Journal of Health & Medical Informatics

From Guidelines to Practice: Assessing the Implementation Fidelity of Partograph Use for Monitoring Labour in Primary Healthcare Settings in India Using a Tablet-Based Mobile Application

Abstract

Arvind Vashishta Rinkoo, Anand Kumar Panjiyar, Dinesh Songara, Arnika Sharma, Priyanka Singh, Meenakshi Pareek, Satyaban Sahu, Rajesh Ranjan Singh and Rakesh Kumar Srivastava

This prospective study uses a tablet-based mobile application (digital partograph named DAKSH) to assess the implementation fidelity of partograph use for monitoring labour in primary healthcare settings in Rajasthan, India. As DAKSH does not allow filling of data retrospectively, only real-time information can be used for generating the partograph using this application. Two algorithms were developed to feed each of the data points for seven fetal and maternal parameters into the research instrument. In this study, percentage of data points captured in real-time for fetal heart rate, status of membranes and colour of amniotic fluid, uterine contractions (frequency and duration), maternal pulse, cervical dilatation, maternal blood pressure, and maternal temperature were 29.63%, 35.32%, 29.36%, 29.45%, 55.06%, 42.51%, and 42.71%, respectively. Notably, implementation fidelity was lowest for capturing real-time information pertaining to uterine contractions (frequency and duration), maternal pulse, and FHR. KEYAR, a secondgeneration e-partograph developed by JANITRI Innovations Private Limited, may significantly contribute towards increasing implementation fidelity in terms of continuous real-time intrapartum monitoring of these three parameters.