The feasibility of task-sharing the identification, emergency treatment, and referral for women with pre-eclampsia by community health workers in India
- PMID: 29945662
- PMCID: PMC6019995
- DOI: 10.1186/s12978-018-0532-5
The feasibility of task-sharing the identification, emergency treatment, and referral for women with pre-eclampsia by community health workers in India
Abstract
Background: Hypertensive disorders are the second highest direct obstetric cause of maternal death after haemorrhage, accounting for 14% of maternal deaths globally. Pregnancy hypertension contributes to maternal deaths, particularly in low- and middle-income countries, due to a scarcity of doctors providing evidence-based emergency obstetric care. Task-sharing some obstetric responsibilities may help to reduce the mortality rates. This study was conducted to assess acceptability by the community and other healthcare providers, for task-sharing by community health workers (CHW) in the identification and initial care in hypertensive disorders in pregnancy.
Methods: This study was conducted in two districts of Karnataka state in south India. A total of 14 focus group discussions were convened with various community representatives: women of reproductive age (N = 6), male decision-makers (N = 2), female decision-makers (N = 3), and community leaders (N = 3). One-to-one interviews were held with medical officers (N = 2), private healthcare OBGYN specialists (N = 2), senior health administrators (N = 2), Taluka (county) health officers (N = 2), and obstetricians (N = 4). All data collection was facilitated by local researchers familiar with the setting and language. Data were subsequently transcribed, translated and analysed thematically using NVivo 10 software.
Results: There was strong community support for home visits by CHW to measure the blood pressure of pregnant women; however, respondents were concerned about their knowledge, training and effectiveness. The treatment with oral antihypertensive agents and magnesium sulphate in emergencies was accepted by community representatives but medical practitioners and health administrators had reservations, and insisted on emergency transport to a higher facility. The most important barriers for task-sharing were concerns regarding insufficient training, limited availability of medications, the questionable validity of blood pressure devices, and the ability of CHW to correctly diagnose and intervene in cases of hypertensive disorders of pregnancy.
Conclusion: Task-sharing to community-based health workers has potential to facilitate early diagnosis of the hypertensive disorders of pregnancy and assist in the provision of emergency care. We identified some facilitators and barriers for successful task-sharing of emergency obstetric care aimed at reducing mortality and morbidity due to hypertensive disorders of pregnancy.
Keywords: Antihypertensives; Blood pressure; Community health workers; Magnesium sulphate; Pre-eclampsia; Task-sharing.
Conflict of interest statement
Ethics approval and consent to participate
This study was approved by ethics review committees at the University of British Columbia, Vancouver Canada (H12–00132)and KLE University, Belgaum (Ref No: MDC/IECHSR/2013–14/A-28) India. Furthermore, approval was also obtained from the Ministry of Health and Family Welfare, India.
Competing interests
The authors declare that they have no competing interests.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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References
-
- Ending Preventable Maternal Mortality: USAID Maternal Health Vision for Action Evidence for Strategic Approaches - January 2015. Available on URL - https://www.usaid.gov/sites/default/files/documents/1864/MH%20Strategy_w... Accessed on 28th Dec at 10.00 am.
-
- Trends in Maternal Mortality: 1990 to 2015 Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Available on URL - http://www.afro.who.int/sites/default/files/2017-05/trends-in-maternal-m... Accessed on 12th Dec 2017 at 09.00 pm.
-
- Alkema L, Chou D, Hogan D, Zhang S, Moller AB, Gemmill A, et al. Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN maternal mortality estimation inter-agency group. Lancet. 2016;387(10017):462–474. doi: 10.1016/S0140-6736(15)00838-7. - DOI - PMC - PubMed
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