Quality of Intrapartum Care in Public Health Centers of Addis Ababa City, Ethiopia: A Mixed-Methods Study

Quality of Intrapartum Care in Public Health Centers of Addis Ababa City, Ethiopia: A Mixed-Methods Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Quality of Intrapartum Care in Public Health Centers of Addis Ababa City, Ethiopia: A Mixed-Methods Study Amaha HaILE ABEBE, Rose Mmusi-Phetoe This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8616911/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To assess the quality of intrapartum care in public health centres in Addis Ababa, Ethiopia. Methods An explanatory sequential mixed-methods study was conducted in 50 public health centers between January and April 2021. Quantitative data were collected through interviews with 500 postpartum women and a review of delivery charts using 34 indicators derived from World Health Organization (WHO) standards. Qualitative data were obtained through in-depth interviews with 20 midwives and 13 health center managers. Quantitative data were analyzed descriptively, while qualitative data were analyzed thematically. Results Overall, 53.6% of women received quality intrapartum care. Proper documentation of obstetric history and examination at admission was observed in 55.8% and 64.0% of cases, respectively. Evidence-based labor monitoring and management were documented in 51.8% of cases, while only 33.4% of newborns received essential newborn care. Qualitative findings identified high workload, weak supervision, and limited accountability as key barriers to guideline adherence. Conclusion The quality of intrapartum care in public health centers in Addis Ababa remains suboptimal. Strengthening adherence to evidence-based guidelines through updated protocols, targeted training, supportive supervision, and accountability mechanisms is essential to improve maternal and newborn outcomes Maternal & Fetal Medicine Intrapartum care quality of care partograph essential newborn care WHO standards Figures Figure 1 Figure 2 Figure 3 Introduction The quality of intrapartum care in public health centers in Addis Ababa remains suboptimal. Strengthening adherence to evidence-based guidelines through updated protocols, targeted training, supportive supervision, and accountability mechanisms is essential to improve maternal and newborn outcomes [ 1 ]. Achieving the Sustainable Development Goal (SDG) target of reducing the global maternal mortality ratio to fewer than 70 per 100,000 live births by 2030 requires not only increased coverage of services but also improvements in the quality of obstetric and newborn care [ 2 ]. In response, the World Health Organization (WHO) articulated a vision in which “every pregnant woman and newborn receives high-quality care throughout pregnancy, childbirth, and the postnatal period.” [ 2 ]. The WHO framework for improving the quality of maternal and newborn care defines eight quality domains, including the provision of evidence-based routine and emergency intrapartum care [ 3 ]. High-quality intrapartum care includes comprehensive obstetric history and physical examination at admission, regular monitoring of labor using a partograph, and timely management of labor and delivery complications [ 4 ]. The WHO quality standard recommends that all women in the active first stage of labor be monitored using a partograph [ 3 ]. The partograph is an effective tool for monitoring labor progress, preventing prolonged and obstructed labor, and improving maternal and fetal outcomes [ 5 ]. However, studies from low-resource settings have documented suboptimal use of partographs due to factors such as high workload, inadequate skills, shortages of supplies, and weak accountability mechanisms [ 6 , 7 , 8 , 9 ]. Essential newborn care, provided immediately after birth, is critical for newborn survival and adaptation to extra-uterine life. Nevertheless, evidence from developing countries indicates that many newborns do not receive the full package of essential newborn care [ 10 ]. This article presents findings on the quality of intrapartum care, drawn from a larger mixed-methods study that assessed the quality of obstetric and newborn care in public health centers in Addis Ababa using the WHO quality framework [ 11 ]. Research methods Study design and setting An explanatory sequential mixed-methods design was employed. The study was conducted between January and April 2021 in 50 public health centers under the Addis Ababa City Administration, Ethiopia. During the quantitative phase, face-to-face interviews were conducted with 500 women in post-partum care, and their delivery charts were reviewed using a structured questionnaire. An in-depth interview was conducted with 33 midwives and managers using an interview guide during the qualitative phase. Study design and methods Study population The quantitative phase included women aged 15–49 years who had delivered in the selected health centres and were attending immediate postpartum or postnatal care services. Women who delivered at home or other facilities, were within six hours of delivery, beyond six weeks postpartum, severely ill, or had critically ill newborns were excluded. The qualitative phase involved midwives who were heads or deputy heads of maternity units and health centre managers with at least six months of service at the facility. Sample size and sampling technique A total of 500 postpartum women were included in the quantitative phase, with an equal allocation of ten women per health centre selected using systematic random sampling. The qualitative sample comprised 20 midwives and 13 managers selected purposively. Detailed sampling procedures have been published elsewhere [ 11 ]. Data collection instruments and Operational definition Quantitative data were collected using a structured questionnaire and a delivery chart review checklist adapted from WHO quality standards and previous studies. Qualitative data were collected using a semi-structured interview guide. Quality of intrapartum care was assessed using 34 indicators covering obstetric history, physical examination, labor monitoring and management, essential laboratory tests, and essential newborn care. A score of ≥ 75% was considered indicative of quality intrapartum care. Data collection Trained midwives conducted face-to-face interviews and reviewed delivery charts. In-depth interviews were conducted by the principal investigator, audio-recorded with participants’ consent, and supplemented by field notes. Data analysis Quantitative data were entered into EpiData and analyzed using SPSS version 20. Descriptive statistics were used to summarize participant characteristics and quality-of-care indicators. Qualitative data were transcribed verbatim and analyzed using Colaizzi’s seven-step phenomenological method to identify key themes and sub-themes. Ethical considerations Ethical approval was obtained from the University of South Africa and the Addis Ababa City Administration Health Bureau. Written informed consent was obtained from all participants, and confidentiality was maintained throughout the study. Limitations of the study The study was conducted in 2022 and uses the WHO obstetric and newborn care quality standard [ 3 ] and the obstetric and newborn care guidline [ 4 ] published in 2016 and 2015, respectively. Therefore, the recent WHO recommendations for obstetric and newborn care services [ 12 ] were not considered in the study tools and quality standards. Results Participant Characteristics Most women (72%) were aged 20–29 years, and 89% were married or living with a partner. Nearly all participants (96%) had some level of formal education, and 71% were unemployed. The majority (92.4%) resided within Addis Ababa city limits (Table-1). The qualitative sample included 27 female and 6 male participants, with most having more than five years of professional experience. Table-1: Percentage distribution of women in the postpartum period by Socio-demographic Characteristics (N=500) Socio Demographic Variables Frequency Percent Age 15-19 years 20-24 years 25-29 years 30-34 years >/=35 Year 21 164 193 77 45 4.2 32.8 38.6 15.4 9.0 Marital Status Never married Married/living together Divorced/separated/Widowed 47 447 6 9.4 89.4 1.2 Educational Status No Formal education Primary (grade 1-8) Secondary (grade 9-12) College education and above 44 238 138 80 8.8 47.6 27.6 16.0 Employment status Employed in Govt, NGO or Private organization Self Employed Not Employed 68 76 356 13.6 15.2 71.2 Family Monthly Income based on tax category ≤1650 birr (≤33.00 USD) 1651-3200 birr (33.01-64.00 USD) 3201-5250 birr (64.01-105.00 USD) ≥5251 birr (≥105.01 USD) Not Reported/disclosed 73 192 117 91 27 14.6 38.4 23.4 18.2 5.4 Place of residence Within Addis Ababa City Outside of Addis Ababa city 462 38 92.4 7.6 Quality of Intrapartum Care Overall, only 53.6% of women received quality intrapartum care according to WHO standards. Obstetric History and Examination at Admission Essential obstetric history was adequately documented in 55.8% of delivery charts. While the time of admission and delivery were frequently recorded, documentation of gestational age, onset of labor, and rupture of membranes was often incomplete (Table-2). Proper physical examination at admission was documented in 64.0% of cases, with particularly low documentation of Leopold’s maneuvers (Table-3). Table-2: Percentage distribution of women's delivery charts with proper obstetric history at admission for labor and delivery at health centers in Addis Ababa city (N=500) Recording of Labor history Frequency Percent ANC follow-up information documented No Yes 22 478 4.4 95.6 Gestational Age was documented No Yes 168 332 33.6 66.4 Time of admission was documented No Yes 72 428 14.4 85.6 Time of onset of labor was documented No Yes 202 298 40.4 59.6 The time of rupture of the membrane was documented No Yes 317 183 63.4 36.6 The time of delivery was documented No Yes 13 487 2.6 97.4 Had essential labor and obstetric history properly documented (met at least five (≥75%) of the six parameters assessed) No Yes 221 279 44.2 55.8 Table-3: Percentage distribution of women's delivery charts that had proper recording of examination at admission for delivery at health centers in Addis Ababa (N=500) Examination at admission Frequency Percent Blood Pressure was taken at admission and documented on the delivery record No Yes 84 416 16.8 17 83.2 Pulse rate was taken and recorded at admission No Yes 115 385 23.0 77.0 Temperature taken and recorded at admission No Yes 173 327 34.6 65.4 All three vital signs (BP, PR, and T ) were taken at admission No Yes 190 310 38.0 62.0 Leopold's examination was done and recorded at admission No Yes 317 183 63.0 37.0 Pelvic examination was done and recorded at admission record No Yes 83 417 16.6 83.4 83 Fetal Heart rate was measured and recorded at admission No Yes 88 88 412 17.6 82.4 82 All three physical examinations (Leopold’s, pelvic examination, and Fetal Heart Rate) were done at admission No Yes 339 161 67.8 32.2 Had a proper examination at admission (met at least five (≥75%) of the six parameters assessed) No Yes 180 320 36.0 64.0 Follow-up and Management of Labour Although 82.4% of women had a partograph attached to their records, only 29.8% had complete documentation consistent with WHO guidelines. Monitoring of fetal heart rate, labour progress, and maternal vital signs was often incomplete. Active management of the third stage of labour was documented in most cases (Figure-1 and Table-4). Figure 1: Percentage distribution of women's delivery charts that show follow-up and management of labour accourding to the WHO guidline Table-4: Percentage distribution of women's delivery charts that had proper recording of follow-up and management of labor at health centers in Addis Ababa (N=500) Follow up of Labor Frequency Percent Labor was followed using a partograph No Yes 88 412 17.6 82.4 Follow-up of labor was done in line with the 2015 WHO guideline (eight labor parameters measured and recorded all the time) No Yes 351 149 70.2 29.8 Have a documented labor management plan at admission or during follow-up of labor No Yes 180 320 36.0 64.0 Active management of thirds stage of labor was applied and documented No Yes 88 412 17.6 82.4 Had follow-up and management of labor and delivery according to the WHO guideline (met at least 8.5 (≥75%) of the eleven parameters) No Yes 241 259 48.2 51.8 Essential laboratory tests during labour and delivery Seventy-eight percent of women had documentation of all five essential laboratory tests during pregnancy or labor (Figure 2). Figure 2: Percentage distribution of women who had a record of five essential laboratory tests during labour and delivery (N=500) Essential Newborn Care Only 33.4% of newborns received essential newborn care as defined by the study. While immediate breastfeeding, skin-to-skin contact, vitamin K administration, and eye prophylaxis were commonly documented, routine newborn examination and vital sign monitoring were rarely recorded (Figure-3). Figure 3: Percentage distribution of women whose newborns had essential newborn care (N=500) Qualitative Findings Two major themes emerged: inconsistent adherence to intrapartum care guidelines and gaps in essential newborn care. Participants cited heavy workload, negligence, weak supervision, and lack of accountability as major barriers to guideline adherence. Routine monitoring of newborn vital signs was generally limited to sick newborns. Discussion This study identified substantial gaps in the quality of intrapartum and newborn care in public health centers in Addis Ababa. Despite high utilization of partographs, adherence to evidence-based labor monitoring and documentation practices remained poor, consistent with findings from other low- and middle-income countries [ 7 , 8 , 9 , 12 ]. Incomplete monitoring of fetal heart rate, cervical dilation, uterine contractions, and labor progress may delay the identification of complications such as fetal distress and prolonged labor, thereby increasing the risk of adverse maternal and neonatal outcomes [ 3 , 4 ].Similar deficiencies have been reported in studies conducted in Bangladesh and Malawi, highlighting persistent systemic challenges in intrapartum care delivery in low-resource settings [ 7 , 8 ] Essential newborn care was particularly suboptimal, with only one-third of newborns receiving care consistent with WHO standards. Limited documentation of newborn examinations and vital signs may result in missed opportunities to identify congenital anomalies, hypothermia, or early signs of neonatal illness, potentially contributing to preventable neonatal morbidity and mortality [ 10 ]. Qualitative findings suggest that these gaps are driven more by systemic and organizational factors than by knowledge deficits. Addressing workload pressures, strengthening accountability mechanisms, and enhancing supportive supervision are critical for improving adherence to evidence-based intrapartum and newborn care practices. Conclusion The quality of intrapartum care in public health centers in Addis Ababa is suboptimal, with significant deficiencies in labor monitoring and essential newborn care. Updating national guidelines, strengthening provider training, introducing simplified clinical checklists, and implementing regular supportive supervision and accountability mechanisms are essential to improve adherence to evidence-based practices and maternal and newborn outcomes. Abbreviations BP Blood Pressure COVID-19 Coronavirus Disease of 2019 HIV Human Immunodeficiency virus LB Live Births MMR Maternal Mortality Ratio PR Pulse rate SDGs Sustainable Development Goals SPSS Statistical Package for the Social Sciences T Temperature UI Uncertainty Interval UNISA University of South Africa USD United States of America Dollar VDRL Venereal disease research laboratory test WHO World Health Organization Declarations Ethics approval and consent to participate The research protocol was reviewed and approved by the Research Ethics Committee of the Department of Health Studies of the University of South Africa. The research protocol was again reviewed and approved by the Ethical Review Committee of Addis Ababa City Administration Health Office. Once the research protocol had been approved by the ethical review committees, support letters were written from the Addis Ababa city administration health office and sub-city health offices to study health facilities. Consent for publication Not applicable. Our manuscript does not contain data from any individual person Competing interests The authors declare that they have no competing interests Funding University of South Africa provided financial support to undertaking of the study. Authors' contributions Amaha Haile Abebe, Corresponding author have conceptualized and designed the study protocol, coordinated, supervised, and conducted the data collection, data entry, analysis, and report write-up. Prepared the manuscript. Acknowledgments We would like to thank the University of South Africa for financing the study. We would like to thank women, midwives, and health center heads in Addis Ababa city for participating in the study. I would like to thank the research assistants who conducted the qualitative data collection, namely, Sr. Hawa Ali, Sr. Hasna Musema, Sr. Aselefech Negewo, and Sr. Abeba Gebrehiwot. References WHO (2021) World Health Statistics 2021, WHO, Geneva Tunçalp Ӧ, Were W, MacLennan C, Oladapo O, Gülmezoglu A, Bahl R (2015) Quality of care for pregnant women and newborns—the WHO vision, Bjog , p. 1045 WHO (2016) Standards for improving quality of maternal and newborn care in health facilities. WHO, Geneva UNICEF & World Bank (2015) Pregnancy, childbirth, postpartum and newborn care: a guide for essential practice. WHO, Geneva Kushwah B, Singh A, Singh S, Kushwah B, Campus S, Huzur R (2013) The partograph: an essential yet underutilized tool. J Evol Med Dent Sci, p. 4373 Bedada K, Huluka T, Bulto G (2020) Low utilization of partograph and its associated factors among obstetric care providers in governmental health facilities at West Shoa Zone, Central Ethiopia. Int J Reproductive Med Khan A, Billah S, Mannan I, Mannan I, Begum T, Khan M (2018) A cross-sectional study of partograph utilization as a decision making tool for referral of abnormal labour in primary health care facilities of Bangladesh. PLoS ONE, p. 13 Mandiwa C, Zamawe C (2017) Documentation of the partograph in assessing the progress of labour by health care providers in Malawi’s South-West zone. Reproductive Health Tilahun A, Gebeyehu D, Adinew Y, Mengstu F (2021) Utilization of partograph and its associated factors among obstetric caregivers in public health institutions of Southwest Ethiopia. BMC Pregnancy Childbirth Atiqzai F, Manalai P, Amin S, Edmond K, Naziri M, Soroush M (2019) Quality of essential newborn care and neonatal resuscitation at health facilities in Afghanistan: a cross-sectional assessment, BMJ , Abebe A, Phetoe R (2023) Quality of obstetric and newborn care in Addis Ababa City health centers: using the WHO quality framework. BMC Health Serv Res, p. 495 WHO (2021) WHO Labour Care Guide: User’s Manual, WHO, Geneva Turigye B, Ngonzi J, Kajjimu J, Kamugisha A, Mulogo E (2025) Evidence-Based Intrapartum Care: A Retrospective Descriptive Assessment of Facility-Based Births in Rural Public Health Facilities in Midwestern Uganda, Cureus , p. e89581 Additional Declarations The authors declare no competing interests. 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16:43:48","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":38717,"visible":true,"origin":"","legend":"\u003cp\u003ePercentage distribution of women who had a record of five essential laboratory tests during labour and delivery (N=500)\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8616911/v1/deda6d1984fb30a4fc17c23c.png"},{"id":100611757,"identity":"a4de127c-1ac1-434e-8735-52a1a8273215","added_by":"auto","created_at":"2026-01-19 16:43:17","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":49627,"visible":true,"origin":"","legend":"\u003cp\u003ePercentage distribution of women whose newborns had essential newborn care (N=500)\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8616911/v1/244a2af5feebd6fe8bae2cda.png"},{"id":100614308,"identity":"ff3f767d-c65d-4eb6-ae8e-5d91fb05c3bb","added_by":"auto","created_at":"2026-01-19 17:18:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":774513,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8616911/v1/2892e235-72b3-4726-a85a-f528b1ad635e.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eQuality of Intrapartum Care in Public Health Centers of Addis Ababa City, Ethiopia: A Mixed-Methods Study\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe quality of intrapartum care in public health centers in Addis Ababa remains suboptimal. Strengthening adherence to evidence-based guidelines through updated protocols, targeted training, supportive supervision, and accountability mechanisms is essential to improve maternal and newborn outcomes [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAchieving the Sustainable Development Goal (SDG) target of reducing the global maternal mortality ratio to fewer than 70 per 100,000 live births by 2030 requires not only increased coverage of services but also improvements in the quality of obstetric and newborn care [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In response, the World Health Organization (WHO) articulated a vision in which \u0026ldquo;every pregnant woman and newborn receives high-quality care throughout pregnancy, childbirth, and the postnatal period.\u0026rdquo; [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe WHO framework for improving the quality of maternal and newborn care defines eight quality domains, including the provision of evidence-based routine and emergency intrapartum care [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. High-quality intrapartum care includes comprehensive obstetric history and physical examination at admission, regular monitoring of labor using a partograph, and timely management of labor and delivery complications [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe WHO quality standard recommends that all women in the active first stage of labor be monitored using a partograph [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The partograph is an effective tool for monitoring labor progress, preventing prolonged and obstructed labor, and improving maternal and fetal outcomes [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, studies from low-resource settings have documented suboptimal use of partographs due to factors such as high workload, inadequate skills, shortages of supplies, and weak accountability mechanisms [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEssential newborn care, provided immediately after birth, is critical for newborn survival and adaptation to extra-uterine life. Nevertheless, evidence from developing countries indicates that many newborns do not receive the full package of essential newborn care [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis article presents findings on the quality of intrapartum care, drawn from a larger mixed-methods study that assessed the quality of obstetric and newborn care in public health centers in Addis Ababa using the WHO quality framework [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e"},{"header":"Research methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and setting\u003c/h2\u003e \u003cp\u003eAn explanatory sequential mixed-methods design was employed. The study was conducted between January and April 2021 in 50 public health centers under the Addis Ababa City Administration, Ethiopia. During the quantitative phase, face-to-face interviews were conducted with 500 women in post-partum care, and their delivery charts were reviewed using a structured questionnaire. An in-depth interview was conducted with 33 midwives and managers using an interview guide during the qualitative phase.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy design and methods\u003c/h3\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eThe quantitative phase included women aged 15\u0026ndash;49 years who had delivered in the selected health centres and were attending immediate postpartum or postnatal care services. Women who delivered at home or other facilities, were within six hours of delivery, beyond six weeks postpartum, severely ill, or had critically ill newborns were excluded.\u003c/p\u003e \u003cp\u003eThe qualitative phase involved midwives who were heads or deputy heads of maternity units and health centre managers with at least six months of service at the facility.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSample size and sampling technique\u003c/h3\u003e\n\u003cp\u003eA total of 500 postpartum women were included in the quantitative phase, with an equal allocation of ten women per health centre selected using systematic random sampling. The qualitative sample comprised 20 midwives and 13 managers selected purposively. Detailed sampling procedures have been published elsewhere [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eData collection instruments and Operational definition\u003c/h3\u003e\n\u003cp\u003e Quantitative data were collected using a structured questionnaire and a delivery chart review checklist adapted from WHO quality standards and previous studies. Qualitative data were collected using a semi-structured interview guide.\u003c/p\u003e \u003cp\u003eQuality of intrapartum care was assessed using 34 indicators covering obstetric history, physical examination, labor monitoring and management, essential laboratory tests, and essential newborn care. A score of \u0026ge;\u0026thinsp;75% was considered indicative of quality intrapartum care.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eTrained midwives conducted face-to-face interviews and reviewed delivery charts. In-depth interviews were conducted by the principal investigator, audio-recorded with participants\u0026rsquo; consent, and supplemented by field notes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eQuantitative data were entered into EpiData and analyzed using SPSS version 20. Descriptive statistics were used to summarize participant characteristics and quality-of-care indicators. Qualitative data were transcribed verbatim and analyzed using Colaizzi\u0026rsquo;s seven-step phenomenological method to identify key themes and sub-themes.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthical considerations\u003c/h3\u003e\n\u003cp\u003e Ethical approval was obtained from the University of South Africa and the Addis Ababa City Administration Health Bureau. Written informed consent was obtained from all participants, and confidentiality was maintained throughout the study.\u003c/p\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eLimitations of the study\u003c/h2\u003e \u003cp\u003eThe study was conducted in 2022 and uses the WHO obstetric and newborn care quality standard [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] and the obstetric and newborn care guidline [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] published in 2016 and 2015, respectively. Therefore, the recent WHO recommendations for obstetric and newborn care services [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] were not considered in the study tools and quality standards.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eParticipant Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMost women (72%) were aged 20\u0026ndash;29 years, and 89% were married or living with a partner. Nearly all participants (96%) had some level of formal education, and 71% were unemployed. The majority (92.4%) resided within Addis Ababa city limits (Table-1). The qualitative sample included 27 female and 6 male participants, with most having more than five years of professional experience.\u003c/p\u003e\n\u003cp\u003eTable-1: Percentage distribution of women in the postpartum period by Socio-demographic Characteristics (N=500)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 336px;\"\u003eSocio Demographic Variables\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003eFrequency\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003ePercent\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 336px;\"\u003eAge\u003cbr\u003e15-19 years\u003cbr\u003e20-24 years\u003cbr\u003e25-29 years\u003cbr\u003e30-34 years\u003cbr\u003e\u0026gt;/=35 Year\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e21\u003cbr\u003e164\u003cbr\u003e193\u003cbr\u003e77\u003cbr\u003e45\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e4.2\u003cbr\u003e32.8\u003cbr\u003e38.6\u003cbr\u003e15.4\u003cbr\u003e9.0\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 336px;\"\u003eMarital Status\u003cbr\u003eNever married\u003cbr\u003eMarried/living together\u003cbr\u003eDivorced/separated/Widowed\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e47\u003cbr\u003e447\u003cbr\u003e6\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e9.4\u003cbr\u003e89.4\u003cbr\u003e1.2\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 336px;\"\u003eEducational Status\u003cbr\u003eNo Formal education\u003cbr\u003ePrimary (grade 1-8)\u003cbr\u003eSecondary (grade 9-12)\u003cbr\u003eCollege education and above\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e44\u003cbr\u003e238\u003cbr\u003e138\u003cbr\u003e80\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e8.8\u003cbr\u003e47.6\u003cbr\u003e27.6\u003cbr\u003e16.0\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 336px;\"\u003eEmployment status\u003cbr\u003eEmployed in Govt, NGO or Private organization\u003cbr\u003eSelf Employed\u003cbr\u003eNot Employed\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e68\u003cbr\u003e76\u003cbr\u003e356\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e13.6\u003cbr\u003e15.2\u003cbr\u003e71.2\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 336px;\"\u003eFamily Monthly Income based on tax category\u003cbr\u003e\u0026le;1650 birr \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; (\u0026le;33.00 USD)\u003cbr\u003e1651-3200 birr \u0026nbsp; \u0026nbsp; \u0026nbsp;(33.01-64.00 USD)\u003cbr\u003e3201-5250 birr \u0026nbsp; \u0026nbsp; \u0026nbsp;(64.01-105.00 USD) \u0026nbsp;\u003cbr\u003e\u0026ge;5251 birr \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;(\u0026ge;105.01 USD)\u003cbr\u003eNot Reported/disclosed\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e73\u003cbr\u003e192\u003cbr\u003e117\u003cbr\u003e91\u003cbr\u003e27\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e14.6\u003cbr\u003e38.4\u003cbr\u003e23.4\u003cbr\u003e18.2\u003cbr\u003e5.4\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 336px;\"\u003ePlace of residence\u0026nbsp;\u003cbr\u003eWithin Addis Ababa City\u0026nbsp;\u003cbr\u003eOutside of Addis Ababa city\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e462\u003cbr\u003e38\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e92.4\u003cbr\u003e7.6\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eQuality of Intrapartum Care\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOverall, only 53.6% of women received quality intrapartum care according to WHO standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eObstetric History and Examination at Admission\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEssential obstetric history was adequately documented in 55.8% of delivery charts. While the time of admission and delivery were frequently recorded, documentation of gestational age, onset of labor, and rupture of membranes was often incomplete (Table-2). Proper physical examination at admission was documented in 64.0% of cases, with particularly low documentation of Leopold\u0026rsquo;s maneuvers (Table-3).\u003c/p\u003e\n\u003cp\u003eTable-2: Percentage distribution of women\u0026apos;s delivery charts with proper obstetric history at admission for labor and delivery at health centers in Addis Ababa \u0026nbsp;city (N=500)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003eRecording of Labor history \u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003eFrequency\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003ePercent\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003eANC follow-up information documented \u0026nbsp;\u0026nbsp;\u003cbr\u003eNo\u003cbr\u003eYes\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e22\u003cbr\u003e478\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;4.4\u003cbr\u003e95.6\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003eGestational Age was documented \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cbr\u003eNo\u003cbr\u003eYes\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e168\u003cbr\u003e332\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e33.6\u003cbr\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;66.4\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003eTime of admission was documented\u0026nbsp;\u003cbr\u003eNo\u003cbr\u003eYes\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e72\u003cbr\u003e428\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e14.4\u003cbr\u003e85.6\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003eTime of onset of labor was documented\u0026nbsp;\u003cbr\u003eNo \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cbr\u003eYes\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e202\u003cbr\u003e298\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e40.4\u003cbr\u003e59.6\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003eThe time of rupture of the membrane \u0026nbsp;was documented \u0026nbsp;\u003cbr\u003eNo \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cbr\u003eYes\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e317\u003cbr\u003e183\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e63.4\u003cbr\u003e36.6\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003eThe time of delivery was documented\u0026nbsp;\u003cbr\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;No\u003cbr\u003eYes\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 13\u003cbr\u003e487\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e2.6\u003cbr\u003e97.4\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003eHad essential labor and obstetric \u0026nbsp;history properly documented (met at least five (\u0026ge;75%) of the six parameters assessed)\u003cbr\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; No\u003cbr\u003eYes\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e221\u003cbr\u003e279\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e44.2\u003cbr\u003e55.8\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;Table-3: Percentage distribution of women\u0026apos;s delivery charts that had proper recording of \u0026nbsp;examination at admission for delivery at health centers in Addis Ababa \u0026nbsp;(N=500)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 420px;\"\u003eExamination at admission \u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 108px;\"\u003eFrequency\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 96px;\"\u003ePercent\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 420px;\"\u003eBlood Pressure was taken at admission and documented on the delivery record \u0026nbsp;\u003cbr\u003eNo\u003cbr\u003eYes\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e84\u003cbr\u003e416\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e16.8 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;17\u003cbr\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 83.2\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 420px;\"\u003ePulse rate was taken and recorded at admission \u0026nbsp;\u003cbr\u003eNo\u003cbr\u003eYes\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\u0026nbsp;\u003cbr\u003e115\u003cbr\u003e385\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\u0026nbsp;\u003cbr\u003e23.0 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;77.0\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 420px;\"\u003eTemperature taken and recorded at admission \u0026nbsp;\u003cbr\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;No\u003cbr\u003eYes\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\u0026nbsp;\u003cbr\u003e173\u003cbr\u003e327\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\u0026nbsp;\u003cbr\u003e34.6\u003cbr\u003e65.4\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 420px;\"\u003eAll three vital signs \u0026nbsp;(BP, PR, and T ) were taken at admission\u0026nbsp;\u003cbr\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; No \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cbr\u003eYes\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\u0026nbsp;\u003cbr\u003e190\u003cbr\u003e310\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\u0026nbsp;\u003cbr\u003e38.0\u003cbr\u003e62.0\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 420px;\"\u003eLeopold\u0026apos;s examination was done and recorded at admission \u0026nbsp;\u003cbr\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;No\u003cbr\u003eYes\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\u0026nbsp;\u003cbr\u003e317\u003cbr\u003e183\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\u0026nbsp;\u003cbr\u003e63.0\u003cbr\u003e37.0\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 420px;\"\u003ePelvic examination was done and recorded at admission record \u0026nbsp;\u003cbr\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;No\u003cbr\u003eYes\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003cbr\u003e83\u003cbr\u003e417\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e16.6\u003cbr\u003e83.4 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;83\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 420px;\"\u003eFetal Heart rate was measured and recorded at admission\u0026nbsp;\u003cbr\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;No\u003cbr\u003eYes\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 88 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;88\u003cbr\u003e412\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\u0026nbsp;\u003cbr\u003e17.6\u003cbr\u003e\u0026nbsp;82.4 \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;82\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 420px;\"\u003eAll three physical examinations (Leopold\u0026rsquo;s, pelvic examination, and Fetal Heart Rate) were done at admission\u0026nbsp;\u003cbr\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; No\u003cbr\u003eYes\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e339\u003cbr\u003e161\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e67.8\u003cbr\u003e32.2\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 420px;\"\u003eHad a proper examination at admission (met at least five (\u0026ge;75%) of the six parameters assessed)\u003cbr\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; No\u003cbr\u003eYes\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 108px;\"\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;180\u003cbr\u003e320\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e36.0\u003cbr\u003e64.0\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFollow-up and Management of Labour\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAlthough 82.4% of women had a partograph attached to their records, only 29.8% had complete documentation consistent with WHO guidelines. Monitoring of fetal heart rate, labour progress, and maternal vital signs was often incomplete. Active management of the third stage of labour was documented in most cases (Figure-1 and Table-4).\u003c/p\u003e\n\u003cp\u003eFigure 1: Percentage distribution of women\u0026apos;s delivery charts that show follow-up and management of labour accourding to the WHO guidline\u003c/p\u003e\n\u003cp\u003eTable-4: Percentage distribution of women\u0026apos;s delivery charts that had proper recording of follow-up and management of labor at health centers in Addis Ababa \u0026nbsp;(N=500)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003eFollow up of Labor\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003eFrequency\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003ePercent\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003eLabor was followed using a partograph\u0026nbsp;\u003cbr\u003eNo\u003cbr\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Yes\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e88\u003cbr\u003e412\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;17.6\u003cbr\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 82.4\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003eFollow-up of labor was done in line with the 2015 WHO guideline (eight labor \u0026nbsp;parameters measured and recorded all the time) \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003cbr\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;No\u003cbr\u003eYes \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e351\u003cbr\u003e149\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e70.2\u003cbr\u003e29.8\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003eHave a documented labor management plan at admission or during follow-up of labor\u003cbr\u003eNo\u003cbr\u003eYes\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e180\u003cbr\u003e320\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e36.0\u003cbr\u003e64.0\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003eActive management of thirds stage of labor was applied and documented\u0026nbsp;\u003cbr\u003eNo\u003cbr\u003eYes\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e88\u003cbr\u003e412\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e17.6\u003cbr\u003e82.4\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 312px;\"\u003eHad follow-up and management of labor and delivery according to the WHO guideline (met at least 8.5 \u0026nbsp;(\u0026ge;75%) of the eleven parameters) \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003cbr\u003eNo\u003cbr\u003eYes \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e241\u003cbr\u003e259\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003cbr\u003e48.2\u003cbr\u003e51.8\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eEssential laboratory tests during labour and delivery\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSeventy-eight percent of women had documentation of all five essential laboratory tests during pregnancy or labor (Figure 2).\u003c/p\u003e\n\u003cp\u003e\u003cspan id=\"_Toc103784162\"\u003eFigure 2: Percentage distribution of women who had a record of five essential laboratory tests during labour and delivery (N=500)\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEssential Newborn Care\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOnly 33.4% of newborns received essential newborn care as defined by the study. While immediate breastfeeding, skin-to-skin contact, vitamin K administration, and eye prophylaxis were commonly documented, routine newborn examination and vital sign monitoring were rarely recorded (Figure-3).\u003c/p\u003e\n\u003cp id=\"_Toc103784163\"\u003eFigure 3: Percentage distribution of women whose newborns had essential newborn care (N=500)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQualitative Findings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTwo major themes emerged: inconsistent adherence to intrapartum care guidelines and gaps in essential newborn care. Participants cited heavy workload, negligence, weak supervision, and lack of accountability as major barriers to guideline adherence. Routine monitoring of newborn vital signs was generally limited to sick newborns.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e This study identified substantial gaps in the quality of intrapartum and newborn care in public health centers in Addis Ababa. Despite high utilization of partographs, adherence to evidence-based labor monitoring and documentation practices remained poor, consistent with findings from other low- and middle-income countries [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIncomplete monitoring of fetal heart rate, cervical dilation, uterine contractions, and labor progress may delay the identification of complications such as fetal distress and prolonged labor, thereby increasing the risk of adverse maternal and neonatal outcomes [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].Similar deficiencies have been reported in studies conducted in Bangladesh and Malawi, highlighting persistent systemic challenges in intrapartum care delivery in low-resource settings [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eEssential newborn care was particularly suboptimal, with only one-third of newborns receiving care consistent with WHO standards. Limited documentation of newborn examinations and vital signs may result in missed opportunities to identify congenital anomalies, hypothermia, or early signs of neonatal illness, potentially contributing to preventable neonatal morbidity and mortality [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eQualitative findings suggest that these gaps are driven more by systemic and organizational factors than by knowledge deficits. Addressing workload pressures, strengthening accountability mechanisms, and enhancing supportive supervision are critical for improving adherence to evidence-based intrapartum and newborn care practices.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe quality of intrapartum care in public health centers in Addis Ababa is suboptimal, with significant deficiencies in labor monitoring and essential newborn care. Updating national guidelines, strengthening provider training, introducing simplified clinical checklists, and implementing regular supportive supervision and accountability mechanisms are essential to improve adherence to evidence-based practices and maternal and newborn outcomes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBP Blood Pressure\u003c/p\u003e \u003cp\u003eCOVID-19 Coronavirus Disease of 2019\u003c/p\u003e \u003cp\u003eHIV Human Immunodeficiency virus\u003c/p\u003e \u003cp\u003eLB Live Births\u003c/p\u003e \u003cp\u003eMMR Maternal Mortality Ratio\u003c/p\u003e \u003cp\u003ePR Pulse rate\u003c/p\u003e \u003cp\u003eSDGs Sustainable Development Goals\u003c/p\u003e \u003cp\u003eSPSS Statistical Package for the Social Sciences\u003c/p\u003e \u003cp\u003eT Temperature\u003c/p\u003e \u003cp\u003eUI Uncertainty Interval\u003c/p\u003e \u003cp\u003eUNISA University of South Africa\u003c/p\u003e \u003cp\u003eUSD United States of America Dollar\u003c/p\u003e \u003cp\u003eVDRL Venereal disease research laboratory test\u003c/p\u003e \u003cp\u003eWHO World Health Organization\u003c/p\u003e "},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003e The research protocol was reviewed and approved by the Research Ethics Committee of the Department of Health Studies of the University of South Africa. The research protocol was again reviewed and approved by the Ethical Review Committee of Addis Ababa City Administration Health Office. Once the research protocol had been approved by the ethical review committees, support letters were written from the Addis Ababa city administration health office and sub-city health offices to study health facilities.\u003c/p\u003e \u003ch2\u003eConsent for publication\u003c/h2\u003e \u003cp\u003eNot applicable. Our manuscript does not contain data from any individual person\u003c/p\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e \u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eUniversity of South Africa provided financial support to undertaking of the study.\u003c/p\u003e\u003ch2\u003eAuthors' contributions\u003c/h2\u003e \u003cp\u003eAmaha Haile Abebe, Corresponding author have conceptualized and designed the study protocol, coordinated, supervised, and conducted the data collection, data entry, analysis, and report write-up. Prepared the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgments\u003c/h2\u003e \u003cp\u003eWe would like to thank the University of South Africa for financing the study. We would like to thank women, midwives, and health center heads in Addis Ababa city for participating in the study. I would like to thank the research assistants who conducted the qualitative data collection, namely, Sr. Hawa Ali, Sr. Hasna Musema, Sr. Aselefech Negewo, and Sr. Abeba Gebrehiwot.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWHO (2021) World Health Statistics 2021, WHO, Geneva\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTun\u0026ccedil;alp Ӧ, Were W, MacLennan C, Oladapo O, G\u0026uuml;lmezoglu A, Bahl R (2015) Quality of care for pregnant women and newborns\u0026mdash;the WHO vision, \u003cem\u003eBjog\u003c/em\u003e, p. 1045\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO (2016) Standards for improving quality of maternal and newborn care in health facilities. WHO, Geneva\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUNICEF \u0026amp; World Bank (2015) Pregnancy, childbirth, postpartum and newborn care: a guide for essential practice. WHO, Geneva\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKushwah B, Singh A, Singh S, Kushwah B, Campus S, Huzur R (2013) The partograph: an essential yet underutilized tool. J Evol Med Dent Sci, p. 4373\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBedada K, Huluka T, Bulto G (2020) Low utilization of partograph and its associated factors among obstetric care providers in governmental health facilities at West Shoa Zone, Central Ethiopia. Int J Reproductive Med\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhan A, Billah S, Mannan I, Mannan I, Begum T, Khan M (2018) A cross-sectional study of partograph utilization as a decision making tool for referral of abnormal labour in primary health care facilities of Bangladesh. PLoS ONE, p. 13\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMandiwa C, Zamawe C (2017) Documentation of the partograph in assessing the progress of labour by health care providers in Malawi\u0026rsquo;s South-West zone. Reproductive Health\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTilahun A, Gebeyehu D, Adinew Y, Mengstu F (2021) Utilization of partograph and its associated factors among obstetric caregivers in public health institutions of Southwest Ethiopia. BMC Pregnancy Childbirth\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAtiqzai F, Manalai P, Amin S, Edmond K, Naziri M, Soroush M (2019) Quality of essential newborn care and neonatal resuscitation at health facilities in Afghanistan: a cross-sectional assessment, \u003cem\u003eBMJ\u003c/em\u003e,\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbebe A, Phetoe R (2023) Quality of obstetric and newborn care in Addis Ababa City health centers: using the WHO quality framework. BMC Health Serv Res, p. 495\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO (2021) WHO Labour Care Guide: User\u0026rsquo;s Manual, WHO, Geneva\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTurigye B, Ngonzi J, Kajjimu J, Kamugisha A, Mulogo E (2025) Evidence-Based Intrapartum Care: A Retrospective Descriptive Assessment of Facility-Based Births in Rural Public Health Facilities in Midwestern Uganda, \u003cem\u003eCureus\u003c/em\u003e, p. e89581\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"University of South Africa","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Intrapartum care, quality of care, partograph, essential newborn care, WHO standards","lastPublishedDoi":"10.21203/rs.3.rs-8616911/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8616911/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo assess the quality of intrapartum care in public health centres in Addis Ababa, Ethiopia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eAn explanatory sequential mixed-methods study was conducted in 50 public health centers between January and April 2021. Quantitative data were collected through interviews with 500 postpartum women and a review of delivery charts using 34 indicators derived from World Health Organization (WHO) standards. Qualitative data were obtained through in-depth interviews with 20 midwives and 13 health center managers. Quantitative data were analyzed descriptively, while qualitative data were analyzed thematically.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOverall, 53.6% of women received quality intrapartum care. Proper documentation of obstetric history and examination at admission was observed in 55.8% and 64.0% of cases, respectively. Evidence-based labor monitoring and management were documented in 51.8% of cases, while only 33.4% of newborns received essential newborn care. Qualitative findings identified high workload, weak supervision, and limited accountability as key barriers to guideline adherence.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe quality of intrapartum care in public health centers in Addis Ababa remains suboptimal. Strengthening adherence to evidence-based guidelines through updated protocols, targeted training, supportive supervision, and accountability mechanisms is essential to improve maternal and newborn outcomes\u003c/p\u003e","manuscriptTitle":"Quality of Intrapartum Care in Public Health Centers of Addis Ababa City, Ethiopia: A Mixed-Methods Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-19 15:39:42","doi":"10.21203/rs.3.rs-8616911/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cfa892c1-3c56-40ce-a69a-f066f55799e0","owner":[],"postedDate":"January 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":61256156,"name":"Maternal \u0026 Fetal Medicine"}],"tags":[],"updatedAt":"2026-01-19T15:39:42+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-19 15:39:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8616911","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8616911","identity":"rs-8616911","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}