Study selection and data extraction
The search strategy identified 80 articles from PubMed, 60 articles from Google Scholar, 45 articles from Cochrane Library, 10 articles from African Journals Online, 7 articles from Ethiopian’s University online library, and 5 articles by manual search. Of which, 134 were excluded due to duplication, 35 through review of titles and abstracts. Additionally, 31 full-text articles were excluded for not reporting the outcome variable and other reasons. Finally, 19 were included to the prevalence and/ or associated factor analysis on partograph use [Fig.2].
Study characteristics
Different factors such as; midwifery profession, presence of supervision, Basic Emergency Obstetric and Newborn Care training (BEmONC), Knowledge of partograph, on-the-job refresher training on partograph, favorable attitude towards partograph, and working at the health center were included in this study. Nineteen cross-sectional studies with a total of 6237 obstetric care providers were included in this review. All of the included articles were facility-based study setting. Regarding the study area, six of the studies were conducted at SNNPR (south nation nationalities and people representative), four in Tigray, Amhara, Oromia; each account three studies respectively (Table 1).
Table 1; Descriptive summary of nineteen included studies in the systematic review and meta-analysis
Author (year of study) (reference number)
|
Sample size
|
Response rate (%)
|
Study region
|
prevalence (95% CI)
|
NOS Quality of score
|
Fantu A.et al(2012)[37]
|
381
|
88
|
Amhara
|
29(24–33)
|
9
|
Habtamu R.et al(2017)[38]
|
224
|
90.2
|
Oromia
|
89(85–93)
|
9
|
Wakeshe W.et al(2015)[39]
|
266
|
97.4
|
Oromia
|
84(80–88)
|
9
|
Negash W.et al(2013)[40]
|
403
|
94.5
|
Amhara
|
40(35–45)
|
8
|
Haymanot M. et al(2015)[41]
|
441
|
98
|
Addis Ababa
|
92.6(90–95)
|
9
|
Tesfay H. et al(2017)[42]
|
220
|
90
|
Tigray
|
73(67–79)
|
9
|
Desalegne A. et al(2015)[43]
|
273
|
100
|
Amhara
|
53(48–60)
|
9
|
Kidist E. et al(2016)[44]
|
300
|
93.3
|
SNNP
|
51(45–57)
|
8
|
Kidest G.et al(2016)[45]
|
442
|
99
|
SNNP
|
73(68–78)
|
9
|
D.Markos et al(2014)[46]
|
401
|
91
|
SNNP
|
70(66–75)
|
9
|
Engida Y.et al(2012)[47]
|
202
|
96.5
|
Addis Ababa
|
57(50–64)
|
8
|
Sena B.et al(2012)[48]
|
340
|
80.6
|
Oromia
|
6.9(4–10)
|
9
|
Gutema C. et al(2015)
|
309
|
89
|
SNNP
|
54(48–59)
|
9
|
Daniel B.et al(2016)[49]
|
127
|
100
|
SNNP
|
26(18–34)
|
9
|
Haftom G et al(2015)[50]
|
233
|
93
|
Tigray
|
57(51–64)
|
9
|
Guesh W.et al(2018)[51]
|
414
|
98.1
|
Tigray
|
83(31–43)
|
9
|
Yosef Haile.et al(2019)[52]
|
436
|
95
|
SNNP
|
55.4(2–9)
|
9
|
Tesfay H. et al(2019)[42]
|
220
|
98
|
Tigray
|
73.3(21–32)
|
9
|
Azeb A.et al(2017)[53]
|
605
|
98.1
|
Addis Ababa
|
69(36–45)
|
9
|
Partograph use among obstetric care providers in Ethiopia
The overall pooled prevalence of partograph is presented with a forest plot (Fig. 3). Therefore, the national estimated prevalence of partograph use among obstetric care providers in Ethiopia was 59.95% (95% CI: 46.8–73.09, I2 = 99.4%, P < 0.001).
Partograph use among obstetric care providers in Ethiopia
The overall pooled prevalence of partograph is presented with a forest plot (Fig. 3). Therefore, the national estimated prevalence of partograph use among obstetric care providers in Ethiopia was 59.95% (95% CI: 46.8–73.09, I2 = 99.4%, P < 0.001).
Sensitivity analysis
This systematic review and meta-analysis showed that the point estimate of its omitted analysis lies within the confidence interval of the combined analysis. Therefore, trim and fill Analysis was no further computed (fig. 5).
Subgroup analysis
Subgroup analysis was employed with the evidence of heterogeneity. In this study, the Cochrane I2 statistic was 99.4%, P < 0.001, which showed the evidence of marked heterogeneity. Therefore, subgroup analysis was done using the study region and year of study. As a result, the use of partograph was highest in Addis Ababa 73.4%, whereas 70.95% in the study conducted between 2018 and 2019 (Fig. 6&7).
Determinants of partograph use in Ethiopia
The association between midwifery profession, presence of supervision, Basic Emergency Obstetric and Newborn Care training (BEmONC), attitude, Knowledge of partograph, on-the-job refresher training on partograph, favorable attitude towards partograph, and working at health centers with partograph use was carried out.
In this meta-analysis, to identify the associated factors, eight articles were used for midwifery profession [37-41, 46, 49, 54], five for knowledge of partograph [39, 40, 43, 52, 53], three for attitude [40, 41, 52], and five for on-the-job refresher training on partograph [37, 41, 46, 52, 53], seven for BEmONC (Basic Emergency Obstetric and Newborn Care) training [37, 39-43, 50], four for presence of supervision[37, 38, 46, 49], and six for working at health center [41, 43, 44, 47, 52, 54].
Obstetric care providers who were midwives were 3.97 times more likely to use partograph as a decision-making tool. Those obstetric care providers who received BEmONC training were 2.9 times more likely to use partograph. The odds ratio of on-the-job refresher training on partograph to use partograph was 5.7. Obstetric care providers who supervised were 3.21 times more likely to use partograph. Additionally, obstetric care providers who had a good Knowledge of partograph were 2.5 times more likely to use partograph.
Obstetric care providers who had a favorable attitude towards partograph utilization were 2.12 more likely to utilize partograph as a decision-making tool. Moreover, those obstetric care providers working at the health center were 3.5 times more likely to use partograph (Table 2).
Variable name
|
NO. of included studies
|
OR (95% CI)
|
Overall (I-squared, p-value)
|
midwifery profession
|
8
|
3.97 (2.63–5.99)
|
28.8%, p = 0.198
|
presence of supervision
|
4
|
3.21(2.22–4.66)
|
0.0%, p = 0.742
|
Emergency Obstetric and Newborn Care training
|
7
|
2.90(2.19–3.84)
|
36.9%, p = 0.134
|
knowledge of partograph
|
5
|
2.46 (1.60–3.77)
|
64.5%, p = 0.024
|
Attitude towards partograph
|
3
|
2.12 (1.48–3.04)
|
0.0%, p = 0.573
|
on-the-job refresher training on partograph
|
5
|
5.66 (2.48–12.92)
|
87.8%, p = 0.000
|
working at health center
|
6
|
3.50 (2.49–4.92)
|
49.1%, p = 0.08
|