Community health workers' knowledge and practice in relation to pre-eclampsia in Ogun State, Nigeria: an essential bridge to maternal survival

J O Sotunsa, M Vidler, D O Akeju, M O Osiberu, E O Orenuga, O T Oladapo, R Qureshi, D Sawchuck, O O Adetoro, P von Dadelszen, O A Dada, CLIP Nigeria Feasibility Working Group, J O Sotunsa, M Vidler, D O Akeju, M O Osiberu, E O Orenuga, O T Oladapo, R Qureshi, D Sawchuck, O O Adetoro, P von Dadelszen, O A Dada, CLIP Nigeria Feasibility Working Group

Abstract

Background: Pre-eclampsia is a leading cause of maternal and fetal morbidity and mortality worldwide. Early detection and treatment have been instrumental in reducing case fatality in high-income countries. To achieve this in a low-income country, like Nigeria, community health workers who man primary health centres must have adequate knowledge and skills to identify and provide emergency care for women with pre-eclampsia. This study aimed to determine community health workers' knowledge and practice in the identification and treatment of pre-eclampsia, as they are essential providers of maternal care services in Nigeria.

Methods: This study was part of a multi-country evaluation of community treatment of pre-eclampsia. Qualitative data were obtained from four Local Government Areas of Ogun State, in south western Nigeria by focus group discussions (N = 15) and in-depth interviews (N = 19). Participants included a variety of community-based health care providers - traditional birth attendants, community health extension workers, nurses and midwives, chief nursing officers, medical officers - and health administrators. Data were transcribed and validated with field notes and analysed with NVivo 10.0.

Results: Community-based health care providers proved to be aware that pre-eclampsia was due to the development of hypertension and proteinuria in pregnant women. They had a good understanding of the features of the condition and were capable of identifying women at risk, initiating care, and referring women with this condition. However, some were not comfortable managing the condition because of the limitation in their 'Standing Order'; these guidelines do not explicitly authorize community health extension workers to treat pre-eclampsia in the community.

Conclusion: Community-based health care providers were capable of identifying and initiating appropriate care for women with pre-eclampsia. These competencies combined with training and equipment availability could improve maternal health in the rural areas. There is a need for regular training and retraining to enable successful task-sharing with these cadres.

Trial registration: NCT01911494 .

Keywords: Community health workers; Developing countries; Hypertension in pregnancy; Maternal welfare; Nigeria; Pre-eclampsia; Pregnancy.

References

    1. Osungbade KO, Ige OK. Public health perspectives to pre-eclampsia in developing countries: implication for health system strengthening. J Pregnancy. 2011(2011). doi:10.1155/2011/481095.
    1. Kwawukume EY. Hypertension in pregnancy in comprehensive obstetrics in the tropics. Ghana: Asante & Hittscher Printing Press Ltd; 2002.
    1. Kim YM, Ansari N, Kols A, Tappis H, Currie S, Zainullah P, Bailey P, van Roosmalen J, Stekelenburg J. Prevention and management of severe pre-eclampsia/eclampsia in Afghanistan. BMC Pregnancy Childbirth. 2013;13:186. doi: 10.1186/1471-2393-13-186.
    1. Myatt L, Cliffor RG, Roberts JM, Sping CY, Havith JC, Varner MW, Thorp JM, Jr, Mercer BM, Peaceman AM, Ranin SM, Carpenter MW, Iams JD, Scissone A, Harper M, Tolossa JE, Saade G, Sorokin Y, Anderson GD. First trimester prediction of pre-eclampsia in nulliparous women at low risk. Obstet Gynecol. 2012;119:1234–42. doi: 10.1097/AOG.0b013e3182571669.
    1. Okereke E, Ahonsi B, Tukur J, Ishaku SM, Oginni AB. Benefits of using magnesium sulphate (MgSO4) for eclampsia management and maternal mortality reduction: lessons from Kano State in Northern Nigeria. BMC Res Notes. 2012;5:421. doi:10.1186/1756-0500-5-421.
    1. Akinola O, Fabamwo A, Gbadegesin A, Ottun A, Kusemiju O. Improving the clinical outcome in cases of Eclampsia: the experience of Lagos State University Teaching Hospital, Ikeja. Internet J Third World Med. 2007;6(2).
    1. Goldenberg RL, McClare EM, Macguire ER, Kanath BD, Jobe AH. Lessons for low-income regions following the reduction in hypertension-related maternal mortality in high-income countries. Int J Gynaecol Obstet. 2011;113(2):91–5. doi: 10.1016/j.ijgo.2011.01.002.
    1. Dolea C, AbouZahr C. Global burden of hypertensive disease in pregnancy in the year 2000. Evidence and Information for Policy (EIP). Geneva: World Health Organization; 2013.
    1. Ige OK, Nwachukwu CC. Area of dissatisfaction with Primary Health Care services in government owned health facilities in a semi-urban community in Nigeria. J Rural Trop Public Health. 2010;9:19–23.
    1. Ishaku SM, Ahonsi BAO, Tukur J, Atodeji O. Attrition from care after the critical phase of severe pre-eclampsia and eclampsia: insights from an intervention with MgSO4 in a primary care setting in Northern Nigeria. Health. 2013;5(9):1461–6. doi: 10.4236/health.2013.59199.
    1. Khowaja AR, Quershi R, Sawchuck D, Oladapo OT, Adetoro OO, Orenuga EA, Bellad M, Mallapur A, Charanthimath U, Sevene E, Munguambe K, Boene H, Vidler M, Bhutta Z, von Dadelszen P, for the CLIP Working Group. The feasibility of community level interventions for pre-eclampsia in south Asia and sub-Saharan Africa: a mixed-methods design. Reprod Health. 2016;13(1):17.
    1. Akeju DO, Vidler M, Oladapo OT, Sawchuck D, Quershi RN, von Dadelszen P, Adetoro OO, Dada OA and the CLIP Nigeria Feasibility Working Group. Community perceptions of pre-eclampsia and eclampsia in Ogun State, Nigeria: A qualitative study. Reprod Health. 2016;13(1):67.
    1. World Health Organization. WHO Recommendations for Prevention and Treatment of Preeclampsia. Switzerland [internet]; 2011. Available from: .
    1. Ekunwe EO. Standing orders--a powerful tool in primary care. World Health Forum. 1984;Vol. 5(No. 1):19–23.
    1. El-Nafaty AU, Omotara BA. Perceived causes of eclampsia in four ethnic groups in Borno State, Nigeria. Afr J Reprod Health. 1998;2(1):20–5.
    1. James EO, Mgbekem MA, Edem OA. Knowledge, attitude and preventive practices towards pregnancy induced hypertension among pregnant women in General Hospital, Calabar, Cross River State, Nigeria. Pak J Soc Sci. 2009;6(1):1–5.
    1. Bigdeli M, Zafar S, Assad H, Ghaffar A. Health system barriers to access and use of MgSO4 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.

Source: PubMed

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