Perceived strengths and challenges of the World Health Organization modified partograph among obstetric care providers in Blantyre, Malawi
Background/Aims The partograph is a tool used to monitor events during labour and was recently modified by the World Health Organization to improve intrapartum care. However, it is unknown how obstetric care providers in Malawi perceive this modified partograph. This study aimed to evaluate the perceived strengths and challenges regarding the World Health Organization's modified partograph design among obstetric care providers in Malawi. Methods For this qualitative study, data were collected from a sample of 34 obstetric care providers from two purposively-selected urban health facilities through in-depth interviews and focus group discussions. The data were subjected to thematic analysis, with the strengths and challenges of using the modified partograph designated as the two major themes. Results The participants reported that there were more challenges than strengths with utilisation of the modified partograph. Two subthemes emerged among the strengths: the partograph is comprehensive and the partograph is clear. Three subthemes emerged from the challenges: 1) unrealistic fetal monitoring intervals, 2) confusing partograph design regarding documentation of caput and moulding and 3) small font. These challenges made partograph use impractical to complete, particularly in the context of chronic understaffing of the labour ward. Conclusions Until staffing levels are improved in Malawi and other resource-limited settings, it is unlikely that the modified partograph design will significantly improve maternal or neonatal outcomes. However, some improvements can be made to the design to help facilitate its use, and more training on its use is needed to prevent confusion.