Feasibility of community level interventions for pre-eclampsia: perspectives, knowledge and task-sharing from Nigeria, Mozambique, Pakistan and India

Abstract

Hypertensive disorders of pregnancy (HDP), particularly pre-eclampsia and eclampsia, remain one of the leading causes of maternal mortality and are contributory in many foetal/newborn deaths. This editorial discusses a supplement of seven papers which provide the results of the first round of the CLIP (Community Level Interventions for Pre-eclampsia) Feasibility Studies. These studies report a number of enablers and barriers in each setting, which have informed the implementation of a cluster–randomized trial (cRCT) aimed at reducing pre-eclampsia-related, and all-cause, maternal and perinatal mortality and major morbidity using community-based identification and treatment of pre-eclampsia in selected geographies of Nigeria, Mozambique, Pakistan and India. This supplement unpacks the diverse community perspectives on determinants of maternal health, variant health worker knowledge and routine management of HDP, and viability of task sharing for preeclampsia identification and management in select settings. These studies demonstrate the need for strategies to improve health worker knowledge and routine management of HDP and consideration of expanding the role of community health workers to reach the most remote women and families with health education and access to health services.

Perceptions on preeclampsia and eclampsia among older women in rural southwestern Uganda

“…Community health workers provide a potential first line of intervention as they have been shown to have sufficient knowledge and ability to identify women with preeclampsia and administer initial treatment. [26][27][28] Interventions will also need to focus on demystifying the prevalent myths and promote a more scientific understanding of the condition and eventually this knowledge could serve as cues for action.…”

Simulation-enhanced nurse mentoring to improve preeclampsia and eclampsia care: an education intervention study in Bihar, India

“…Key enablers included simulation training, effective provider communication, and physician leadership. Other studies in low-resource settings have also identified participatory learning approaches [35], teamwork among doctors and nurses [3, 32, 36], and effective leadership [13] as facilitators of improved obstetric and emergency care. We found that communication techniques, such as the two-challenge rule, and clinical discussions can improve communication between providers, findings which are supported by results of related studies in high-resource settings [37, 38].…”

Management of Preeclampsia, Severe Preeclampsia, and Eclampsia at Primary Care Facilities in Bangladesh

“…Marked by high blood pressure (BP) and the presence of albumin in urine, preeclampsia is a risk factor for the potential development of severe preeclampsia or full-blown eclampsia and should be monitored. Management of SPE/E poses a challenge in low- and middle-income countries due to a lack of basic supplies, health worker shortages, limited competencies of frontline providers, and systems challenges that lead to delays in women receiving necessary treatment 2 – 4 . In Bangladesh, eclampsia-related conditions are the second leading direct cause of obstetric deaths and lead to 24% of all maternal deaths 5 .…”