Effectiveness of a structured checklist of risk factors in identifying pregnant women at risk of gestational diabetes mellitus: a cross-sectional study.

BACKGROUND: Gestational diabetes mellitus (GDM) is associated with increased risk of mortality and morbidity for pregnant women and newborns. Identifying pregnant women with risk factors for GDM based on the clinical suspicion is a popular approach. However, the effectiveness of the use of a structured checklist of risk factors is yet to be evaluated. This study assessed the effectiveness of a structured checklist of risk factors in identifying pregnant women at risk of GDM at the University College Hospital, Ibadan. MATERIALS AND METHODS: It was a comparative cross-sectional study implemented in two phases. The first phase (Group A) of the study was a prospective study that involved 530 pregnant women who presented at the booking clinic. A structured checklist containing risk factors was used to identify women at the risk of GDM. The second phase (Group B) was a retrospective study of 530 pregnant women managed 2 years previously who were selected by systematic random technique. RESULTS: The mean age, gestational age at booking, gestational age at delivery and birth weight were 30.2 ± 5.2 years, 21 ± 10.8 weeks, 38.7 ± 2.7 weeks and 3.1 ± 0.7 kg respectively. The prevalence of GDM in Group A and B were 4.9% and 1.6% respectively ( P < 0.05). There was about three fold increase in identification of women at risk of GDM by use of a checklist. CONCLUSION: Identification of women at risk of GDM was approximately 3-4 fold higher with the use of checklist of risk factors. Exhaustive clinical identification with a checklist of risk factors for GDM should be encouraged.

Survival of ovarian cancer patients in Ibadan: clinical and pathological factors.

This retrospective cross-sectional study evaluated the applicability of the universal grading system in a selected patient population and compared the results with the FIGO staging. A total of 49 patients who met the inclusion criteria, were studied. The slides were independently examined by two pathologists, using Silverberg's parameters. The prognostic value of their findings was analysed using Kaplan-Meier graphs. Papillary subtype and abnormal nuclear features were the most frequent histological pattern and a younger age was associated with improved survival. The longest surviving patient (250 weeks) had the lowest mitotic activity, predominantly glandular architecture and little or no nuclear pleomorphism, the reverse is the case for the shortest-term survivor (120 weeks). The universal grading system is useful and comparable with the FIGO staging. The two systems are complementary.

Predictors of maternal mortality in institutional deliveries in Nigeria.

BACKGROUND: Maternal mortality in poor countries reflects the under-development in these societies. Global recognition of the burden of maternal mortality and the urgency for a reversal of the trend underpin the Millenium Development Goals (MDGs). OBJECTIVE: To determine risk factors for maternal mortality in institutional births in Nigeria. METHOD: Twenty one health facilities in three states were selected using stratified multi-stage cluster sampling strategy. Information on all delivered mothers and their newborn infants within a three-month period was culled from medical records. RESULTS: A total of 9 208 deliveries were recorded. About one-fifth (20.5%) of women had no antenatal care while 79.5% had at least one antenatal visit during pregnancy. Four-fifths (80.5%) of all deliveries were normal deliveries. Elective and emergency caesarean section rates were 3.1% and 11.5% respectively. There were 79 maternal deaths and 8 526 live births, giving a maternal mortality ratio of 927 maternal deaths per 100 000 live births. No antenatal care, parity, level of education, and mode of delivery were significantly associated with maternal mortality. Low maternal education, high parity, emergency caesarean delivery, and high risk patients risk independently predicted maternal mortality. CONCLUSION: Meeting goal five of the MDGs remains a major challenge in Nigeria. Multi-sectoral approaches and focused political will are needed to revert the high maternal mortality.

Asymptomatic bacteriuria among an obstetric population in Ibadan.

BACKGROUND: Asymptomatic bacteriuria in pregnancy is the major risk factor for symptomatic urinary tract infection during pregnancy. Screening and identification of bacteriuria during pregnancy have been recommended. OBJECTIVE: To determine the prevalence and pattern of asymptomatic bacteriuria associated with pregnancy. METHODS: The study was a descriptive, cross sectional survey of pattern of asymptomatic bacteriuria among consecutive patients presenting for the first antenatal visit at a University College Hospital, during a period of two months. Relevant information obtained from all the patients recruited for the study included age, parity, educational level, gestational age and occupation of participant. Haemoglobin electrophoresis patterns were also retrieved and recorded. Main outcome measures were prevalence of asymptomatic bacteriuria, bacterial isolates and their antibiotic sensitivities. RESULTS: There were 205 eligible participants with a mean age of 30.6 ± 4.3 years and a mean gestational age at booking of 20.9 ±7.0 weeks. The prevalence of asymptomatic bacteriuria was 22(10.7%). The isolated pathogens were predominantly coliforms (Klebsiella and E. coli) accounting for 45.5% and Staphylococcus saprophyticus (27.3%). Only gentamycin, nitrofurantoin and ofloxacin demonstrated high efficacy against these uropathogens with antibiotic sensitivity rates of 72.7%-81.8%. CONCLUSION: Prevalence of asymptomatic bacteriuria in this centre is relatively high. This underscores the need for routine screening of pregnant women for bacteriuria.

Asymptomatic bacteriuria in pregnancy: evaluation of reagent strips in comparison to microbiological culture.

Screening for asymptomatic bacteriuria during pregnancy, the major risk factor for symptomatic urinary tract infection during pregnancy have been recommended. This cross sectional study was conducted to determine prevalence of asymptomatic bacteriuria in Ibadan and evaluate the diagnostic accuracy and relative cost effectiveness of dipstick tests for nitrite and leucocyte esterase in comparison to laboratory culture. Two hundred and five patients, presenting for their first antenatal visit at the University College Hospital, Ibadan, participated in the study. Urine samples obtained from the participants were subjected to two tests; reagent dipstick test for nitrite and leucocyte esterase and routine laboratory culture, which is the gold standard for diagnosis. Main outcome measures were sensitivity, specificity, positive and negative predictive values of the reagent dipstick tests as well as likelihood ratios. The prevalence of asymptomatic bacteriuria in pregnancy with routine laboratory culture and using combined leucocyte esterase and nitrite strip tests were 10.7% and 11.7% respectively. Compared with laboratory culture, combined strip tests had sensitivity, specificity and negative predictive values of 50%, 92.9% and 93.9% respectively, indicating a statistically significant lower level of accuracy (P < 0.05). The corresponding likelihood ratios for positive and negative strip tests (LR+ and LR-) were 7 and 0.5 respectively. The study concludes that combined Leucocyte esterase-nitrite dipstick test is not sufficiently sensitive and specific to be used for routine screening of bacteriuria in pregnancy in place of laboratory culture, though may be more cost effective in low resource settings.

Predictors of asymptomatic bacteriuria among obstetric population in Ibadan.

BACKGROUND: Asymptomatic bacteriuria in pregnancy is the major risk factor for symptomatic urinary tract infection during pregnancy. Screening and identification of bacteriuria during pregnancy have been recommended. The general objective of the study was to determine the pattern as well as possible predictors of asymptomatic bacteriuria at the University College Hospital, Ibadan. METHODS: The study was a descriptive, cross sectional, exploratory survey of the pattern of asymptomatic bacteriuria among all consecutive patients presenting for the first antenatal visit at the University College Hospital, Ibadan during the study period. RESULTS: The prevalence of asymptomatic bacteriuria was 10.7%. Although no statistically significant association was found, the prevalence was higher among women aged between 26 - 35 years (11.5%) and those with only secondary education (14.6%). Other demographic parameters characterized by high rates of bacteriuria were Christian women (12.7% compared to 4.3% among Muslims) and genotypes AS and AC (16.4% and 16.7% respectively). Low parity (para 1-2), 2nd and 3rd trimesters of pregnancy were the identified possible obstetric predictors of bacteriuria in pregnancy. Staphylococcus species constitute the predominant isolates in 3rd trimester and among Muslim pregnant women. CONCLUSION: Since no statistically significant predictors for bacteriuria in pregnancy were found, routine screening of all our pregnant women for this condition in 2nd trimester is recommended.

Utilization of the partograph in primary health care facilities in southwestern Nigeria.

OBJECTIVE: To assess knowledge about the partograph and its utilization among maternity care providers in primary health care in southwestern Nigeria. METHOD: Two hundred and seventy-five maternity care providers comprising of 64 CHEWS (23.3%), 74 Auxiliary midwives (26.9%), 123 Nurses/midwives (44.7%) and 14 medical doctors (5.1%) were interviewed in primary health centres and private hospitals in three states in southwestern Nigeria using a multi-stage sampling strategy. Knowledge about the partograph and assessment of labour were assessed with an interviewer-administered questionnaire. RESULTS: About a quarter of respondents, 75 (27.3%) had received prior training on the partograph. Only 25 (9.1%) reported that the partograpgh was available in their labour wards. Knowledge about the partograph was poor; only 18 (16.0%) of all respondents correctly mentioned at least one component part of the partograph, 21 (7.6%) correctly explained function of the alert line and 30 (10.9%) correctly explained function of the action line. Prior training significantly influenced knowledge about the partograph (gamma2 = 49.2; p < 0.05). Knowledge about assessment of labour was also poor: less than 50% of all respondents knew the normal duration of labour and just about 50% understood assessment for progress of labour. CONCLUSION: The partograpgh is not utilized for labour management in Nigeria. Knowledge about partograph and assessment during labour is grossly deficient. Findings suggest poor quality intrapartum care. Effective interventions to improve labour supervision skills and partograph utilization are urgently required.

Gynaecological morbidities among adolescents in Ibadan.

A descriptive retrospective study, was conducted on adolescent girls (10 to 19 years) at the University College Hospital (UCH), Ibadan to determine the common gynaecological conditions among these group of girls that attended gynaecological clinic of UCH between January 2000 and December 2007. Demographic characteristics including age, sex, occupation, religion, marital status and level of education were extracted from patients' medical records and recorded on a pre-designed data sheet. Presenting complaints and the definitive diagnosis were also recorded. A total of 243 adolescents presented within the study period. The commonest gynaecological complaint was abnormal vaginal discharge (44.4%) while the least was breast lump (1.7%). The commonest gynaecological diagnosis was reproductive tract infection (62.6%), out of which sexually transmitted infections constituted 40%. Infertility (1%) was the least diagnosed condition. Other gynaecological conditions included pregnancy related complications (6.6%), sexual abuse (3.3%), menstrual abnormalities (4.5%) and dysfunctional uterine bleeding (1.7%). Gynaecological complaints were commoner among the older (15 to 19 years) than the younger (10 to 14 years) adolescents (p < 0.01). It was concluded from this study that adolescents experience various forms of gynaecological morbidities, especially reproductive tract infections. We recommend sexual education and counselling for adolescents to help withstand peer pressure in initiating sexual activity. Pregnancy prevention programmes to encourage contraceptive use are imperative.

Prevalence of violence against pregnant women in Ibadan, Nigeria.

Women are at risk of violence at all stages of their life, including during pregnancy. Using a interviewer-administered questionnaire, 306 pregnant women were interviewed in two public secondary health facilities in Ibadan to compare prevalence and risk factors of VAW before and during pregnancy. Prevalence ofVAW a year before current pregnancy was 41.5% compared to 17.7% during pregnancy. Perpetrators before pregnancy were mostly relatives (22%), while during pregnancy, partners (64%). Major reasons for violence were "not obeying instructions" (33.3%) and "misbehaving" (26%). Education (OR 0.49; 95% CI 0.29-0.83) and polygamous union (OR 9.56; 95% CI 3.71-24.63) and consumption of alcohol (OR 7.19; 95% CI 0.04-0.53) were statistically significant a year before pregnancy. Mothers occupation (OR 0.19; 95% CI 1.05-4.49); type of union (OR14.13; 95% CI 6.13-32.59), alcohol consumption by partner (OR 6.06; 95% CI 0.05-0.54); and not wanting pregnancy (OR 3.53; 95% CI 1.20-9.30) were statistically significant in the index pregnancy. Hemorrhage (7.4% vs. 4.8%), abortion (1.9% vs. 1.2%), intrauterine death (3.7% vs. 1.2%) and premature labour (9.3% vs. 3.2%) were more often found in women who experienced VAW than those who did not, the latter was statistically significant (P < 0.05). Violence avoidance strategies included 'playing along' (51.3%) and 'praying' (21%). Pregnancy was protective against VAW. Empowerment of women through education and employment is crucial. Counselling on planning of families is also necessary. Screening for violence in pregnancy and close monitoring of the abused to ensure good obstetric outcome is recommended.

Predictors of Asymptomatic Bacteriuria among Obstetric Population in Ibadan

Asymptomatic bacteriuria in pregnancy is the major risk factor for symptomatic urinary tract infection during pregnancy. Screening and identification of bacteriuria during pregnancy have been recommended.The general objective of the study was to determine the pattern as well as possible predictors of asymptomatic bacteriuria at the University College Hospital; Ibadan. The study was a descriptive; cross sectional; exploratory survey of the pattern of asymptomatic bacteriuria among all consecutive patients presenting for the first antenatal visit at the University College Hospital; Ibadan during the study period. The prevalence of asymptomatic bacteriuria was 10.7. Although no statistically significant association was found; the prevalence was higher among women aged between 26 - 35 years (11.5) and those with only secondary education (14.6). Other demographic parameters characterized by high rates of bacteriuria were Christian women (12.7compared to 4.3among Muslims) and genotypes AS andAC (16.4and 16.7respectively). Low parity (para 1-2); 2 and 3 trimesters of pregnancy were the identified possible obstetric predictors of bacteriuria in pregnancy. Staphylococcus species constitute the predominant isolates in 3 trimester and among Muslim pregnant women. Since no statistically significant predictors for bacteriuria in pregnancy were found; routine screening of all our pregnant women for this condition in 2 trimester is recommended

Menstrual characteristics of secondary school girls in Ibadan, Nigeria.

BACKGROUND: Disturbances of menstrual function are the commonest complaints among adolescents. Disorders of menstruation may have implications for future reproductive health. OBJECTIVE: To assess menstrual patterns among school girls in Ibadan, south-western Nigeria. METHODS: This was cross-sectional descriptive study in which 1,213 apparently healthy school girls were selected by multistage sampling technique in fifteen secondary schools from the five local governments within the metropolis. Information about details of menstrual experience was obtained with a self-administered questionnaire. RESULTS: The girls were aged between 9 and 23 years. Majority of respondents 768 (633%) experienced normal cycle length, 391 (32.2%) had short cycles; and 55 (4.5%) had cycle length greater than 35 days. Prevalence of normal cycles increased with increasing age; abnormalities of cycle length tended to decrease with increasing age (p < 0.01). The majority, 1,152 (95%), had normal menstrual loss. The majority 882 (72.7%) experienced dysmenorrhoea; severe dysmenorrhoea was reported by 154 (12.7%). Cycle length was not associated with presence of dysmenorrhoea (p > 0.05); 695 (57.3%) had symptoms of pre-menstrual syndrome. CONCLUSION: Prevalence of menstrual abnormalities among adolescent schoolgirls is high. More attention should be paid to identify and treat these menstrual morbidities.

Attitude of health care workers to patients and colleagues infected with human immunodeficiency virus.

Discrimination against persons living with HIV/AIDS in hospital settings has been documented. This study examined the attitude of health care workers (HCWs) to nurses, doctors and patients infected with HIV. A total of 345 respondents selected by multistage sampling techniques were surveyed, using a semi-structured questionnaire, which explored respondents' attitude to HIV-infected patients and colleagues with HIV/AIDS. HCWs were unwilling to accept that medical procedures be carried out on them by HIV-infected doctors and nurses, with almost 80% refusing surgery or assistance at surgery on them by an HIV-infected doctor or nurse. They were also significantly more unwilling to accept that medical procedures be carried out on them by an infected colleague, compared with their carrying out the same procedure on an HIV-infected patient. Thus, HCWs seemed to believe that the risk of contracting HIV was higher if an infected HCW were to perform medical procedures on them, and fear of contracting HIV seemed to be the driving force for their negative attitudes. Education on occupational risks of HIV, provision of a safe working environment with enforcement of universal precautions, as well as provision of post-exposure prophylaxis are suggested as ways to enable HCWs to change their attitudes.

Attitude of Health Care Workers to Patients and Colleagues Infected with Human Immunodeficiency Virus

Discrimination against persons living with HIV/AIDS in hospital settings has been documented. This study examined the attitude of health care workers (HCWs) to nurses; doctors and patients infected with HIV. A total of 345 respondents selected by multistage sampling techniques were surveyed; using a semi-structured questionnaire; which explored respondents' attitude to HIV-infected patients and colleagues with HIV/AIDS. HCWs were unwilling to accept that medical procedures be carried out on them by HIV-infected doctors and nurses; with almost 80refusing surgery or assistance at surgery on them by an HIV-infected doctor or nurse. They were also significantly more unwilling to accept that medical procedures be carried out on them by an infected colleague; compared with their carrying out the same procedure on an HIV-infected patient. Thus; HCWs seemed to believe that the risk of contracting HIV was higher if an infected HCW were to perform medical procedures on them; and fear of contracting HIV seemed to be the driving force for their negative attitudes. Education on occupational risks of HIV; provision of a safe working environment with enforcement of universal precautions; as well as provision of post-exposure prophylaxis are suggested as ways to enable HCWs to change their attitudes

Perception and practice of malaria prophylaxis in pregnancy among primary health care providers in Ibadan, Nigeria.

BACKGROUND: Pregnant women and their unborn babies are especially vulnerable to malaria. Malaria infection during pregnancy is associated with increased risk of maternal anaemia, spontaneous abortion, stillbirth, low birth weight and neonatal death. OBJECTIVE: To assess knowledge and practice of malaria prophylaxis during pregnancy among primary health care providers in Ibadan, south-western Nigeria. METHODS: Participants were randomly selected from primary health centres and private health facilities in two local governments within Ibadan municipality. All cadres of health professionals in the selected health facilities were interviewed using a semi-structured self -administered questionnaire. RESULTS: Two hundred and eighty-seven participants selected from 42 primary healthcare facilities comprising of 48 (16.7%) CHEWs, 133 (46.3%) auxiliary nurses, 84 (29.3%) trained nurses and 22 (7.7%) medical doctors completed the questionnaires. Healthcare providers in private health facilities formed the bulk (80.5%) of respondents. Respondents' knowledge of malaria prevention strategies was generally poor across all professional cadres. Only 40 (13.9%) respondents had correct knowledge of WHO strategies. Awareness of IPT was significantly higher among respondents from public health facilities compared with private health facilities--93.0% versus 80.9% (p < 0.05) One hundred and fifty-six (54.4%) respondents knew the correct drug, dosage and timing of IPT. Only forty-six (16.0%) respondents were aware that at least three doses of IPT were required for HIV patients. Pyrimethamine was significantly more commonly prescribed in private health facilities compared with public health facilities (p < 0.05) Chloroquine was still commonly prescribed by respondents in public and private health facilities. The use of insecticide treated nets was recommended by 77.4% of respondents. CONCLUSION: Knowledge about current malaria prevention strategies during pregnancy is poor among health care providers at the primary level of care. Efforts aimed at improving malaria prevention in the primary health care setting must incorporate providers in private health facilities who are responsible for a larger proportion of health care delivery at this level.

Gestational age at antenatal booking and delivery outcome.

Antenatal care is a form of preventive medicine that pregnant women to allows maintain a state of good health throughout pregnancy, and to improve their chances of having a safe delivery of healthy infants. To achieve this aim, it is a widely held belief that pregnant women need to book early preferable before 14 weeks gestation. This is a retrospective study which reveals among others that late booking is still a common practice in the developing countries with average gestational age at booking being 23.59 (+/- 8.45) weeks, and only 14% of the women booked before the end of first trimester. Nulliparity or low parity was found to be the only factor that favoured early booking. However, gestational age at booking as a sole factor for predicting the pregnancy outcome was found to be insignificant as the outcome was same for early and late bookers. Unbooked pregnant women were found to be twice at risk of operative delivery, four times more likely to suffer delivery complications and twice likely to have low birthweight babies when compared to booked patients. In conclusion, findings of this study confirm the importance of antenatal care for better maternal and foetal outcome, however gestational age at booking as a sole factor is a poor predictor of pregnancy outcome. It is believed that this finding which is in tandem with the new WHO antenatal care protocol will generate divergent views among the health care givers and modify our current practice of Antenatal care to a more focused and effective risk assessment system.

Antenatal cardiotocography: experience in a Nigerian tertiary hospital.

OBJECTIVES: To compare selected perinatal characteristics between infants of mothers with reactive and non-reactive antenatal cardiotocography (non-stress test) results. PATIENTS AND METHODS: The medical records of all women who delivered within one week of a non-stress test were retrieved. The indication, test result, gestational age at delivery, Apgar score at 5 minutes, perinatal complications and neonatal ward admission were documented. RESULTS: One hundred and twelve women met study criteria among whom 51 tests were reactive and 61 were non-reactive. Post-datism, intra-uterine growth restriction, hypertensive disorders of pregnancy, and premature rupture of membranes were the commonest indications for the test. Post-datism was more commonly associated with a non-reactive test result. Women with non-reactive tests were almost twice as likely to be delivered by emergency Caesarean section, compared with women with reactive tests; although the test result did not significantly influence the mode of delivery. A non-reactive test was significantly associated with a higher perinatal mortality (p = 0.04). Although the reactive test was associated with a three-fold reduction in the incidence of low Apgar scores compared with the non-reactive test, this difference was not statistically significant (p = 0.18). A non-reactive test was significantly associated with small for gestational age infants (p = 0.01). CONCLUSIONS: Non-reactive non-stress test may be associated with higher perinatal mortality. When appropriately utilised, the test is a valuable tool for early detection of foetal compromise. Antenatal cardiotocography has a place in obstetric practice in low-resource settings for improving perinatal care.

Evaluation of criteria-based clinical audit in improving quality of obstetric care in a developing country hospital.

Study evaluated criteria-based clinical audit in measuring and improving quality of obstetric care for five life-threatening obstetric complications: obstetric haemorrhage, eclampsia, genital tract infections, obstructed labor and uterine rupture. Clinical management of 65 patients was audited using a 'before (Phase I) and after (Phase II)' audit cycle design using standard criteria. Following Phase I, areas in need of improvement were identified; mechanisms for improving quality of care were identified and implemented. Overall care of the complications improved significantly in obstetric haemorrhage (61 to 81%, p = 0.000), eclampsia (54.3 to 90%, p = 0.00), obstructed labour (81.7 to 93.5%, p < 0.001) and genital tract sepsis (66 to 85.2%, p < 0.01). Clinical monitoring, drug use, and urgent attention by senior medial staff also improved significantly after intervention. Criteria-based clinical audit is feasible and acceptable for improving management of life-threatening obstetric complications. Its application is recommended in health institutions in developing countries.

Influence of parity on the partographic management of labour in a Nigerian tertiary hospital.

OBJECTIVE: To assess whether parity influences progress of labour between primigravidae and multiparae as recorded on the partgraph. PATIENT AND METHODS: Retrospective analysis of partographs of women who were monitored with partograph prior to delivery. Participants were selected using specified exclusion criteria. RESULTS: Out of the 1,319 deliveries in the year 2004, 445 women had partographic monitoring; 368 medical records were retrieved and analysed. There were 136 (37.0%) primigravidae and 232 (63.0%)multiparae. The two groups were similar in booking status and risk level. Primigravidae had lower rates of spontaneous labour onset (78.7%) and thus higher rates of induction labour (21.3%) than multiparae [p< 0.05; OR.51, 95% Cl (0.28 - 0.93). Primigravidae presented at lower cervical dilatations and had more frequent vaginal examination than multiparae. Most multiparae (78.2%) had delivered within 6 hours of admission compare with primigravidae (53.1%); prolonged labour occurred more frequently in primigravidae than multiparae (6.9% vs 1.8%). These differences were statistically significant (p=0.000). Higher rates of inadequate uterine contractions were noted among primigravidae. Primigravidae more frequently crossed the alert and reached the action lines compared with multiparae; higher rates of augmentation of labour and emergency caesarean section were also recorded among primigravidae. The outcomes for mother and infant were similar in the two groups. CONCLUSION: Primigravidae are at a higher risk of dystocia compared with the multipara. Quality monitoring of the primigravida with the partograph will reduce the morbidity and mortality in both mother and the newborn.

Knowledge and utilization of the partograph among obstetric care givers in south west Nigeria.

This cross-sectional study assessed knowledge and utilization of the partograph among health care workers in southwestern Nigeria. Respondents were selected by multi-stage sampling method from primary, secondary and tertiary levels of care. 719 respondents comprising of CHEWS--110 (15.3%), Auxiliary Nurses--148 (20.60%), Nurse/Midwives--365 (50.6%), Physicians--96 (13.4%) were selected from primary (38.2%), secondary (39.1%) and tertiary levels (22.7%). Only 32.3% used the partograph to monitor women in labour. Partograph use was reported significantly more frequently by respondents in tertiary level compared with respondents from primary/secondary levels of care (82.4% vs. 19.3%; X2 = 214.6, p < 0.0001). Only 37.3% of respondents who were predominantly from the tertiary level of care could correctly mention at least one component of the partograph (X2 = 139.1, p < 0.0001). The partograph is utilized mainly in tertiary health facilities; knowledge about the partograph is poor. Though affordable, the partograph is commonly not used to monitor the Nigerian woman in labour.

Knowledge and utilization of the partograph among obstetric care givers in South West Nigeria

This cross-sectional study assessed knowledge and utilization of the partograph among health care workers in southwestern Nigeria. Respondents were selected by multi-stage sampling method from primary; secondary and tertiary level care. 719 respondents comprising of CHEWS - 110 (15.3); Auxiliary Nurses - 148 (20.6); Nurse/Midwives - 365 (50.6); Physicians - 96 (13.4) were selected from primary (38.2); secondary (39.1) and tertiary levels (22.7). Only 32.3used the partograph to monitor women in labour. Partograph use was reported significantly more frequently by respondents in tertiary level compared with respondents from primary/secondary levels of care (82.4vs. 19.3; X2 = 214.6; p 0.0001). Only 37.3of respondents who were predominantly from the tertiary level of care could correctly mention at least one component of the partograph (X2 = 139.1; p 0.0001). The partograph is utilized mainly in tertiary health facilities; knowledge about the partograph is poor. Though affordable; the partograph is commonly not used to monitor the Nigerian woman in labour