Factors contributing to suboptimal partograph use include lack of availability of partographs and labor management guidelines, insufficient knowledge, training or supportive supervision of SBAs related to partograph use, negative perceptions of the partograph and its value, and insufficient institutional commitment to partograph use. Routine use of the paper partograph in resource-constrained settings is low and inconsistent, with partographs often completed retrospectively for recordkeeping purposes only. In addition, the information on the partograph can be used to reassure the woman and her family about appropriate progress in labor, or explain abnormalities and potential interventions. While there is limited evidence that partograph use alone will improve maternal and neonatal survival, a multicenter WHO study demonstrated promising effects on care and labor outcomes when the partograph is implemented with a clear labor management protocol. Strengthening service delivery and improving quality of care during labor and delivery is essential for improving maternal and neonatal survival. For the last four decades, the World Health Organization (WHO) has recommended that, during labor, skilled birth attendants (SBAs) Footnote 1 use the partograph as a tool to improve documentation of intrapartum maternal and fetal measurements, identify abnormalities, and inform appropriate labor management. Regular and timely monitoring of maternal and fetal parameters during labor is critically important to assessing maternal and fetal well-being, supporting normal labor, identifying complications and spurring clinical decision-making to address them in a timely manner. These findings point to the ePartogramвЂ™s potential to improve quality of care in resource-constrained labor and delivery settings.

Qualitative findings revealed that SBAs felt the ePartogram improved timeliness of care and supported decision-making. With structured training and support during initial use, SBAs quickly became competent and confident in ePartogram use. It is feasible and acceptable for SBAs to use the ePartogram to support labor management and care. SBAs expressed confidence in their ability to interpret and act on these reminders and alerts. SBAs noted the helpfulness of auditory reminders (indicating that measurements were due) and visual alerts (signaling abnormal measurements). SBAs expressed positive impressions of the ePartogram and found it efficient and easy to use, beginning with first client use. Nearly all SBAs (93%) demonstrated confidence and all SBAs demonstrated comfort in using the ePartogram by the fifth shift. Observations of 23 SBAs using the ePartogram to monitor 103 women over 84 shifts showed that the majority of SBAs (87вЂ“91%) completed each of four fundamental ePartogram tasks-registering a client, entering first and subsequent measurements, and navigating between screens-with ease or increasing ease on their first shift this increased to 100% by the fifth shift. A thematic analysis of interview transcripts was completed. After the observation period, in-depth interviews were conducted ( nВ =вЂ‰15). Short interviews, conducted with SBAs ( nВ =вЂ‰82) after each of their first five ePartogram-monitored labors, detected differences over time. During each observed shift, data collectors used a structured observation form to document SBA comfort, confidence, and ability to use the ePartogram. Following 3 days of training, skilled birth attendants (SBAs) were observed for 2 weeks using the ePartogram to monitor laboring women. The ePartogram was introduced at three facilities in Zanzibar, Tanzania. This studyвЂ™s primary objective was to evaluate the feasibility and acceptability of ePartogram use in resource-constrained clinical settings. The application is designed to provide real-time decision support, improve data entry, and increase access to information for appropriate labor management. The ePartogram is a tablet-based application developed to improve care for women in labor by addressing documented challenges in partograph use.

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