Chandhiok Nomita, Shrotri Aparna, Joglekar Neelam Sanjay, Chaudhury Nayanjeet, Choudhury Panna, Singh Shalini
Indian Council of Medical Research, Ansari Nagar, New Delhi 110029, India.
40/1a, Karve Road, Pune 411004, India.
Midwifery. 2015 Jul;31(7):702-7. doi: 10.1016/j.midw.2015.03.004. Epub 2015 Mar 18.
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).
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.
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.
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).
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.
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.
with appropriate training, it is feasible for AYUSH practitioners to use partograph for monitoring progress of labour.
了解接受过熟练接生/基本急诊产科护理（SBA/BEmOC）培训的印度阿育吠陀医学体系从业者（APs）对产程图的使用情况。
混合方法观察性研究，包括探讨APs、项目管理人员和SBA培训师对使用产程图的必要性、可行性和障碍的看法。
在印度拉贾斯坦邦、马哈拉施特拉邦和奥里萨邦三个邦各两个有目的地选择的地区的初级和社区卫生中心，部署了接受SBA/BEmOC培训的APs以提供SBA服务。在州、区和街区各级项目管理人员各自的总部进行了深入访谈。
83名APs根据给定的分娩病例情景绘制了简化产程图。对36名项目管理人员和37名APs（24名阿育吠陀医学从业者和13名顺势疗法从业者）进行了深入访谈。
根据先前设计的评分系统对完成的简化产程图进行分析，得分70%或更高表明具备能力。拉贾斯坦邦和马哈拉施特拉邦的APs表现出良好的产程图绘制技能（分别为72.1%和82%），能力得分超过70%。然而，奥里萨邦APs的总体表现较差（11.1%），除了正确记录胎儿状况外，APs在产程图其他组成部分的绘制上得分不高。错误主要发生在宫颈扩张和子宫收缩的记录方面。深入访谈显示，大多数APs在分娩延长或胎儿窘迫时关于及时转诊的决策背景下对该工具表现出良好的理解。人们高度认为SBA培训课程需要更多实践培训。项目管理人员也表示需要适当的培训和监督以确保产程图的良好绘制。产程图使用的障碍包括工作量增加、培训不足、产程图表格不可用以及对分娩后期入院的妇女无用。
在两个邦，产程图绘制知识和正确解读总体良好，但需要更多实践来提高提供者的技能。已确定的障碍可通过进一步培训和当地管理支持来解决。应对奥里萨邦APs表现不佳的原因进行分析。建议对APs进行关于完成产程图的岗前和定期在职培训、定期支持性监督、实施关于强制完成产程图并营造支持其正确和一致使用的环境的项目指南。
通过适当培训，阿育吠陀医学从业者使用产程图监测分娩进展是可行的。
