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Background <p>The partograph and WHO safe childbirth checklist (SCC), which include on-admission, before-birth, after-birth and discharge components, are quality improvement (QI) tools in intrapartum care that have long been recommended for use. However, poor-quality intrapartum care remains a significant barrier to improving maternal and newborn health outcomes in countries like Ethiopia, largely due to total non-use or poor adherence to these QI tools. eHealth-based interventions present promising strategies to enhance healthcare quality. Therefore, we conducted implementation research to examine the effect of ADHERE (<b>A</b>ntenatal care, chil<b>D</b>birt<b>H</b> car<b>E</b> and postnatal ca.<b>RE</b>), an innovative eHealth system with a clinical decision support element, on adherence to QI tools during intrapartum care in health facilities in Ethiopia.</p> Methods <p>A quasi-experimental study was conducted in 3 hospitals and 6 health centers (5 intervention and 4 control) in Ethiopia, guided by the Implementation Research Logic Model. Data were collected from labor and delivery charts by trained data collectors. A total of 2,190 charts (1,076 baseline [538 per arm] and 1,114 end-line [554 control and 560 intervention arms] charts) were included in the analysis. Difference-in-difference (DiD) analysis was used to estimate the effect of the intervention. The partograph adherence score and SCC completion rates were compared between the two arms. Statistically significant differences were determined using a p-value &lt; 0.05 cutoff.</p> Results <p>Baseline mean partograph scores in the control and intervention arms were 4.11 and 4.23, respectively. Baseline SCC adherence rates at admission, before-birth, after-birth, and discharge were 25.8%, 24.9%, 24.9%, and 24.3% in the control arm, respectively, and 49.6%, 47.8%, 45.9%, and 45.5% in the intervention arm, respectively. The ADHERE intervention increased partograph adherence score by 4.27 units (DiD = 4.27, 95%CI [1.80, 5.09]). The ADHERE intervention increased SCC adherence by 9.3%-points (DiD = 0.093, 95%CI [0.036, 0.151]) at admission, 22.3%-points (DiD = 0.223, 95%CI [0.121, 0.325]) before-birth, and 15.2%-points (DiD = 0.152, 95%CI [0.072, 0.231]) after-birth. Conversely, the ADHERE intervention did not significantly change SCC adherence at discharge (DiD = -0.025, 95%CI [-0.071, 0.021]). The lack of significant improvement may be due to providers less attention to discharge evaluation because of work overload.</p> Conclusion <p>The ADHERE intervention significantly improved adherence to partograph and SCC at admission, before-birth, and immediately after-birth during intrapartum care. However, it did not significantly improve adherence to the discharge checklist. Therefore, ADHERE-assisted implementation of QI tools can potentially prevent adverse birth outcomes related to low-quality intrapartum care and could be considered for scale up across health facilities in Ethiopia.</p>

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Effect of eHealth intervention (ADHERE) on adherence to partograph and WHO safe childbirth checklist in intrapartum care: implementation research in Ethiopia

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月16日

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  • Dabere Nigatu,
  • Muluken Azage Yenesew,
  • Eyaya Misgan,
  • Daniel A. Enquobahrie,
  • Tegegn Kebebaw,
  • Enyew Abate,
  • Esubalew Alemneh,
  • Mirkuzie Woldie,
  • Tsinuel Girma

摘要

Background

The partograph and WHO safe childbirth checklist (SCC), which include on-admission, before-birth, after-birth and discharge components, are quality improvement (QI) tools in intrapartum care that have long been recommended for use. However, poor-quality intrapartum care remains a significant barrier to improving maternal and newborn health outcomes in countries like Ethiopia, largely due to total non-use or poor adherence to these QI tools. eHealth-based interventions present promising strategies to enhance healthcare quality. Therefore, we conducted implementation research to examine the effect of ADHERE (Antenatal care, chilDbirtH carE and postnatal ca.RE), an innovative eHealth system with a clinical decision support element, on adherence to QI tools during intrapartum care in health facilities in Ethiopia.

Methods

A quasi-experimental study was conducted in 3 hospitals and 6 health centers (5 intervention and 4 control) in Ethiopia, guided by the Implementation Research Logic Model. Data were collected from labor and delivery charts by trained data collectors. A total of 2,190 charts (1,076 baseline [538 per arm] and 1,114 end-line [554 control and 560 intervention arms] charts) were included in the analysis. Difference-in-difference (DiD) analysis was used to estimate the effect of the intervention. The partograph adherence score and SCC completion rates were compared between the two arms. Statistically significant differences were determined using a p-value < 0.05 cutoff.

Results

Baseline mean partograph scores in the control and intervention arms were 4.11 and 4.23, respectively. Baseline SCC adherence rates at admission, before-birth, after-birth, and discharge were 25.8%, 24.9%, 24.9%, and 24.3% in the control arm, respectively, and 49.6%, 47.8%, 45.9%, and 45.5% in the intervention arm, respectively. The ADHERE intervention increased partograph adherence score by 4.27 units (DiD = 4.27, 95%CI [1.80, 5.09]). The ADHERE intervention increased SCC adherence by 9.3%-points (DiD = 0.093, 95%CI [0.036, 0.151]) at admission, 22.3%-points (DiD = 0.223, 95%CI [0.121, 0.325]) before-birth, and 15.2%-points (DiD = 0.152, 95%CI [0.072, 0.231]) after-birth. Conversely, the ADHERE intervention did not significantly change SCC adherence at discharge (DiD = -0.025, 95%CI [-0.071, 0.021]). The lack of significant improvement may be due to providers less attention to discharge evaluation because of work overload.

Conclusion

The ADHERE intervention significantly improved adherence to partograph and SCC at admission, before-birth, and immediately after-birth during intrapartum care. However, it did not significantly improve adherence to the discharge checklist. Therefore, ADHERE-assisted implementation of QI tools can potentially prevent adverse birth outcomes related to low-quality intrapartum care and could be considered for scale up across health facilities in Ethiopia.