Health care provider knowledge and routine management of pre-eclampsia in Pakistan

Sana Sheikh, Rahat Najam Qureshi, Asif Raza Khowaja, Rehana Salam, Marianne Vidler, Diane Sawchuck, Peter von Dadelszen, Shujat Zaidi, Zulfiqar Bhutta, CLIP Working Group, Payne Beth, Aina Olabisi, Chomiak Marianne, Olukayode A Dada, Drebit Sharla, Firoz Tabassum, Goudar Shivaprasad, Kariya Chirag, Katageri Geetanjali, Lee Tang, Li Jing, Lui Man Sun, Makanga Tatenda, Ramadurg Umesh, Sharma Sumedha, Solarin Kunle, Laura A Magee, Sana Sheikh, Rahat Najam Qureshi, Asif Raza Khowaja, Rehana Salam, Marianne Vidler, Diane Sawchuck, Peter von Dadelszen, Shujat Zaidi, Zulfiqar Bhutta, CLIP Working Group, Payne Beth, Aina Olabisi, Chomiak Marianne, Olukayode A Dada, Drebit Sharla, Firoz Tabassum, Goudar Shivaprasad, Kariya Chirag, Katageri Geetanjali, Lee Tang, Li Jing, Lui Man Sun, Makanga Tatenda, Ramadurg Umesh, Sharma Sumedha, Solarin Kunle, Laura A Magee

Abstract

Background: Maternal mortality ratio is 276 per 100,000 live births in Pakistan. Eclampsia is responsible for one in every ten maternal deaths despite the fact that management of this disease is inexpensive and has been available for decades. Many studies have shown that health care providers in low and middle-income countries have limited training to manage patients with eclampsia. Hence, we aimed to explore the knowledge of different cadres of health care providers regarding aetiology, diagnosis and treatment of pre-eclampsia and eclampsia and current management practices.

Methods: We conducted a mixed method study in the districts of Hyderabad and Matiari in Sindh province, Pakistan. Focus group discussions and interviews were conducted with community health care providers, which included Lady Health Workers and their supervisors; traditional birth attendants and facility care providers. In total seven focus groups and 26 interviews were conducted. NVivo 10 was used for analysis and emerging themes and sub-themes were drawn.

Results: All participants were providing care for pregnant women for more than a decade except one traditional birth attendant and two doctors. The most common cause of pre-eclampsia mentioned by community health care providers was stress of daily life: the burden of care giving, physical workload, short birth spacing and financial constraints. All health care provider groups except traditional birth attendants correctly identified the signs, symptoms, and complications of pre-eclampsia and eclampsia and were referring such women to tertiary health facilities. Only doctors were aware that magnesium sulphate is recommended for eclampsia management and prevention; however, they expressed fears regarding its use at first and secondary level health facilities.

Conclusion: This study found several gaps in knowledge regarding aetiology, diagnosis and treatment of pre-eclampsia among health care providers in Sindh. Findings suggest that lesser knowledge regarding management of pre-eclampsia is due to lack of refresher trainings and written guidelines for management of pre-eclampsia and presentation of fewer pre-eclamptic patients at first and secondary level health care facilities. We suggest to include management of pre-eclampsia in regular trainings of health care providers and to provide management protocols at all health facilities.

Trial registration: NCT01911494.

Keywords: Community health services; Community health worker; Eclampsia; Health personnel; Pakistan; Pre-eclampsia; Pregnancy.

References

    1. National Collaborating Centre for Ws. Children’s H . Hypertension in pregnancy: the management of hypertensive disorders during pregnancy. London: RCOG press; 2010.
    1. Mattar F, Sibai BM. Eclampsia. VIII. Risk factors for maternal morbidity. Am J Obstet Gynecol. 1990;163:1049–55. doi: 10.1016/0002-9378(90)91123-T.
    1. Saving mother’s lives in Pakistan. The White Ribbon Alliance; [October 10, 2013; cited 22 April 2014]; Available from: .
    1. Pakistan Demographic Health Survey 2006–07.
    1. Group TETC. Which anticonvulsant for women with eclampsia? Evidence from the collaborative eclampsia trial. Lancet. 1995;345(8963):1455–63. doi: 10.1016/S0140-6736(95)91034-4.
    1. Altman D, Carroli G, Duley L, Farrell B, Moodley J, Neilson J, et al. Do women with pre-eclampsia, and their babies, benefit from magnesium sulphate? The magpie trial: a randomised placebo-controlled trial. Lancet. 2002;359(9321):1877–90. doi: 10.1016/S0140-6736(02)08778-0.
    1. Lelia Duley AMG, David J Henderson-Smart and Doris Chou. Magnesium sulphate and other anticonvulsants for women with pre-eclampsia. Cochrane Database Syst Rev. 2010;11. doi:10.1002/14651858.CD000025.pub2.
    1. World Health Organization. Reproductive H. Managing complications in pregnancy and childbirth: a guide for midwives and doctors. Geneva: World Health Organization; 2003.
    1. National essential medicines list of Pakistan. Ministry of Health, Government of Pakistan; 2007 [updated 2007; cited 22 April 2014]; Available from: = 1
    1. Siddiqui GK, Hussein R, Dornan JC. Dying to give birth: the Pakistan liaison committee’s strategies to improve maternal health in Pakistan. BJOG. 2011;118(s2):96–9. doi: 10.1111/j.1471-0528.2011.03118.x.
    1. Shaikh BT, Hatcher J. Health seeking behaviour and health service utilization in Pakistan: challenging the policy makers. J. Public Health. 2005;27(1):49–54. doi: 10.1093/pubmed/fdh207.
    1. Plotkin M, Tibaijuka G, Makene CL, Currie S. Quality of Care for Prevention and Management of Common Maternal and Newborn Complications. USAID, MCHIP; 2013 [updated 2013; cited 2015 May 4, 2015]; Available from:
    1. Thein TT, Myint T, Lwin S, Oo WM, Kyaw AK, Myint MK, et al. Promoting antenatal care services for early detection of pre-eclampsia. SEAJPH. 2012;1(3):290–98.
    1. Bigdeli M, Zafar S, Assad H, Ghaffar A. Health system barriers to access and use of magnesium sulfate for women with severe pre-eclampsia and eclampsia in Pakistan: evidence for policy and practice. PLoS One. 2013;8(3):e59158. doi: 10.1371/journal.pone.0059158.
    1. Aaserud M, Lewin S, Innvaer S, Paulsen EJ, Dahlgren AT, Trommald M, et al. Translating research into policy and practice in developing countries: a case study of magnesium sulphate for pre-eclampsia. BMC Health Serv Res. 2005;5(1):68. doi: 10.1186/1472-6963-5-68.
    1. Hyderabad District, Sindh. 2014 [updated 2014; cited 27 Mar 2014]; Available from: .
    1. Bhutta ZA, Memon ZA, Soofi S, Salat MS, Cousens S, Martines J. Implementing community-based perinatal care: results from a pilot study in rural Pakistan. Bull World Health Organ. 2008;86(6):452–9. doi: 10.2471/BLT.07.045849.
    1. Khowaja AR. Methodology for assessing the feasibility of community level interventions for pre-eclampsia in South Asian and African contexts. Abstracts/Pregnancy Hypertension. 2015;5(1):53–156.
    1. Adamu A, Ekele B, Tunau K, Hassan M. Perception of relations of patients with eclampsia. Int J Gynecol Obstet. 2009;107(2):93–6. doi: 10.1016/j.ijgo.2009.07.039.
    1. Guerrier G, Oluyide B, Keramarou M, Grais RF. Factors associated with severe preeclampsia and eclampsia in Jahun, Nigeria. Int J Womens Health. 2013;5:509. doi: 10.2147/IJWH.S47056.
    1. Jeffrey Smith SC, Julia Perri, Julia Bluestone, Tirza Cannon. National Programs for the Prevention and Management of Postpartum Hemorrhage and Pre-Eclampsia/Eclampsia; A Global survey 2012. USAID, MCHIP. 2012
    1. Kim YM, Ansari N, Kols A, Tappis H, Currie S, Zainullah P, et al. Prevention and management of severe pre-eclampsia/eclampsia in Afghanistan. BMC Pregnancy Childbirth. 2013;13(1):186. doi: 10.1186/1471-2393-13-186.
    1. Balancing the scales. Engender health; 2007 [updated 2007; cited 2012 13 Dec 12]; Available from: .
    1. Jayanna K, Mony P, Ramesh BM, Thomas A, Gaikwad A, Mohan HL, et al. Assessment of facility readiness and provider preparedness for dealing with postpartum haemorrhage and pre-eclampsia/eclampsia in public and private health facilities of northern Karnataka, India: a cross-sectional study. BMC Pregnancy Childbirth. 2014;14(1):304. doi: 10.1186/1471-2393-14-304.
    1. Harvey SA, Ayabaca P, Bucagu M, Djibrina S, Edson WN, Gbangbade S, et al. Skilled birth attendant competence: an initial assessment in four countries, and implications for the safe Motherhood movement. Int J Gynecol Obstet. 2004;87(2):203–10. doi: 10.1016/j.ijgo.2004.06.017.
    1. Ridge AL, Bero LA, Hill SR. Identifying barriers to the availability and use of magnesium sulphate injection in resource poor countries: a case study in Zambia. BMC Health Serv Res. 2010;10(1):1. doi: 10.1186/1472-6963-10-340.
    1. Liljevik S, Lohre ESVB. Evaluation of knowledge and management practices of hypertension in pregnancy among health care workers in Moshi urban, Tanzania. [updated 2012. Thesis work. University of Oslo, Norway; cited 24 Aug 2016]; Available from: .
    1. Report On The Status Of Millennium Development Goals Sindh. United Nations Development Programme Pakistan & Government of Sindh. 2012.
    1. Sindh Health Sector Strategy 2012 – 2020. TRF, Government of Sindh, HSRU; [cited 2015 23 June 2015]; Available from: .
    1. Jalal S. The lady health worker program in Pakistan-a commentary. Eur J Public Health. 2011;21(2):143–4. doi: 10.1093/eurpub/ckq199.

Source: PubMed

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