The result is reported in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) checklist, and the PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of healthcare interventions (see checklist in Additional file 1).
Search process and study selection
We searched PubMed, Cochrane Library, Google scholar, and African Journals Online databases for all available studies using the following search terms: “partograph utilization”; “knowledge”; “intrapartum monitoring”; “midwives”; “documentation of partograph”; “decision making”; “attitude”; nurses “outcome”; “health institution”; “attitude”; “labour”; “health care providers”;”childbirth”;”factors”;”determinants”;”health center”;”components”; “partograph”;and “Ethiopia”. The search string was developed using “AND” and “OR” Boolean operators.
For unpublished studies, master’s thesis and PhD dissertation, the official website of Ethiopian’s University research repository online library (University of Gondar and Addis Ababa University) was searched. Also, a manual search of the reference lists of included articles was performed.
Inclusion and exclusion criteria
The studies were included if they met the following inclusion criteria: (1) studies conducted in Ethiopia; (2) observational studies, including cross-sectional, case-control and cohort studies (3) 4) the outcome partograph utilization (4) both published and unpublished studies reported in the English language were considered.
Studies focused on the assessment of knowledge, attitude, and partograph utilization without the outcome of interest of this study, studies available only as abstract with unclear outcomes, editorials, commentaries, reviews were excluded.
Definition of terms
Universal utilization of a Partograph was recommended by world health organization at every birth. In this review, partograph utilization was considered when Health care providers working in labour ward use and documenting all components partograph that are applicable for individualized women(4).
Outcome of interest
The primary outcome of this review was partograph utilization among health care providers to monitor the progress of labour and feto-maternal condition. Universal utilization of a Partograph was recommended by world health organization at every birth. Health care professionals working in labour and delivery unit used partograph and documenting all components that are applicable for individualized women were considered as partograph utilizer (4).
The secondary outcomes were: determinants of partograph utilization such as sex of health care providers, supportive supervision, the professional difference among health care providers, job-related training like Emergency Obstetric Newborn Care, knowledge of partograph, training on partograph and institutional differences like referral hospital, health centers, and district hospitals, an attitude of health care providers, work overload, educational status of health care providers, service year of health care providers, shortage of staff, age of health care providers, using different monitoring tools like ( clinical records, monitoring charts, piece of papers) during labour.
Methods for data extraction and quality assessment
Two reviewers (AAA, BFZ) extract the data independently. Any disagreements between the reviewers were fixed by repeated reading of the articles independently, discussion, and consensus amongst the authors.
A prespecified form that was designed to extract data of methodological and scientific quality was used. As recommended by PRISMA [53], the following data were extracted from each study: first authors name, study setting, study period, study design, method of data collection, sample size, response rate, odds ratio (OR), and the possible associated factors of partograph utilization.
A modified version of NOS (the Newcastle-Ottawa Scale) [51] was used to assess the methodological quality of a study. The modified the Newcastle—Ottawa scales consists of three sections. The first section tool is rated up to five stars for methodological evaluation. The second section tool is ranked up to three stars for comparability assessment. The third section tool is evaluated up to two points that deal with the statistical analysis and the outcome of each study. The original study was assessed by two reviewers independently and any disagreement between the reviewers was resolved by taking the mean score of the two reviewers. Finally, the original studies with the scale of ≥7 out of 10 were considered as high quality after reviewing different literature.
Data synthesis and statistical analysis
For further analysis, we imported the data into STATA Version 11.0 statistical software after extracting the data using Microsoft Excel format. Using the binomial distribution formula, Standard error was calculated for each study. We identify the heterogeneity between the studies using Cochrane’s Q statistics (Chi-square), inverse variance (I2), and p-values [51]. The statistical output showed that there was significant heterogeneity among the studies (I2 = 99.4%, p = 0.000) so a random-effects meta-analysis model was used to estimate the pooled prevalence and associated factors of partograph utilization in Ethiopia. A forest plot used to detect the presence of heterogeneity. Furthermore, subgroup analysis and meta-regression were used to identify the possible source of heterogeneity. The evidence of publication bias was checked using funnel plot symmetry. Besides, the statistical significance of publication bias was assessed using both Egger’s and Beggar’s test, subsequently, a trim-and-fill analysis was performed, with the p-value, less than 5% used to declare the presence of publication bias [34,55].