge about partograph among nurses of the study done in North Shoa Zone, Central Ethiopia
were 60% (AOR ¼ 0.40, 95% CI ¼ 0.19, 0.85) less likely when where 287 (71.2%) obstetric care providers had a good level

Table 4 e Factors affecting respondents' knowledge on partograph in public health institutions of Bale Zone, Oromia
region, Southeast Ethiopia 2014.
Variable Overall knowledge COR (95% CI) AOR (95% CI)
Poor [N (%)] Good [N (%)]
Sex
Male 86 (45.0) 105 (55.0) 1 1
Female 54 (31.2) 119 (68.8) 1.80 (1.17, 2.77) 0.94 (0.56, 1.58)
Age in years
20e29 108 (36.4) 189 (63.6) 1.89 (0.83, 4.30)
30e39 19 (45.2) 23 (54.8) 1.31 (0.48, 3.53)
40þ 13 (52.0) 12 (48.0) 1
Type of institution
Hospital 12 (25.5) 35 (74.5) 1.97 (0.98, 3.95)
Health Center 128 (40.4) 189 (59.6) 1
Profession
Midwife (Diploma þ BSc) 5 (5.1) 94 (94.9) 7.05 (2.30, 21.55) 7.70 (2.38, 24.94)
Nurse (Diploma þ BSc) 123 (55.7) 98 (44.3) 0.29 (0.14, 0.61) 0.40 (0.19, 0.85)
Public Health Officer 12 (27.3) 32 (72.7) 1 1
From where did you graduate?
Private 72 (59.0) 50 (41.0) 1 1
Government 68 (28.0) 174 (71.9) 3.68 (2.33, 5.81) 2.04 (1.22, 3.42)
Year of service
<5 year 86 (35.2) 158 (64.8) 1
Over five year 54 (45.0) 66 (55.0) 0.66 (0.42, 1.03)
Receive training on partograph
Yes 3 (5.6) 51 (94.4) 2.06 (0.59, 7.19)
No 21 (10.8) 173 (89.2) 1

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Table 5 e Factors affecting utilization of partograph in public health institutions of Bale Zone, Oromia region, Southeast
Ethiopia, 2014.
Variable Overall utilization COR (95% CI) AOR (95% CI)
Not utilized [N (%)] Utilized [N (%)]
Sex
Male 51 (42.1) 70 (57.9) 1 1
Female 23 (18.1) 104 (81.9) 3.29 (1.84, 5.87) 2.39 (1.17, 4.89)
Age
20e29 63 (30.6) 143 (69.4) 2.64 (0.85, 8.19) 1.43 (0.39,5.17)
30e39 4 (13.8) 25 (86.2) 7.29 (1.59, 33.25) 4.73 (0.90, 24.85)
40þ 7 (53.8) 6 (46.2) 1 1
Profession
Midwife (Diploma þ BSc) 16 (16.7) 80 (83.3) 3.75 (1.59,8.84) 1.13 (0.37, 3.46)
Nurse (Diploma þ BSc) 43 (36.8) 74 (63.2) 1.29 (0.59, 2.78) 0.82 (0.33, 2.02)
Public Health Officer 15 (29.8) 20 (57.1) 1 1
From where did you graduate?
Private 20 (31.2) 44 (68.8) 1
Government 54 (29.3) 130 (70.7) 1.09 (0.59, 2.02)
Type of institution
Hospital 1 (2.9) 34 (97.1) 17.72 (2.37, 132.13) 17.78 (2.32, 135.98)
Health center 73 (34.3) 140 (65.7) 1 1
Length of experience
<5 year 56 (31.6) 121 (68.4) 1
>¼5 year 18 (25.4) 53 (74.6) 1.36 (0.73, 2.53)
Receive training on partograph
Yes 7 (13.0) 47 (87.0) 3.54 (1.51, 8.26) 2.94 (1.15, 7.54)
No 67 (34.5) 127 (65.5) 1 1

of knowledge on partograph.15 But, it is not in agreement the study conducted in south western Nigeria,12 in Port-Said
with the finding of the study done in Addis Ababa, Ethiopia and Ismailia Cities in Egypt,14 in Addis Ababa, Ethiopia4 and
where more than half of respondents had fair knowledge of in North Shoa Zone, Centeral Ethiopia.16 The possible reason
partograph, while less than half of them had good knowl- could be due to the difference in study period where this study
edge and few had poor knowledge of partograph.4 This was conducted in a time where more attention for maternal
difference could be due the difference in study setup where health was given and a difference in way of assessing
the majority of our study participants were enrolled from utilization.
rural health centers in addition to a few urban health cen- The odds of partograph utilization were about two times
ters, as well as including all functional departments that greater among female health professionals than males. The
might have low training opportunity. This is further evi- possible justification for this finding could be due to the fact
denced by their source of information about partograph that majority of females in this study were midwifes and it
where university/college and training were their sources for was these group who received training on partograph which is
78.2% and 23.4% of study subjects, respectively. But in Addis one of the predictor variable for utilization of partograph.
Ababa and Amhara regions, university/college was the Again, the odds of partograph utilization were almost three
source of information for 53.2% and about training for times higher among participants who received training on
81.7%, respectively. partograph than those who did not. It is consistent with the
The odds of good level of knowledge about partograph finding of the study done in Addis Ababa, Ethiopia.4
among midwives were eight times higher than public health Furthermore, the odds of partograph utilization were
officers. On the other hand, the odds of good knowledge nearly 18 times higher among hospital staff than health center
regarding partograph among nurses was 60% less likely when staff. It is not in agreement with the finding of the study done
compared with public health officers. This is in agreement in Addis Ababa.4 This difference could be due to the difference
with the study finding done in Port-Said and Ismailia Cities in in close supervision made by senior obstetricians and gyne-
Egypt, where 98.6% of nurses had unsatisfactory knowledge.14 cologists in hospitals, unlike health centers. It could also be
On the other hand, the odds of good level of knowledge due to the fact that the majority of obstetric care provider in
about partograph were two times higher among respondents hospital were midwifes and it was the majority of midwifes
who had graduated from governmental higher institutions (74.1%) who received training on partograph which is one of
than private institution graduates. This finding could give the independent predictors of partograph utilization.
some insight to check the curriculum of private teaching in- As limitation of this study, socially desirable bias may not
stitutions to assess whether they have included or not the be totally avoided in reporting for the question that ask utili-
issue of partograph on their curriculum. zation of partograph because professionals might feel shame
The magnitude of partograph utilization among re- to respond saying ‘no’ for utilization question in this current
spondents was 70.2%. It is not in agreement with the finding of situation where great emphasis for maternal health is given.

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Additionally, relaying on self-report to assess utilization and references

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Acknowledgments 9. World Health Organization. Partograph in management of
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10. RTI International. Mandate maternal and neonatal directed
We are grateful to Madawalabu University for financial sup-
assessment of technology; partograph for prevention of prolonged
port to undertake this study. We are also indebted to
labor; 2013.
acknowledge data collectors and supervisors for their enthu- 11. Ogwang S, Karyabakabo Z, Rutebemberwa E. Assessment of
siastic participation in data collection. Finally, we would like partogram use during labour in Rujumbura health Sub
to extend our thanks to all study subjects who participated in District, Rukungiri District, Uganda. Afr Health Sci 2009
the study and showed us their utmost kindness and patience Aug;9:1.
in responding to the study questions. 12. Fawole AO, Hunyinbo KI, Adekanle DA. Knowledge and
utilization of the partograph among obstetric care givers in
South West Nigeria. Afr Reprod Health 2008;12:22e9.
Ethical approval 13. Magon N. Partograph revisited. Int J Clin Cases Investig
2011;3:1e2.
Ethical Review Committee of Madawalabu University. 14. Salama NS, Allah IMA, Heeba MF. The partograph:
knowledge, attitude, and utilization by professional birth
Funding attendances in Port-Said and Ismailia. Cities Med J Cairo Univ
2010 Jun;78(1):165e74.
Funding for this study was made possible through the grants 15. Wakgari N, Tessema GA, Amano A. Knowledge of partograph
and its associated factors among obstetric care providers in
offered by Madawalabu University.
North Shoa Zone. Cent Ethiop a cross Sect study BMC Res Notes
2015;(407):8.
Competing interests 16. Wakgari N, Amano A, Berta M, Tessema GA. Partograph
utilization and associated factors among obstetric care
The authors report that there are no conflicts of interest in this providers in North Shoa Zone. Cent Ethiop a cross Sect study Afr
work. Health Sci 2015 Jun;(2):15.

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