Effect of structured teaching programme on knowledge regarding modified partograph among auxiliary nurse midwives in selected community health centers

Background of The Study

Today in public health, maternal mortality remains one of the major problems especially in developing countries where maternal mortality is estimated to be 100 times higher than in developed countries.

The development of the partograph provided health professionals with a pictorial overview of the labour to allow early identification and diagnosis of the pathological labour. The first obstetrician to provide a realistic tool for the study of individual labours was Emanuel Friedman. In 1954, Friedman introduced the concept of a partogram by graphically depicting the dilation of the cervix during labour. In his study of 100 primigravidae at term, cervical dilatation was determined by frequent rectal examinations. For reproducibility, the examination was carried out at the peak of the contraction and for uniformity, measurements were recorded in centimetres. A simple, but effective chart was devised whereby square graph paper was used, with 10 divisions representing the cervical dilatation. The measurements were recorded and joined to the previous measurement in a straight line. The slope of each line was determined in terms of centimetres of dilatation per hour. Friedman’s explanation divided the first stage of labour into two parts: firstly, the latent phase which extends over 8–10 h and up to 3 cm dilatation; secondly, the active phase, characterized by acceleration from 3 to 10 cm, at the end of which is a decelerative phase. The major criticism of the development of this curve was the fact that no exclusions were made for malpresentations, malpositions or multiple pregnancies. Similarly, women receiving oxytocin infusions, caudal analgesia and/or operative delivery were included. The current partogram is designed to monitor not only the progress of labour, but also the condition of the mother and the fetus during labour.1, 2, 3, 4, 5

In late sixties and early seventies several extensive studies were carried out and it was inferred that labour in primipara and multipara behaved differently and deviation from normal could be diagnosed by the use of the partograph. Over last two decades several developed and developing countries have used partograph pragmatically in variety of different setting and have found it to be inexpensive and effective tool for diagnosing labour outcome. An estimated 358,000 women died due to complications developed during pregnancy and childbirth.

WHO, UNICEF and UNFPA produced a report with statistics gathered. The world average per 100,000 was 400, the average for developed regions were 20, and for developing regions 440. Seventy-five percent of maternal deaths occur during childbirth and postpartum period.

The studies above revealed that partogram is a valuable tool in the improvement of labour outcome and among these skilled attendances during pregnancy, labour and delivery have been identified as the most important factor in the reduction of maternal mortality and morbidity. Keeping the above facts in view, the investigator took up the task to assess the knowledge of ANM’s regarding partogram so that making aware of the standard protocol on partogram can fill missing links and knowledge gaps. 6, 7, 8, 9, 10, 11

Materials and Methods

Data analysis and interpretation

Section-I: Distribution of auxiliary nurse midwives according to their demographic variable.

Figure 1

Pie diagram showing the percentage distribution of auxiliary nurse midwives according to allowance of partograph to use

Figure 2

Pie diagram showing the percentage distribution of Auxiliary Nurse Midwives according to their confidence in using partograph

Section-II Assessment of pre test knowledge score of auxiliary nurse midwives regarding modified partograph

Figure 3

Pie diagram showing thepre test knowledge scores on modified partograph among auxiliary nurse midwives

The data in the figure reveals that in the pre test knowledge scores of auxiliary nurse midwives on modified partograph more than half of samples (51.67%) had inadequate knowledge where (48.3%) had satisfactory knowledge.

Section-III: Assessment of post test knowledge score of auxiliary nurse midwives regarding modified partograph

Figure 4

Pie diagram showing thepost test knowledge scores on modified partograph among Auxiliary Nurse Midwives

The data in the figure depicts that in the post test knowledge scores of auxiliary nurse midwives on modified partograph more than half of the samples (60%) had satisfactory knowledge where (40%) had adequate knowledge.

Section IV: Comparison between the pre and post test knowledge score of auxiliary nurse midwives regarding modified partograph.

The data in the table depicts that the pre test mean score of knowledge assessed by structured knowledge questionnaire was 10.65 with SD of +/- 3.82. In the post test mean score was 19.17 with SD of +/-3.92. This indicates that there is significant difference between pre-test and post-test knowledge score on modified partograph among auxiliary nurse midwives at 0.05 level of significance hence research hypothesis H₁ is accepted.

Figure 5

Cylindrical diagram showing the comparison between pre test and post test knowledge scores on modified partograph among auxiliary nurse midwives.

The data in the figure depicts that in the pre test knowledge scores of auxiliary nurse midwives on modified partograph more than half of the samples (51.7%) had inadequate knowledge where (48%) had satisfactory knowledge. Whereas in post test knowledge scores of auxiliary nurse midwives on modified partograph more than half of the samples (60%) had satisfactory knowledge where (40%) had adequate knowledge.

Line diagram was drawn to compare the pre test and post test knowledge scores of Auxialiary Nurse Midwives regarding modified partograph shows that the lowest pre test score values were between 4-6 obtained by 17% Auxialiary Nurse Midwives and highest score values were between 19-21 obtained by only 3% Auxialiary Nurse Midwives. However, during the post test, the lowest score values were between 10-12 obtained by 5% Auxialiary Nurse Midwives and highest score values were between 25-27 obtained by only 11% Auxialiary Nurse Midwives. Further, during the pre test the highest percentage (35%) Auxialiary Nurse Midwives score between 10-12, whereas during post test the highest percentage (27%) Auxialiary Nurse Midwives scored between.12, 13, 14

Further, the mean and median plotted for pre and post test scores shows that during pre test mean and median values were 10.65 and 10, whereas during post test it was 19.17 and 19 respectively revealing that the difference of approximately 9 scores. Hence, it can be interpretated that the STP was effective in improving the knowledge of Auxialiary Nurse Midwives regarding modified partograph.

O-give curve showing the comparison between pre test and post test cumulative percentage of knowledge scores on modified partograph among Auxiliary Nurse Midwives shows that the O-give curve values on post test score was higher than the pre test scores.

In the pre test 25^th percentile score was 2.8, whereas it was 5.5 for the post test that the difference of 2.7. The 50^th percentile score for pre test was 3.5, which was 6.2 for the post test revealing the difference of 2.7. The 75^th percentile score of pre test was 4.2, which was 7.5 for the post test revealing the difference of 3.3. It reveals that difference between pre and post test curve is highest at 75^th percentile revealing the effect of STP regarding modified partograph among Auxiliary Nurse Midwives

Section V: Association of pre test knowledge score of auxiliary nurse midwives with their selected demographic variables.

The data in the table depicts that the association of pre test knowledge score on modified partograph with their selected demographic variables. In relation to age, marital status, basic qualification, professional qualification, clinical experience, experience in labour room, practice of partograph in labour room, previous information and its source, supply of partograph and their confidence in using partograph with modified partograph, the chi square value obtained 0.028, 0.232, 3.202, 1.337, 4.558, 0.39, 1.253, 0.466, 3.338 and 1.654 respectively. It is identified that there is no significant association of pre test knowledge score on modified partograph in relation to age, marital status, basic qualification, professional qualification, clinical experience, experience in labour room, practice of partograph in labour room, previous information and its source, supply of partograph and their confidence in using partograph of auxiliary nurse midwives except the allowance of using partograph by medical officers / gynaecologists with chi square value 4.869 at 0.05 level of significance.15, 16

Conclusion

On the basis of the findings of the study, the following conclusions were drawn:

Highest percentage of Auxiliary Nurse Midwives (38.3%) were in the age group >35 years and (88.3%) were married. Highest percentage of Auxiliary Nurse Midwives (66.6%) were having high school basic qualification and (85%) were from 18 months revised auxiliary nurse midwives MPHW (F). Highest percentage of Auxiliary Nurse Midwives (58.3%) had 9 years and above total clinical experience, (41.6%) had 7 and above years of experience in labour room and (33.3%) Auxiliary Nurse Midwives had seldom used partograph in labour room. Highest percentage of Auxiliary Nurse Midwives (86.6%) had previous source of information during training. Highest percentage of Auxiliary Nurse Midwives (46.6%) agreed that partograph sheet is been supplied by the concerning department, (75%) agreed that use of partograph is allowed by medical officers / gynaecologists where (63.3%) are confident in using partograph.

Prior to the administration of structured teaching plan the highest percentage of Auxiliary Nurse Midwives (51.7%) had inadequate knowledge whereas highest percentage of Auxiliary Nurse Midwives (60%) had satisfactory knowledge after administration of structured teaching plan.

The mean pre test knowledge score was 10.65 whereas the mean post test knowledge score was 19.17. The post test scores proved that the structured teaching programme given by the investigator, helped auxiliary nurse midwives to improve their knowledge.

There is no significant association of pre test knowledge score on modified partograph with their selected demographic variables of Auxiliary Nurse Midwives except the allowance of using partograph by medical officers / gynaecologists with chi square value 4.869 at 0.05 level of significance.

Source of Funding

None.

Conflict of Interest

None.