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.

Keywords: Facility readiness; Healthcare providers; Kinshasa; Knowledge; Pre-eclampsia.

Fig. 1

Median knowledge score about diagnosis, management and prevention of pre-eclampsia among midwives in hospitals and PHCs, and among physicians in hospitals and PHCs, within 58 antenatal clinics in Kinshasa. n_i: 56 midwives in hospitals and 66 in PHCs; 51 physicians in hospitals and 24 in PHCs. For each box, the bottom and the top represent the first and the third quartiles, respectively. The horizontal line within the box represents the median. Numbers inside the box are median (interquartile range). The I bars represent 1.5 times interquartile range. The black dots refer to outliers. ^#P-value from the Mann-Whitney test comparing the median knowledge scores between midwives in hospitals and those in PHCs; and between physicians in hospitals and those in PHCs

Fig. 2

Median knowledge score about diagnosis, management and prevention of pre-eclampsia among midwives in public and private facilities, and among physicians in in public and private facilities, within 58 antenatal clinics in Kinshasa. n_i: 26 midwives in public and 96 in private facilities; 42 physicians in apublic and 33 in private facilities. For each box, the bottom and the top represent the first and the third quartiles, respectively. The horizontal line within the box represents the median. Numbers inside the box are median (interquartile range). The I bars represent 1.5 times interquartile range. The black dots refer to outliers. ^#P-value from the Mann-Whitney test comparing the median knowledge score between midwives in public and those in private facilities; and between physicians in public and those in private facilities