Health facility readiness and provider knowledge as correlates of adequate diagnosis and management of pre-eclampsia in Kinshasa, Democratic Republic of Congo

Abstract

Background Hypertensive disorders in pregnancy are the second most common cause of maternal mortality in the Democratic Republic of Congo (DRC), accounting for 23% of maternal deaths. This study aimed to assess facility readiness, and providers’ knowledge to prevent, diagnose, and treat pre-eclampsia. Methods A facility-based cross-sectional study was conducted in 30 primary health centres (PHCs) and 28 referral facilities (hospitals) randomly selected in Kinshasa, DRC. In each facility, all midwives and physicians involved in maternal care provision (n = 197) were included. Data on facility infrastructure and providers’ knowledge about pre-eclampsia were collected using facility checklists and a knowledge questionnaire. Facility readiness score was defined as the sum of 13 health commodities needed to manage pre-eclampsia. A knowledge score was defined as the sum of 24 items about the diagnosis, management, and prevention of pre-eclampsia. The score ranges from 0 to 24, with higher values reflecting a better knowledge. The Mann-Witney U test was used to compare median readiness scores by facility type and ownership; and median knowledge scores between midwives in hospitals and in PHCs, and between physicians in hospitals and in PHCs. Results Overall, health facilities had 7 of the 13 commodities, yielding a median readiness score of 53.8%(IQR: 46.2 to 69.2%). Although all provider groups had significant knowledge gaps about pre-eclampsia, providers in hospitals demonstrated slightly more knowledge than those in PHCs. Midwives in public facilities scored higher than those in private facilities (median(IQR): 8(5 to 12) vs 7(4 to 8), p = 0.03). Of the 197 providers, 91.4% correctly diagnosed severe pre-eclampsia. However, 43.9 and 82.2% would administer magnesium sulfate and anti-hypertensive drugs to manage severe pre-eclampsia, respectively. Merely 14.2 and 7.1% of providers were aware of prophylactic use of aspirin and calcium to prevent pre-eclampsia, respectively. Conclusion Our study showed poor availability of supplies to diagnose, prevent and treat pre-eclampsia in Kinshasa. While providers demonstrated good knowledge regarding the diagnosis of pre-eclampsia, they have poor knowledge regarding its prevention and management. The study highlights the need for strengthening knowledge of providers toward the prevention and management of pre-eclampsia, and enhancing the availability of supplies needed to address this disease.

Effects of lipid based Multiple Micronutrients Supplement on the birth outcome of underweight pre-eclamptic women: A randomized clinical trial

“…Preeclampsia is the second most common cause of maternal mortality in the world responsible for 10-15% of maternal death. 3 It affects 3-5% of pregnant women worldwide and reported one of the main causes of maternal mortality, morbidity and still births. 4 The prevalence of complication with maternal and fetal outcome is 19% with pre-eclampsia in Pakistan.…”

“…5 According to recent ranking Pakistan is third in terms of burden of fetal, maternal and child mortality. 3 Our country has poorest pregnancy outcomes worldwide, maternal mortality was found to be 319 per 100,000 live births. 6 …”

“…5 According to recent ranking Pakistan is third in terms of burden of fetal, maternal and child mortality. 3 Our country has poorest pregnancy outcomes worldwide, maternal mortality was found to be 319 per 100,000 live births. 6 The incidence of pregnancy induced hypertension including pre-eclampsia and eclampsia in Sukkar Pakistan was 5.56%.…”

Assessment of Knowledge and Readiness for the Diagnosis and Management of Preeclampsia among Healthcare Workers from Selected Healthcare Facilities in Lusaka, Zambia

“…Similar results were also recorded in a study carried out in Northern Karnataka in India [14] that found out that majority of respondents had high knowledge on pre-eclampsia. Another study done in Kinshasa revealed that although all provider groups had significant knowledge gaps about pre-eclampsia, health providers in hospitals demonstrated slightly more knowledge compared to those in PHCs [15] . This finding is not surprising given that physicians are more plentiful in hospitals than in PHCs and they tend to be more knowledgeable than other health specialists.…”

“…Similar findings were discovered in a study that was done in Kinshasa which revealed poor availability of health commodities to manage pre-eclampsia, as half of facilities had a readiness score lower than 53.8% and no facility had all the nominated commodities at the time of the study. This poor availability was attributed to inconsistent supply chain as only a few facilities mainly hospitals and public facilities received these commodities from government or NGOs and as a result health facilities usually asked patients or their relatives to purchase drugs from outside pharmacies [15] . The implication of poor availability of drugs and supplies in the management of PE in health facilities is that there may be a lag of time till the drug is made available, depending on affordability and proximity to the pharmacies where they are purchased by patients and this delay may worsen the pregnancy outcome which can contribute to high maternal mortality deaths.…”