Health Care Readiness in Management of Preeclampsia/Eclampsia in Ethiopia: Evidence from National Facility-Based Survey

Abstract

Background Early case detection, treatment, and timely referral for better services can significantly reduce the negative outcomes of preeclampsia and eclampsia. However, evidence on health facilities’ readiness to provide such services and the associated challenges is limited in Ethiopia. Therefore, this study aimed to assess the readiness of Ethiopian health care facilities to manage preeclampsia and eclampsia. Methods This study used the 2016 Ethiopia national emergency management of obstetrics and newborn care (EmONC) survey. This survey was a national cross-sectional census of health facilities that provided delivery services. Data on facility infrastructure, equipment and supplies were collected through a facility checklist, and interview health provider experiences. Cross tabulation, summarisation and chi square tests by facility type, location, and management authority were conducted. Results There were 3804 health facilities included in the survey across all regions of Ethiopia. The majority of facilities (92%) were public/government managed with only 1% of available hospitals located in rural areas. Poor availability of dipsticks for proteinuria tests (55.3%), caesarean sections (7.9%), and ambulance services (18.4%) were reported across health facilities with high variations in terms of facility type, location, and type of managing authority. Diazepam was a widely available anticonvulsant compared with magnesium sulfate (MgSO 4 ), with more available in private for-profit facilities compared with public facilities. Nearly one third of health care providers were not trained to administer MgSO 4 intravenously. The result indicated that the chi-square test was statistically significant at P < 0.001. Conclusions and Recommendations There were notable gaps in readiness of facilities in detection and management of preeclampsia/eclampsia that increase maternal and perinatal mortality in Ethiopia. Therefore, availability of essential supplies, medications, and referrals are required. In addition, refresher training to healthcare providers on screening, diagnosis and management of preeclampsia/eclampsia and continuous supervision should be provided.

Experiences of referral with an obstetric emergency: voices of women admitted at Mbarara Regional Referral Hospital, South Western Uganda

“…Studies in Ethiopia and northern Karnataka region of India investigating readiness of HC to manage eclampsia, found poor availability of dipsticks for proteinuria tests, caesarean sections, reported across almost all the public health facilities. Magnesium sulphate, the drug of choice for controlling convulsions was more available in private for-profit health facilities compared with public facilities [52,53]. Participants in our study were also referred mostly from public health facilities due to stock-outs of magnesium sulphate.…”

Neurological disorders in pregnant women in low- and middle-income countries—Management gaps, impacts, and future prospects: A review perspective

“…19,20 Moreover, in Ethiopia, the majority of public and government-operated health centers and rural health facilities were observed to have inadequate resources and infrastructure for managing and preventing NDP complications. 24 Similarly, in India, where NDPs are becoming increasingly common, there are only a few clinical centers that provide specialized care for these conditions. 25 The shortage of healthcare facilities is further compounded by the scarce distribution of these facilities, with few available in rural areas and an overwhelming concentration in urban centers.…”