Potential for task-sharing to Lady Health Workers for identification and emergency management of pre-eclampsia at community level in Pakistan

Abstract

BackgroundAn estimated 276 Pakistani women die for every 100,000 live births; with eclampsia accounting for about 10 % of these deaths. Community health workers contribute to the existing health system in Pakistan under the banner of the Lady Health Worker (LHW) Programme and are responsible to provide a comprehensive package of antenatal services. However, there is a need to increase focus on early identification and prompt diagnosis of pre-eclampsia in community settings, since women with mild pre-eclampsia often present without symptoms. This study aims to explore the potential for task-sharing to LHWs for the community-level management of pre-eclampsia and eclampsia in Pakistan.MethodsA qualitative exploratory study was undertaken February-July 2012 in two districts, Hyderabad and Matiari, in the southern province of Sindh, Pakistan. Altogether 33 focus group discussions (FGDs) were conducted and the LHW curriculum and training materials were also reviewed. The data was audio-recorded, then transcribed verbatim for thematic analysis using QSR NVivo-version10.ResultsFindings from the review of the LHW curriculum and training program describe that in the existing community delivery system, LHWs are responsible for identification of pregnant women, screening women for danger signs and referrals for antenatal care. They are the first point of contact for women in pregnancy and provide nutritional counselling along with distribution of iron and folic acid supplements. Findings from FGDs suggest that LHWs do not carry a blood pressure device or antihypertensive medications; they refer to the nearest public facility in the event of a pregnancy complication. Currently, they provide tetanus toxoid in pregnancy. The health advice provided by lady health workers is highly valued and accepted by pregnant women and their families. Many Supervisors of LHWs recognized the need for increased training regarding pre-eclampsia and eclampsia, with a focus on identifying women at high risk. The entire budget of the existing lady health worker Programme is provided by the Government of Pakistan, indicating a strong support by policy makers and the government for the tasks undertaken by these providers.ConclusionThere is a potential for training and task-sharing to LHWs for providing comprehensive antenatal care; specifically for the identification and management of pre-eclampsia in Pakistan. However, the implementation needs to be combined with appropriate training, equipment availability and supervision.Trial registrationClinicalTrial.gov, NCT01911494 Electronic supplementary materialThe online version of this article (doi:10.1186/s12978-016-0214-0) contains supplementary material, which is available to authorized users.

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.…”

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

“…Community health workers provide a potential rst line of intervention as they have been shown to have su cient knowledge and ability to identify women with preeclampsia and administer initial treatment. [42][43][44] Future programs will need to develop interventions that focus on demystifying the prevalent myths and promote a more scienti c understanding of the condition and eventually this knowledge could serve as cues for action.…”

A primary health care model for managing pre-eclampsia and eclampsia in low- and middle- income countries

“…If BP is not controlled or severe PE/E ensues, stabilize with antihypertensive, loading dose of MgSO 4 and refer to appropriate facility [16,22,23]. Ensure hypertension is controlled:…”

“…At referral facilities, providers should have the expertise and capacity for optimal emergency management of PE/ E. Providers should benefit from refresher training, emergency drills/updates as needed, ongoing supportive supervision, and mentoring. However, it is important to recognize that task shifting or sharing to lower cadres only makes sense if those cadres already have basic clinical skills (for example taking BP, administering injections) [22,23]. Evidence shows that MgSO 4 should not be 'pushed' to the lowest level in communities (i.e.…”