• Awring Maroof Raof Department of Community Medicine, College of Medicine, Hawler Medical University, Erbil, Kurdistan Region, Iraq.
  • Tariq Salman AL-Hadithi Department of Community Medicine, College of Medicine, Hawler Medical University, Erbil, Kurdistan Region, Iraq.
  • Namir Gh. Al-Tawil Department of Community Medicine, College of Medicine, Hawler Medical University, Erbil, Kurdistan Region, Iraq.



Auditing, Partograph, Substandard practices



Criterion based audits of medical care and services have developed over the last 15 years. Criterion based audit is a well- known approach or tool for improving the quality of care in maternal units.


The aim of this study was to assess the quality of care provided for normal deliveries in Erbil city, Iraq.


The study extended from 1st of April to the 30th of June 2009. A total of 1299 normal and 120 complicated birth records from the Maternity Teaching Hospital and Mala-Afandy Health Center were reviewed. The WHO questionnaire on Safe Motherhood Needs Assessment was adapted for this study. An initial assessment of the current practice was made by collecting information on five monitoring procedures or criteria (vaginal examin ation, fetal heart monitoring, blood pressure monitoring, birth weight measurement, and assessment of the condition of the newborn) then it was compared to the standard (norm).


Vaginal examination, fetal heart monitoring, blood pressure measurement and birth weight were recorded in 92.8%, 98.8%, 97.1% and 96.7% of total records, respectively. Substandard practices for vaginal examination, fetal heart monitoring, and blood pressure measurement were 69.6%, 45.4%, and 68.7% respectively. Partograph forms were available in labour rooms, but they were not in use. Assessment of the condition of newborn was not recorded.


The overall quality of care was poor with no use of partography. There is a need for development of clinical guidelines and protocols.


Benbow A, Maresh M. Reducing maternal mortality: reaudit of recommendations in reports of confidential inquires into maternal deaths. BMJ [Internet] 1998[cited 2009 Sep 7]; 317: 1431-2. Available from: DOI:

WHO. Beyond the numbers: Reviewing maternal deaths and complications to make pregnancy safer. Geneva: WHO, department of reproductive health and research [Internet];2004[cited 2009 Sep 10] .Available from:

Malcolm R. Principles for best practice in clinical audit. Physiotherapy [Internet] 2002[cited 2009 Oct 21]; 88(12):774[about 8 screens].Available from: http:// DOI:

Smits HL, Leatherman S, Berwick DM. Quality improvement in the developing world. Int J Qual Health Care [Internet] 2002[cited 2009 Nov 20]; 14:439-40.Available from: DOI:

Hussein J, Goodburn EA, Damisoni H, Lema V, Graham W. Monitoring obstetric services; putting the 'UN Guidelines' into practice in Malawi: 3 years on. Int J Gynaecol and Obstet [Internet] 2001[cited 2009 Dec 2]; 75(1):63-73. Available from: http:// DOI:

Kongnyuy EJ,van den Broek N . Criteria for clinical audit of women friendly care and providers' perception in Malawi. BMC PregnancyChildbirth [Internet]2008[cited 2010 Jan 3]; 8:(28)[about 6 screens]. Available from: DOI:

Dujardin B, De Schampheleire , Sene H, Ndiaye F. Value of alert and action lines on the partogram. Lancet [Internet] 1992[cited 2010 Jan 3]; 339:1336-8. Available from: http:// DOI:

Anker M, Guidotte RT, Orzeslynas S, Sapirie A, Thuriaux MS.Rapid evaluation method (REM) of health services performance: Methodological observation .Bull World Health Organ [Internet] 2007[cited 2010 Jan 4];(1):15-21.Available from: .

Khayat R, Campbell O. Hospital practice in maternity ward in Lebanon. Health PolicyPlan [Internet], 2000 [cited 2010Feb 5]; 15(3): 270-8. Available from: http://www DOI:

WHO. Safe motherhood needs assessment. Geneva: WHO, department of reproductive health and research, [Internet]; 2001[cited 2010 Feb 8]. Available from: bookorders MDIbookJPG/Book.

WHO. Care in normal birth: a practical guide. Report of a Technical Working Group. Geneva: WHO, department of reproductive health and research, [Internet] 1999[cited 2010 Apr 10].Available from:

WHO. Preventing prolonged Labour: A practical guide. The PartographPart I. Principle and strategy. Geneva: WHO, [Internet]; 1994[cited 2010 May 4].Available from: ttp://

Ehrenberg A, Ehnfors M. The accuracy of patient record in Swedish nursing homes: congruences of record content and nursing and patients descriptions. Scand J Caring Sci [Internet] 2001[cited 2010 May 5]; 15(4):303-10.Available from: DOI:

Griffiths L, Hutchings W. The wider implications of an audit of care plan documentation. Journal of Clinical Nursing [Internet] 1999 [cited 2010 May 8];8,57-65. Available from: http://www3.interscience. DOI:

Sandin-Bojo AK, Larsson BW, Axelsson O, Hall-lord ML. Intrapartal Care documented in Swedish maternity unit and considered in relation to World Health Organization recommendations for care in normal birth. Midwifery [Internet] 2006[cited 2010 June 9]; 22:207-17.Avalible from: http://www. Elsevier. com. DOI:

Therese D, Odile AT, Valerie GK, Patrice B. Quality of normal delivery care in Cote d Ivoire. Afr J Repro Health [ Internet]2007[cited 2010 July 24];11(1):22-32.Available from: http:// DOI:

Nyamtema AS,Urassa DP,Massawe S. Partogram use in the Dar es Salaam perinatal care study . Int J Gynacol Obstet [Internet] 2008[cited 2010 Aug 10];100(1):37-40. Available from: http://www DOI:

Ogwang S,Karyabakabo Z,Rutebemberwa E. Assessment of partogram use during labour in Rujumbura health sub district,Rukungiri district,Uganda.Afr Health Sci [Internet]2009[cited 2010 Aug 20];9(S1)[ about 6screens]. Available from:

Ghebrehiwet M, Morrow RH. Competence and performance of the skilled birth attendants to undertake normal delivery and emergency obstetrical care in Eritrea. J Eritr Med Assoc [Internet] 2006[cited 2010 Sep 20]; 1(1):40-46.Available from: DOI:

WHO ,UNFPA. Safe motherhood needs assessment in Albania. Finalreport. Copenhagen : WHO regional office for Europe,[Internet]; 1999[cited 2010 Sep 22].Available from :

Matthews MK, Welly RL. Working with midwives to improve maternal health in rural Ghana. Canad J Midwifery [Internet] 2005[cited 2010 Sep 22]; 3(3):24- 33.Availablefrom:

Al-Deen L D, Al-Ward N. Assessment of the quality of care provided for normal delivery in three hospitals in Baghdad. Iraq J Comm Med [Internet] 2005[cited 2010 Oct 21]; 18(3):229-34.






How to Cite

Raof A, AL-Hadithi T, Al-Tawil N. DELIVERY CRITERION–BASED AUDITING SYSTEM AT TWO HEALTH FACILITIES IN ERBIL CITY-IRAQ. JSMC [Internet]. 2012 Dec. 1 [cited 2024 Jul. 15];2(1):9-16. Available from: