PERSISTING CHALLENGES IN THE PROVISION OF QUALITY OBSTETRIC CARE TO WOMEN WITH PRE-ECLAMPSIA - PowerPoint Presentation

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PERSISTING CHALLENGES IN THE PROVISION OF QUALITY OBSTETRIC CARE TO WOMEN WITH PRE-ECLAMPSIA AND ECLAMPSIA IN NIGERIA: ASSESSMENT OF HEALTH PROVIDERS' PREPAREDNESS AND FACILITY READINESS

Gloria Adoyi Salisu Mohammed Ishaku; Oginni Ayodeji Babatunde; Karen Kirk.

20th World Congress meeting of the International Society for the Study of Hypertension in Pregnancy (ISSHP) 24 October 2016Sao Paulo, Brazil.

Background

In Nigeria, an estimated 40 percent of pregnant women experienced pregnancy-related health problems during or after pregnancy and childbirth (

Mutihir, 2011).Common maternal health problems/complications a woman may experience during pregnancy include Pre-eclampsia and Eclampsia (PE/E).Screening, early antenatal detection, and timely management are the most effective

ways for preventing

morbidity

and mortality from these pregnancy-related

disorders

However

,

low

level of access to, and utilization of quality obstetric care is a major

contributing factor to

why most

maternal deaths occur

in

Nigeria.

Objectives

To assess the preparedness of frontline health care providers and facilities readiness for early detection and management of PE/E in seven states in

NigeriaTo analyze the gaps in providers’ competence to prevent, detect and manage PE/ETo determine facility capacity to manage PE/E

FACILITY INSIGHTS

EARLY DETECTION OF PE

Study area

Data collection : June

to August, 2015Study sites: Secondary, primary health care facilities

and a few tertiary Study Design: Quantitative research using a self- administered, semi-structured questionnaires. Provider AssessmentFacility Inventory

methodology

Summary of quantitative data

States

Health providerInterview Facility inventory Cross River5911Ebonyi

4620

Ondo

59

11

Kogi

44

8

Sokoto

61

11

Bauchi

55

14

Katsina

55

21

Total

379

96

HEALTH PROVIDERS' PREPAREDNESS findings

Type of facility (inventory)

Distribution of health provider respondents by: (n=376)

Level of health facility

Type of provider

PROVIDER KNOWLEDGE: A

pregnant woman was seen in the ANC at 12 weeks gestation with BP of 160/100 mmHg with no proteinuria. What is the diagnosis?

PROVIDER KNOWLEDGE:

What are the signs/symptoms of PE, SPE & E?

PROVIDER KNOWLEDGE: What drugs do you use to control hypertension in

clients with PE with mild to moderate hypertension?

PROVIDER PRACTICE: Assessing the risk of PE, screening for PE and advising client of danger signs of PE/E

PROVIDER KNOWLEDGE: Less than 21% were aware of prophylactic drugs for prevention of PE

PROVIDER KNOWLEDGE

Only 12% providers knew correct loading dose of MgSO4 (Pritchard regime) 10% knew the correct maintenance dose7% knew which drug used to manage MgSO4 toxicity<11% providers could list 3 ways

to monitor MgSO4 toxicity

FACILITY READINESS

FACILITY INVENTORY: How do facilities obtain MgSO4?

Availability of guidelines for

management of PE/E , ANC equipment and MgSO4

You see, the problem here is that, all these policies are available at the national level; but we the implementers don’t have or see the copies.

INVENTORY: Is MgSO4 used for treating Pre-eclampsia or eclampsia in this facility? (n-96)

Conclusion

Reduction in PE/E-related mortality and morbidity hinges on health care providers’ ability to recognize PE/E and have essential tools and commodities available to manage cases

Attention must be paid to the in-service training of frontline antenatal care providers (in Nigeria, these include nurses, midwives and community health extension workers) to be able to early detect, prevent and manage PE/E effectively. H

ealth care facilities should be equipped with essential

tools and live-saving commodities for managing women with PE/E.