Evidence-Based Intrapartum Care: A Retrospective Descriptive Assessment of Facility Based Births in Rural Public Health Facilities in Midwestern Uganda

Abstract

Introduction: Efforts to reduce maternal and newborn deaths, especially in sub-Saharan Africa, have not been sufficient to achieve Sustainable Development Goal (SDG) 3 for 2030. The quality of care around childbirth is critical for both mothers and newborns, and the use of evidence-based practices (EBPs) is vital in ensuring optimal outcomes. However, there is a paucity of recent research on the use of evidence-based practices in childbirth health facilities. Aims: This study aimed to describe the use of intrapartum evidence-based practices for facility-based births in rural lower public health facilities in Midwestern Uganda. Methods: A descriptive retrospective chart review was conducted of mothers who delivered at all public health facilities in the Kasese and Bundibugyo districts. Mothers who had given birth in 42 health facilities two months preceding the study period were systematically sampled using probability proportionate to the size of expected respective facility births. Data was collected between November and December 2024. A structured questionnaire adopted from the World Health Organization (WHO) Quality Maternal and Newborn Care (QMNC) was used to extract data on the use of EBPs. A descriptive analysis was done, and the results were presented as frequencies and percentages. Results: Of the 353 mothers, 73.1% (n=258) were monitored using a partograph. Blood pressure (BP) was the least monitored at only 23.6% (n=83). At admission, apart from Leopold’s examination, which was performed and recorded in 86.7% (n=306) of the charts, all other practices were below 50%. About 32.3% (n=114) of the charts had a documented management plan, and all expected laboratory investigations were in less than 2% of the charts. The record of the examination of newborns prior to discharge was low, at 15.6% (n=55). The coverage of EBPs was lowest in hospitals and highest in facilities at the health center 3 (HCIII) level. Conclusions: The findings indicate a need for strategies and research to improve the implementation of evidence-based practices in rural public health facilities, especially in hospitals