CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND TO THE STUDY

Labour, the process of giving birth is often a difficult time for many pregnant women. The
process requires adequate management by midwives and obstetricians for pregnant women to
have safe delivery. One of the tools recommended by the World Health Organization to
effectively manage labour is the partograph. Partograph is derived from the Latin word partum
(childbirth) + graph which means ‘labour curve’. The partograph is a printed chart on which
observations in labour are recorded in a graphic format to provide midwives and obstetricians
information about the progress of labour and to monitor maternal or fetal wellbeing (Lavender,
et.al., 2009 as cited in Ojong, 2021). The partograph is an inexpensive tool designed to provide a
continuous pictorial overview of labour and has been shown to improve outcomes when used to
monitor and manage labour. It is a single sheet of paper which includes information about the
fetal heart rate, uterine contraction, any drugs used and other important factor with its use.

Maternal mortality rate has continued to rise, especially in the developing countries despite
advancements in health technology (Sageer, et al., 2019,). Globally, an estimated annual
maternal death of more than 295 000 from complications of pregnancy and childbirth, occur in
developing countries (WHO, 2019). And about 303,000 maternal deaths occurred in the year
2015 during and following pregnancy or childbirth. Of all the deaths, 99% were in developing
countries in which 546 per 100,000 live births (66%) of them occurred only in Sub-Saharan
Africa. Nigeria has a maternal mortality ratio of about 814 per 100,000 live birth as at 2015
(WHO, 2017).

Most of the time, maternal deaths and complications are the results of obstructed and prolonged
labour. Prolonged labour is a leading cause of death among mothers and newborns in the
developing world. If the labour does not progress normally, a woman may experience serious
complications such as obstructed labour, dehydration, exhaustion, or rupture of the uterus. It may
also contribute to maternal infection or hemorrhage and to neonatal infection. This can be
prevented by accessing skilled delivery services such as plotting partograph during the progress
of labour (Leven & Smith, 2013).
World Health Organization (WHO) recommends the partograph to be used for monitoring all
labouring mothers. It is still not broadly used in the developing world especially in Africa due to
different factors such as lack of human resources, time pressure, stock-outs of partograph paper,
inadequate monitoring of maternal and fetal key indicators (Luwei, 2014). In Nigeria, 70.8% of
obstetric care givers were well aware and had good general knowledge of the partograph but far
below expectation. They also lacked detailed knowledge of the components (Asibong, 2014).

1.2 STATEMENT OF THE PROBLEM

In 2015, Nigeria’s estimated maternal mortality ratio was over 800 maternal deaths per 100 000
live births, with approximately 58 000 maternal deaths during that year. By comparison, the total
number of maternal deaths in 2015 in the 46 most developed countries was 1700, resulting in a
maternal mortality ratio of 12 maternal deaths per 100 000 live births. In fact, a Nigerian woman
has a 1 in 22 lifetime risk of dying during pregnancy, childbirth or postpartum/post-abortion;
whereas in the most developed countries, the lifetime risk is 1 in 4900 (WHO, 2019). Majority of
these deaths, complications and neonatal outcome could be prevented by cost-effective and
affordable health interventions like utilization of the partograph to monitor labour.

Although the partograph is a simple and inexpensive tool that prevents maternal deaths and
complications due to obstructed or prolonged labour, it is not as widely implemented as it should
be. Studies done in Nigeria reported that only 25% to 33% of caregivers surveyed were using the
partograph for routine monitoring of labour (Fawole et al., 2008 as cited in Yisma et al., 2013).
In Cross River State, Oyo-lta, et al. (2013) reported that the rate of utilization of the partograph
in monitoring the progress of labor in 13 health facilities was low (42%). Opiah et al. (2012)
assessed utilized partograph charts in Federal Medical Center (FMC), Yenagoa and Niger Delta
University Teaching Hospital (NDUTH), Okolobir. Their fundings revealed that only 18 (37.5%)
out of 48 in FMC and 17 (32.6%) out of 52 in NDUTH were properly filled. However, their
study also showed that despite midwives good knowledge of the partograph, there was poor
utilization in labor monitoring in both centers.

The partograph is the most commonly used tool for monitoring of labour, and it's widely
supported and recommended by the world health organization (WHO) and it should be used in
active phase of labour, but during my three years of posting experience I have notice a great low
usage of the partograph especially in Federal medical center (FMC) which we are mostly posted
to for clinical experience. In the light of the above, this study seek to assess the Low utilization
of partograph and it resultant effect among Midwives in Federal medical center Yenagoa.

1.3 OBJECTIVE OF THE STUDY

The objectives of this study is;

1. To assess the knowledge of partograph among Midwives in Federal Medical Center,

Yenagoa.
2. To identify the factors affecting the utilization of partograph in monitoring of labour
among Midwives in Federal Medical Center, Yenagoa.
3. To determine the extent of low utilization of partogragh in monitoring of labour in
Federal Medical Center Yenagoa.

1.4 SIGNIFICANCE OF THE STUDY

1. The result of the this study will enable health policy makers to implement policies to reduce
maternal and child morbidity and mortality.

2. Midwifery is concerned about maternal and child health, therefore, this study will help
midwives to take measures to prevent complications associated with prolonged labour by using
partogragh on every woman during labour.

3. This study will help hospital administrators on the need to train midwives on the use and
importance of partograph during delivery.

1.5 RESEARCH QUESTIONS

1. What is the knowledge of partograph among midwives in Federal Medical Center, Yenagoa.

2. What are factors affecting the utilization of partograph in monitoring labour among midwives
in Federal Medical Center, Yenagoa.

3. What is the extent of low utilization of partogragh in monitoring of labour in Federal Medical
Center Yenagoa.

1.6 SCOPE OF THE STUDY

The scope of this will cover all midwives in Federal Medical Center, Yenagoa.

1.7 OPERATIONAL DEFINITION OF TERMS

Partograph: a partograph is a graphical record of the observations made of a women in labour

Low utilization: using something below the acceptable standard

Midwives: are people who have completed midwifery education and are licensed to practice
midwifery.
 CHAPTER TWO

LITERATURE REVIEW

The focus of this is a common term and as such, so many research studies have been carried out
on the subject matters.

Therefore, this chapter shall discuss broadly on the following subheadings;

 Conceptual framework
 Theoretical review
 Empirical review

2.1. CONCEPTUAL FRAMEWORK

2.1.1 THE CONCEPT OF PARTOGRAPH

According to WHO (1994) as cited in Melese (2020) Partograph is a single sheet of paper where
maternal care providers utilize to monitor labour progress, fetal and maternal condition while a
mother is in the active first stage of labour. This labour monitoring sheet has; Personal
identification, fetal heart monitoring, amniotic fluid color, molding status, cervical dilation,
decent of the head, contraction frequency and strength, fluid and medication intake, maternal
vital sign and, urine output documentation.

2.1.2 HISTORY OF PARTOGRAM

Friedman's partogram devised in 1954 was based on observations of cervical dilatation and foetal
station against time elapsed in hours from onset of labour. The time onset of labour was based on
the patient's subjective perception of her contractility. Plotting cervical dilation against time
yielded the typical sigmoid or 'S' shaped curve and station against time gave rise to the hperbolic
curve. Limits of normal were defined.

Philpott and Castle in 1973 introduced the concept of "ALERT" and "ACTION" lines. The aim
of this study was to fulfill the needs of paramedical personnel practising obstetrics in Rhodesian
African primigravidae. The alert line represented the mean rate of progress of the slowest 10% of
patients in the African population whom they served. Alert line was drawn at a slope of 1
centimetre/hr for nulliparous women starting at zero time i.e. time of admission. Action line
drawn four hours to the right of the alert line showing that if the patient has crossed the alert line
active management should be instituted within 4 hours, enabling the transfer of the patient to a
specialised tertiary care centre. The action line was subsequently drawn two hours to the right of
the altert line.

2.1.3 OVERVIEW OF PARTOGRAPH

The partograph can be used by health workers with adequate training in midwifery who are able
to:
– Observe and conduct normal labour and delivery.
– Perform vaginal examination in labour and assess cervical dilation accurately
– Plot cervical dilation accurately on a graph against time
• There is no place for partograph in deliveries at home conducted by attendants other than those
trained in midwifery
• Whether used in health centers or in hospitals, the partograph must be accompanied by a
program of training in its use and by appropriate supervision and follow up.

Objectives of Partogragh

• Early detection of abnormal progess of a labour

• Prevention of prolonged labour
• Recognize cephalopelvic disproportion long before obstructed labour
• Assist in early decision on transfer, augmentation, or termination or labour
• Increase the quality and regularity of all observations of mother and fetus
• Early recognition of maternal or fetal problems
• The partograph can be highly effective in reducing complications from prolonged labour for the
mother (postpartum hemmorage, sepsis, uterine rupture and its sequelae) and for the
newborn(death, anoxia, infections, etc.).

FUNCTION OF PARTOGRAGH

The partograph is designed for use in maternity settings, but has a different level of function at
different levels of health care.
• In health center, the partographs critical function is to give early warning if labour is likely to
be prolonged and to indicate that the woman should not be transferred to a hospital.
• In hospital settings, moving to the right of alert line serves as a warning for extra vigilance, but
the action line is the critical point at which specific management decisions must be made.
• Other observations on the progress of labour are also recorded on the partograph and are
essential features in managment of labour.

Components of The Partograph

Part 1: fetal conditon (at top)

Part 11: progress of labour (at middle)
Part 111: maternal condition (at bottom)
Outcome

Part 1 : Fetal condition

• This part of the graph is used to monitor and assess fetal condition
• Fetal heart rate
• Membranes and liqour
• Moulding the fetal skull bones

Basal fetal heart rate

• > 160 beats/mi - tachycardia
• < 120 beats/min = bradycardia
• < 100 beats/min = severe bradycardia

Membranes and Liqour

• Intact membranes......................I
• Ruptured membranes + clear liqour............C
• Ruptured membranes + meconium -stained liquor ......M
• Ruptured membranes + blood - stained liquor...........B
• Ruptured membranes + absent liquor...........A

Moulding of the fetal skull

Molding is an important indication of how adequately the pelvis can accommondate the fetal
head
• Increasing molding with the head high in the pelvis is an ominious sign of cephalopelvic
disproportion
• Separated bones. sutures felt easily............O
• Bones just touching each other...........+
• Overlapping bones (reducible 0.................++
• Severely overlapping bones (non - reducible)....+++

Part 2 - progress of labour

• Cervical diltation
• Descent of the fetal head
Fetal position
• Uterine contractions
• This section of the paragraph has as its central feature a graph of cervical dilation against time
• It is divided into a latent phase and an active phase

Latent phase:
• It starts from onset of labour until the cervix reaches 3 cm diltation
• Once 3 cm diltation is reached, labour enters the active phase
• Lasts 8 hours or less
• Each lasting > 20 seconds
• At least 2/10 min contractions

Active phase:
• Contractions at least 3/10 min
• Each lasting > 40 seconds
• The cervix should dilate at a rate of 1 cm/ hour or faster

Alert line (health facility line)

• The alert line drawn from 3 cm diltation represents the rate of dilation of 1 cm/ hour
• Moving to the right or the alert line means referral to hospital for extra vigilance

Action line (hospital line)

• The action line is drawn 4 hour to the right of the alert line and parallel to it
• This is the critical line at which specific management decisions must be made at the hospital
Cervical dilatation

• It is the most important information and the surest way to assess progress of labour, even
though other findings discovered on vaginal examination are also important
• When progress of labour is normal and satisfactory, plotting of cervical diltation remains on the
alert line or left of it
• If a woman arrives in the active phase of labour, recording of cervical diltation starts on the
alert line
• When the active phase of labor begins, all recordings are transferred and start by pltting
cervical diltation on the alert line

Decent of the fetal head

• It should be assessed by abdominal examination immediately before doing a vaginal
examination, using the rule of fifth to assess engagement
• The rule of fifth means the palpable fifth of the fetal head are felt by abdominal examination to
be above the level of symphysis pubis
• When 2/5 or less of fetal head is felt above the level of symphysis pubis, this means that the
head is engage, and by vaginal examination, the lowest part of vertex has passed or is at the level
of ischial spines. Assessing descent of the fetal head by vaginal examination; 0 station is at the
level of the ischial spine

Uterine contractions
• Observations of the contractions are made every hour in the latent phase and every half-hour in
the active phase
• Frequency how often are they felt?
• Assessed by number of contractions in a 10 minutes period
• Duration how long do they last?
Measured in seconds from the time the contraction is first felt abdominally, to the time the
contraction phases off
• Each square represents one contraction number of contraction in ten minutes and duration of
each contraction in seconds
• Less than 20 seconds:
• Between 20 and 40 seconds:
• More than 40 seconds

Part 3: maternal condition

Name/ DOB / Gestation
Medical / Obsterical issues
Assess maternal condition regularly by monitoring:
• Drugs, IV fluids, and oxytocin, if labour is augment
• Pulse, blood pressure
• Temperature
• Urine volume, analysis for protein and acetone

2.2 THEORETICAL REVIEW

Dorothea Orem’s Self-Care Deficit Theory

Between 1959 and 2001, Dorothea Orem developed the Self-Care Nursing Theory or the Orem
Model of Nursing. It is considered a grand nursing theory, which means the theory covers a
broad scope with general concepts applicable to all instances of nursing.

Dorothea Orem’s Self-Care Deficit Theory defined Nursing as “The act of assisting others in the
provision and management of self-care to maintain or improve human functioning at the home
level of effectiveness.” It focuses on each individual’s ability to perform self-care, defined
as “the practice of activities that individuals initiate and perform on their own behalf in
maintaining life, health, and well-being.”

“The condition that validates the existence of a requirement for nursing in an adult is the absence
of the ability to maintain continuously that amount and quality of self-care which is therapeutic
in sustaining life and health, in recovering from disease or injury, or in coping with their effects.
With children, the condition is the parent’s inability (or guardian) to maintain continuity for the
child the amount and quality of care that is therapeutic.” (Orem, 1991)

Assumptions of the Self-Care Deficit Theory

Dorothea Orem’s Self-Care Theory assumptions are: (1) To stay alive and remain functional,
humans engage in constant communication and connect among themselves and their
environment. (2) The power to act deliberately is exercised to identify needs and to make needed
judgments. (3) Mature human beings experience privations in the form of action in care of self
and others involving making life-sustaining and function-regulating actions. (4) Human agency
is exercised in discovering, developing, and transmitting to others ways and means to identify
needs for, and make inputs into, self and others. (5) Groups of human beings with structured
relationships cluster tasks and allocate responsibilities for providing care to group members.

Major Concepts of the Self-Care Deficit Theory

In this section are the definitions of the major concepts of Dorothea Orem’s Self-Care Deficit
Theory:

Nursing

Nursing is an art through which the practitioner of nursing gives specialized assistance to persons
with disabilities, making more than ordinary assistance necessary to meet self-care needs. The
nurse also intelligently participates in the medical care the individual receives from the
physician.

Humans

Humans are defined as “men, women, and children cared for either singly or as social units” and
are the “material object” of nurses and others who provide direct care.

Environment

The environment has physical, chemical, and biological features. It includes the family, culture,
and community.

Health

Health is “being structurally and functionally whole or sound.” Also, health is a state that
encompasses both the health of individuals and groups, and human health is the ability to reflect
on oneself, symbolize experience, and communicate with others.

Self-Care

Self-care is the performance or practice of activities that individuals initiate and perform on their
own behalf to maintain life, health, and well-being.
Self-Care Agency

Self-care agency is the human’s ability or power to engage in self-care and is affected by basic
conditioning factors.

Basic Conditioning Factors

Basic conditioning factors are age, gender, developmental state, health state, socio-cultural
orientation, health care system factors, family system factors, patterns of living, environmental
factors, and resource adequacy and availability.

Therapeutic Self-Care Demand

Therapeutic Self-care Demand is the totality of “self-care actions to be performed for some
duration to meet known self-care requisites by using valid methods and related sets of actions
and operations.”

Self-Care Deficit

Self-care Deficit delineates when nursing is needed. Nursing is required when an adult (or in the
case of a dependent, the parent or guardian) is incapable of or limited in providing continuous
effective self-care.

Nursing Agency

Nursing Agency is a complex property or attribute of people educated and trained as nurses that
enables them to act, know, and help others meet their therapeutic self-care demands by
exercising or developing their own self-care agency.

Nursing System

Nursing System is the product of a series of relations between the persons: legitimate nurse and
legitimate client. This system is activated when the client’s therapeutic self-care demand exceeds
the available self-care agency, leading to nursing.

2.3 EMPIRICAL REVIEW

Melese et al., (2020) in their study on Utilization of partograph during labour: A case of Wolaita
Zone, Southern Ethiopia. They opined that the overall knowledge of participants on the
utilization of partograph in their study was 322 (73%). The majority 427 (96.6%) of participants
had learned partograph while they were in college or university. More than half 252 (57%) of
participants had received on the job training. Participants with a favorable attitude were 193
(44%). Out of the total particpants, 413 (93.4%) utilizes partograph and 29 (6.6%) were not
utilizing partograph. From 413 (93.4%) participants who claimed utilization of partograph, 304
(73.6%) utilized partograph routinely, 56 (13.5%) sometimes and 53 (12.8%) occasionally.
FromFrom 29 (6.6%) participants who were not utilizing partograph, 17 (58.62%) were due to
the utilization of different monitoring tools. Of the total 109 participants who were utilizing
partograph sometimes or occasionally 86 (79%) were due to the utilization of different
monitoring tools.

In another study to assess utilization of partograph and its predictors among midwives working
in public health facilities, Addis Ababa city administration, Ethiopia. The authours posited that
the overall knowledge of midwives was511(86%,CI: 84.6, 87.4%). Nearly all 98%, of
participants mentioned at least one component of the partograph (not all components). More than
two third of them define what partograph means but Less than half of the participants knew the
function of action line. Direct observation was made to all 594 midwife participants while
attending the progress of labour. It indicated that 537(90%) participants recorded blood pressure
while 409(69%) participants recorded amniotic fluid during the progress of labour. They
recorded temperature, cervical dilatation and uterine contraction almost in a similar frequency
that is 528(89%), 532(90%), 525(88%) respectively. In this study, 409(69%) midwives utilized
partograph during the progress of labour (Hagos et al., 2020).

According to Talihun et al. (2021) who conducted a study on Utilization of partograph and its
associated factors among obstetric caregivers in public health institutions of Southwest Ethiopia.
In their study, the magnitude of partogragh utilization was 43 %. This means 169(43)% of
obstetric caregivers utilized partograph routinely, while 113(29 %) of the participant utilized it
sometimes and 87 (22 %) utilized partograph occasionally. The reasons for not using the
partograph among their study participants were unavailability of partograph sheet 84(37.5 %),
lack of training on how to use partograph 46(20.53 %), partograph is time consuming 27(12.05),
shortage of staff 32(14.28 %) and it is easier to use another monitoring tool 17(7.58 %), were the
reasons given for not utilizing partograph routinely in the study area. They also noted that, being
a Nurse or Health officer decrease utilization of partograph by 63 % as compared to being
Midwifery professionals. Similarly, being a degree holder in qualification decrease partograph
utilization by 68 % as compared to diploma level obstetric care giver. Also, the odds of
partograph utilization for obstetric caregivers who received on job training was 7 times higher
than those not got training. In addition, the odds of partograph utilization was 5.84 times higher
among obstetric caregivers who have good knowledge of partograph as compared to those who
have poor knowledge of partograph. Finally, the odds of partograph utilization was 1.99 times
higher among caregivers who works in hospital as compared to caregivers who works at health
centers. Regarding the knowledge about partograph, more than two thirds (70.5%) of the care
providers were knowledgeable. Almost all (99.8%) of the participants were learned about
partograph while at college or university. More than half (59.3%) of them received on the job
training on partograph. The majority (83.6%) of obstetric care providers had a favorable attitude
towards partograph.

In a similar study carried out to determine partograph utilization and associated factors among
obstetric care providers in North Shoa Zone, Central Ethiopia: a cross sectional study. An
Institution based cross-sectional study was conducted in June, 2013 on 403 obstetric care
providers. The majority 327 (81.1%) of obstetric care providers in this study reportedly utilizes
partograph to monitor labour. Of those who were utilizing partograph 162 (40.2%) used,
routinely for all labouring mothers. Among reasons cited by respondents for not utilizing
partograph to monitor labour; using different monitoring tools accounted for (52.6%). Similarly,
among those who were using the partograph sometimes or occasionally; 97 (58.79%) of them
were using different monitoring tools like clinical records, monitoring charts, piece of papers to
monitor labour other than partograph, while 68 (41.21%) of them were citing shortage of staff as
barrier for not utilizing partograph routinely during labour. Those who were midwives by
profession were about 8 times more likely to have a consistent utilization of the partograph than
general practitioners. Those obstetric care providers who received on the job training on
partograph were about 3 times more likely to utilize partograph than who haven't received on-
job training. In addition, those who were knowledgeable on partograph were about 4 times more
likely to utilize partograph than the non knowledgeable (Negash et al., 2015).
According to Ojong et al. (2021) which conducted a study on Knowledge and Utilization of
Partograph in Labor Monitoring Among Nurses and Midwives in a Tertiary Health Facility in
South-South Nigeria. The result of their findings on the level of knowledge of partograph among
nurses and midwives in maternity annex revealed that majority of the nurse and midwives 73
(84.9%) had good knowledge of partograph. This study shows that knowledge about partograph
was a significant factor in its utilization in monitoring labour. The study also revealed that
despite the good knowledge demonstrated by majority of the nurses and midwives used for the
study, majority of them 13 (15.1%) still demonstrated poor knowledge on the use of labor
monitoring. Also, findings on the level of utilization of partograph in monitoring progress of
labour among nurses and midwives using observational check list to assess utilized partograph
charts, out of the 100 partograph charts used for the study, 84 were properly filled and 16 were
not properly filled as 84 (84%) of the partograph were opened at 4cm while 16 (16%) were not
opened at 4cm. In 80 (80%) partograph cervical dilation was assessed at every vaginal
examination; in 84 (84%) partographs, vaginal examination was done every 4 hourly. In 85
(85%) partograph, cervical dilation was plotted with X sign, while 16 (16%) was not. In 90
(90%) partograph first cervical dilation was plotted on alert line, while 10 partographs cervical
dilation was not plotted on alert line. In monitoring of uterine contractions, 84 partographs future
contracting were monitored every 30 minutes. In 80 partographs fetal conditions was monitored
1/2 hourly while in 20 partographs were not monitored correctly. In 86 partographs maternal
pulse was monitored every 30 minutes while temperature and BP were monitored 4 hourly. Lack
of knowledge, non-availability, time consuming, shortage of staff, and detailed filling were
factors listed to affect the utilization of partogragh in the study area.

Opiah et al. (2012) assessed knowledge and utilization of the partograph among midwives in two
tertiary health facilities in the Niger Delta Region of Nigeria. A descriptive survey design was
utilized, using a structured questionnaire administered to 165 midwives purposively selected
from the Federal Medical Center (FMC) (79) and Niger Delta University Teaching Hospital
(NDUTH) (86). Results revealed that 84% of midwives knew what the partograph was and
92.7% indicated that the use of the partograph reduces maternal and child mortality. About
50.6% midwives in FMC and 98.8% in NDUTH indicated that it was routinely utilized in their
centers. Assessment of utilized partograph charts revealed that only 18 (37.5%) out of 48 in
FMC and 17 (32.6%) out of 52 in NDUTH were properly filled. Factors in the utilization of the
partograph were:-non-availability of the partograph (30.3%), shortage of staff (19.4%), little or
no knowledge in the use of the partograph (22.2%), and 8.6 percent indicated it was time
consuming.

CHAPTER THREE

RESEARCH METHODOLOGY

This chapter presents the method and procedure that will be used for this study in a way to test
the research questions and also to achieve the objective of the study.
This chapter shall be discussed under the following;

 Research design
 Setting of the study
 Target population
 Sampling technique
 Instrument for data collection
  Validity of instrument
 Reliability of instrument
 Method of data collection
 Method of data analysis
 Ethical consideration

3.1 RESEARCH DESIGN

The research design that will be use in the study is a descriptive survey method. It involves
description of an invent, situation and phenomena to enable the researcher to evaluate the extent
of low utilization of partogragh in Federal Medical Center, Yenagoa.

3.2 SETTING OF THE STUDY

The study will be carried out in Federal Medical Center, Yenagoa Bayeslsa State. The hospital
was established on the 9th of April 1959 and it existed as a general hospital, it become a
specialist hospital on the 5th of September 1999, the hospital is accessible by road and water. By
road it is through Melford Okilo road (formerly Mbiama / Yenagoa road) by a junction know as
hospital junction. By water it is via the Ebebelebiri river (hospital waterside) which leads to the
facility at Ovom Yenagoa. It is bound to the north by ministry of land and housing, Ebebelebiri
river on the west and Creek Motel and civil servant quarters in the east, it is surrounded by 18km
perimeter fence. It is a 300 bedded hospital with staff strength of about 508 nurses and is made
up of 27 wards. Apart from health care delivery it is also involved in research activities and
serves as a training ground for medical, nursing and paramedical personnel within the state, it is
the most patronized health facility in the state and meets the health needs of people within and
outside the state.

3.3 TARGET POPULATION

The target population of this study are Midwives working in labour room of Federal Medical
Center, Yenagoa mothers which is about 18 midwives.
3.4 SAMPLING TECHNIQUE

The sampling technique that will be use for this study is simple random technique where every
individual will be given equal opportunity to participate. All Nurses and Midwives working in
the labour room will be selected for the study.

3.5 INSTRUMENT FOR DATA COLLECTION

The instrument to be use for data collection in this study will be a standardize and self-structured
questionnaire and observational checklist which will be carefully develop and adapted from
related journals and articles by the researcher. The questionnaire will comprise of four (4three
(3) sections (A,B, and C and D).). Section A will be on Demographic data of respondents.
Section B will be on mother’sassessing knowledge of the prevention and management of
diarrhea in under 5 children.partogragh among Midwives. Section C will be on factors affecting
the utilization of partogragh in labour monitoring by Midwives. The observation checklist will
consist of one (1) section (section D), to determine the extent of utilization of partogragh by
Midwives. It will be used to assess and score used partogragh in the labour room.

3.6 VALIDITY OF INSTRUMENT

A sample of the questionnaire and the observational checklist will be submitted to the
researcher's supervisor for expert validity in order for the objectives of the study to be achieve.

3.7 RELIABILITY OF INSTRUMENT

The questionnaire will be pretested on 5% of the sample size to ensure its validity. Findings from
the pretesting will be utilize for modifying and adjustment of the instrument.

3.8 METHOD OF DATA COLLECTION

The researcher will distribute one hundred and ten questionnaires to mothers in Tombia
community, after which the researcher will retrieve the questionnaires and the record the
findings.

3.9 METHOD OF DATA ANALYSIS

The generated data will be analyze using statistical methods; frequencies and percentages and
display in tables.

3.10 ETHICAL CONSIDERATION

A copy of ethical clearance from the ethical and research committee will be obtain. Participants
will be informed that participation in voluntary and that the study will be for academic purpose
only. They will also be made to understand that all information that will be given will be treated
as confidential. The right to withdraw from participating at any stage will be emphasize.