Factors associated with partograph utilization in labor monitoring by skilled birth attendants in Rubanda District, Uganda: a cross-sectional study

Abstract Background The partograph is a crucial tool for monitoring labor and reducing maternal and neonatal mortality, yet its utilization remains suboptimal in many low-resource settings. In Uganda, particularly in rural areas like Rubanda District, high maternal mortality rates are linked to complications during childbirth that effective labor monitoring could prevent. This study aimed to assess the factors associated with partograph utilization among skilled birth attendants (SBAs) in Rubanda District, Uganda. Methods A cross-sectional study was conducted in six health facilities involving 205 skilled birth attendants (SBAs) selected using a multi-stage sampling approach (purposive for medical officers and systematic random sampling for others. The questionnaire assessed socio-demographic characteristics, knowledge, training, attitudes, and organizational factors. A descriptive review of 36 partographs was also conducted to provide context on documentation quality. Quantitative data were analyzed using SPSS Version 20. Bivariate analysis using the Chi-square test and multivariate logistic regression were performed to identify factors independently associated with consistent partograph use. Results Awareness of the partograph was high (92.2%), with 81.4% of SBAs reporting having used it. However, only 64.1% reported consistent (always) use in routine labor monitoring. Key challenges included a lack of recent refresher training (85.4% had not been trained in the last year), difficulty with interpretation (38.7%), and inaccurate completion (42.3%). A descriptive review of 36 partographs (non-generalizable due to small, non-random sample) revealed a moderate overall utilization quality score of 6.1 out of 9, with weaknesses in correctness (mean score 2.1/3), accuracy (2.0/3), and completeness (2.0/3). In the multivariate logistic regression analysis, four factors were found to be independent predictors of consistent partograph use: high knowledge on partograph filling (SBAs with high knowledge were 3.5 times more likely to use it consistently compared to those with low knowledge; AOR: 3.5, 95% CI: 1.50–8.12), consistent availability of partographs (AOR: 2.7, 95% CI: 1.18–6.15), having received training (AOR: 2.3, 95% CI: 1.09–4.85), and the presence of clear labor management guidelines (AOR: 2.1, 95% CI: 1.06–4.16). Conclusion Despite high awareness, consistent and correct partograph utilization in Rubanda District is primarily hindered by gaps in knowledge and skills, inconsistent availability of the tool, and the absence of clear, enforced institutional guidelines. Interventions should move beyond simple awareness campaigns to focus on strengthening health systems through regular, practical training, ensuring a reliable supply of partographs, and enforcing policies that institutionalize their use in routine practice.