Screening and management of pre-eclampsia and eclampsia in antenatal and labor and delivery services: findings from cross-sectional observation studies in six sub-Saharan African countries

Abstract

BackgroundPreeclampsia and eclampsia (PE/E) are major contributors to maternal and neonatal deaths in developing countries, associated with 10–15% of direct maternal deaths and nearly a quarter of stillbirths and newborn deaths, many of which are preventable with improved care. We present results related to WHO-recommended interventions for screening and management of PE/E during antenatal care (ANC) and labor and delivery (L & D) from a study conducted in six sub-Saharan African countries.MethodsFrom 2010 to 2012, cross-sectional studies which directly observed provision of ANC and L & D services in six sub-Saharan African countries were conducted. Results from 643 health facilities of different levels in Ethiopia (n = 19), Kenya (n = 509), Madagascar (n = 36), Mozambique (n = 46), Rwanda (n = 72), and Tanzania (n = 52), were combined for this analysis. While studies were sampled separately in each country, all used standardized observation checklists and inventory assessment tools.Results2920 women receiving ANC and 2689 women in L & D were observed. Thirty-nine percent of ANC clients were asked about PE/E danger signs, and 68% had their blood pressure (BP) taken correctly (range 48–96%). Roughly half (46%) underwent testing for proteinuria. Twenty-three percent of women in L & D were asked about PE/E danger signs (range 11–34%); 77% had their BP checked upon admission (range 59–85%); and 6% had testing for proteinuria. Twenty-five cases of severe PE/E were observed: magnesium sulfate (MgSO4) was used in 15, not used in 5, and for 5 use was unknown. The availability of MgSO4 in L & D varied from 16% in Ethiopia to 100% in Mozambique.ConclusionsObserved ANC consultations and L & D cases showed low use of WHO-recommended practices for PE/E screening and management. Availability of MgSO4 was low in multiple countries, though it was on the essential drug list of all surveyed countries. Country programs are encouraged to address gaps in screening and management of PE/E in ANC and L & D to contribute to lower maternal and perinatal mortality.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-1972-1) contains supplementary material, which is available to authorized users.

Access to sexual and reproductive health commodities in East and Southern Africa: a cross-country comparison of availability, affordability and stock-outs in Kenya, Tanzania, Uganda and Zambia

“…Availability of levonorgestrel 750mcg, the emergency contraceptive, was for example low across the countries, and this finding is reflected in the trends of use [49][50][51][52]. Comparable to other studies, magnesium sulphate, critical in managing pre-eclampsia and eclampsia, also had a low availability in all countries, with an especially low availability in Zambia [28,53,54]. Medical devices also had a suboptimal availability: tubal ligation and vasectomy kits had a very low availability across the countries, while availability of ultrasound scans was shown to be variable, with a higher availability in Kenya's and Uganda's public sector than in Tanzania and Zambia.…”

What the percentage of births in facilities does not measure: readiness for emergency obstetric care and referral in Senegal

“…Subnational budgets should prioritise paving roads from health posts to main roads, and additional interventions should be trialled, including strategically placed shared ambulances and maternity waiting homes adjacent to health centres and hospitals 22 68 69. Strengthening antenatal care would enable referral to higher-level facilities for women with preidentifiable conditions (including twin pregnancy and pre-eclampsia) 70–72. The extent of informal use of health services between Senegal and neighbouring Gambia is unknown; however, providers in Senegal are unable to refer to facilities in the Gambia, even if those are nearer: reciprocal formal arrangements between these countries for obstetric emergencies should be considered.…”

Provision of essential evidence-based interventions during facility-based childbirth: cross-sectional observations of births in northeast Nigeria

“… 50–52 Observations of WHO-recommended practices for screening of pre-eclampsia/eclampsia in six sub-Saharan African countries, similarly found that a low proportion of women admitted to labour and delivery services were asked about danger signs, but substantially more women (77%) had their blood pressure checked on admission. 51 Low implementation of evidence-based care measures during the initial assessment and postpartum period indicate potential missed opportunities to identify and manage complications, as evident in the referral cases. Referrals post partum and intrapartum included women with high-risk pregnancies such as severe pre-eclampsia/eclampsia, breech position and twins who should have been referred to a higher level of care.…”