Prevention and management of severe pre-eclampsia/eclampsia in Afghanistan

BMC Pregnancy and Childbirth

Jelle Stekelenburg¹  Jos van Roosmalen⁶  Patricia Bailey³  Partamin Zainullah²  Sheena Currie⁵  Hannah Tappis⁴  Adrienne Kols⁵  Nasratullah Ansari²  Young Mi Kim⁵ 

[1] Department of Obstetrics & Gynecology, Leeuwarden Medical Center, Leeuwarden, The Netherlands;Jhpiego/Afghanistan, an affiliate of Johns Hopkins University, Baltimore, MD, USA;FHI 360 and Averting Maternal Death and Disability, Washington, USA;Johns Hopkins Bloomberg School of Public Health (JHSPH), Baltimore, USA;Jhpiego/USA, an affiliate of Johns Hopkins University, 1615 Thames Street, Baltimore, MD 21231, USA;Free University, Amsterdam, The Netherlands

关键词: Afghanistan;    Emergency obstetric care;    Magnesium sulfate;    Eclampsia;    Pre-eclampsia;   

Others  :  1137850
DOI  :  10.1186/1471-2393-13-186

 received in 2013-04-02, accepted in 2013-10-10,  发布年份 2013

【 摘 要 】

Background

An evidence-based strategy exists to reduce maternal morbidity and mortality associated with severe pre-eclampsia/eclampsia (PE/E), but it may be difficult to implement in low-resource settings. This study examines whether facilities that provide emergency obstetric and newborn care (EmONC) in Afghanistan have the capacity to manage severe PE/E cases.

Methods

A further analysis was conducted of the 2009–10 Afghanistan EmONC Needs Assessment. Assessors observed equipment and supplies available, and services provided at 78 of the 127 facilities offering comprehensive EmONC services and interviewed 224 providers. The providers also completed a written case scenario on severe PE/E. Descriptive statistics were used to summarize facility and provider characteristics. Student t-test, one-way ANOVA, and chi-square tests were performed to determine whether there were significant differences between facility types, doctors and midwives, and trained and untrained providers.

Results

The median number of severe PE/E cases in the past year was just 5 (range 0–42) at comprehensive health centers (CHCs) and district hospitals, compared with 44 (range 0–130) at provincial hospitals and 108 (range 32–540) at regional and specialized hospitals (p < 0.001). Most facilities had the drugs and supplies needed to treat severe PE/E, including the preferred anticonvulsant, magnesium sulfate (MgSO₄). One-third of the smallest facilities and half of larger facilities reported administering a second-line drug, diazepam, in some cases. In the case scenario, 96% of doctors and 89% of midwives recognized that MgSO₄ should be used to manage severe PE/E, but 42% of doctors and 58% of midwives also thought diazepam had a role to play. Providers who were trained on the use of MgSO₄ scored significantly higher than untrained providers on six of 20 items in the case scenario. Providers at larger facilities significantly outscored those at smaller facilities on five items. There was a significant difference between doctors and midwives on only one item: continued use of anti-hypertensives after convulsions are controlled.

Conclusions

Drugs and supplies needed to treat severe PE/E are widely available at EmONC facilities in Afghanistan, but providers lack knowledge in some areas, especially concerning the use of MgSO₄ and diazepam. Providers who have specialized training or work at larger facilities are better at managing cases of severe PE/E. The findings suggest a need to clarify service delivery guidelines, offer refresher training, and reinforce best practices with supervision and reinforcement.

【 授权许可】

   
2013 Kim et al.; licensee BioMed Central Ltd.

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