53 Hypertensive disorders during pregnancy: Are we giving enough attention?: Preeclampsia in low and middle income countries

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• 作者：Nur Rahat Ara ; Kanij Sultana ; Sharif Hossain
• 刊名：Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health
• 出版年：2016
• 出版时间：July 2016
• 年：2016
• 卷：6
• 期：3
• 页码：202-203
• 全文大小：45 K

文摘

About 1200 women die each year in Bangladesh due to pre-eclampsia/eclampsia (PE/E), the second largest cause of maternal deaths. Providing high quality antenatal care (ANC) improves the prevention, early detection and management of PE/E. The correct knowledge of primary health care providers (PHCs), who are the first contact point for ANC clients, and reliable availability of drugs and equipment are important to prevent, detect and manage PE/E.

Objective

This study assessed the knowledge of health care providers and facility readiness to provide PE/E services.

Methods

Data were separated from a larger cross-sectional survey to understand the exact situation of policy, programs, facility readiness and community perceptions about PE/E in four districts of Bangladesh. A total of 289 service providers from 134 facilities were interviewed using pre-structured questionnaire. Facility inventory assessments were conducted in 134 facilities using a checklist. Data entry was conducted using CSPro and analysis was conducted using SAS software. During analysis, physicians were separated from other service providers (nurse, midwives and paramedics) for better representation.

Results

Analysis suggests that 16% of the physicians and 21% of other service providers were not able to correctly define hypertension. Service providers’ knowledge was assessed on three hypothetical situations related to diagnosing hypertensive disorders of pregnancy. (a) “A pregnant woman seen in the ANC clinic at 30 weeks gestation with blood pressure (BP) of 180/115 mmHg and proteinuria of 2++,” (b) “A pregnant woman seen in the antenatal clinic at 12 weeks gestation with BP of 160/100 mmHg with no proteinuria,” (c) “A pregnant woman found to have developed hypertension and significant proteinuria at 30 weeks of gestation. One week later, her partner brought her to the clinic with complaints of convulsion”. In each case we wanted to know the diagnosis. The service providers’ knowledge on correct diagnosis are presented in the Figure 1 below.

Physicians and other service providers had reasonably good knowledge on the signs and symptoms of PE/SPE/E. However many service providers, had poor knowledge on correct timing for introducing anti-hypertensives in pregnant women with hypertensive disorders. Just over half (53%) of physicians and 39% of other service providers knew when anti-hypertensive drugs should be initiated ⩾140/90–159/109). Regarding loading and maintenance doses of magnesium sulphate (MgSO₄) as per the Pritchard regimen, 35% and 36% of physicians knew the loading and maintenance doses of MgSO₄ respectively while other service provider’s knowledge was very poor on this. All PHC facilities and some secondary facilities had shortages of one or more drugs and supplies essential to providing PE/E services.

Conclusions

Gaps clearly remain in both knowledge and skills of all levels of health care providers. While majority know the diagnosis of eclampsia and chronic hypertension –reported management of when to start anti-hypertensives and dosage of magnesium sulphate is lacking. Moreover ensuring the supply of essential drugs and equipment is a prerequisite to providing quality PE/E services. Improving knowledge and skills of PHC providers is critical to reduce morbidity and mortality due to hypertensive disorders in pregnancy.