Feasibility of task-sharing with community health workers for the identification, emergency management and referral of women with pre-eclampsia, in Mozambique

Reproductive Health

Mohsin Sidat¹  Marianne Vidler²  Peter von Dadelszen³  Helena Boene⁴  Salésio Macuacua⁴  Anifa Valá⁴  Orvalho Augusto⁵  Khátia Munguambe⁵  Esperança Sevene⁶  Eusébio Macete⁷  Quinhas Fernandes⁸  Cassimo Bique⁹ 

[1] Department of Community Health, Faculty of Medicine,, Universidade Eduardo Mondlane, Maputo, Mozambique;Department of Obstetrics and Gynaecology, and The Child and Family Research Unit, University of British Columbia, Vancouver, BC, Canada;King’s College London, London, UK;Maternal Health Unit, Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique;Maternal Health Unit, Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique;Department of Community Health, Faculty of Medicine,, Universidade Eduardo Mondlane, Maputo, Mozambique;Maternal Health Unit, Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique;Department of Physiologic Science, Clinical Pharmacology, Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique;Maternal Health Unit, Centro de Investigação em Saúde da Manhiça (CISM), Manhiça, Mozambique;Ministério da Saúde, Maputo, Mozambique;Ministério da Saúde, Maputo, Mozambique;Ministério da Saúde, Maputo, Mozambique;Hospital Central de Maputo, Maputo, Mozambique;

关键词: Task-sharing;    Community health workers;    Pre-eclampsia;    Maternal mortality;    Mozambique;   

DOI  :  10.1186/s12978-021-01192-x

来源: Springer

【 摘 要 】

BackgroundMaternal mortality is an important public health problem in low-income countries. Delays in reaching health facilities and insufficient health care professionals call for innovative community-level solutions. There is limited evidence on the role of community health workers in the management of pregnancy complications. This study aimed to describe the feasibility of task-sharing the initial screening and initiation of obstetric emergency care for pre-eclampsia/eclampsia from the primary healthcare providers to community health workers in Mozambique and document healthcare facility preparedness to respond to referrals.MethodThe study took place in Maputo and Gaza Provinces in southern Mozambique and aimed to inform the Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomized controlled trial. This was a mixed-methods study. The quantitative data was collected through self-administered questionnaires completed by community health workers and a health facility survey; this data was analysed using Stata v13. The qualitative data was collected through focus group discussions and in-depth interviews with various community groups, health care providers, and policymakers. All discussions were audio-recorded and transcribed verbatim prior to thematic analysis using QSR NVivo 10. Data collection was complemented by reviewing existing documents regarding maternal health and community health worker policies, guidelines, reports and manuals.ResultsCommunity health workers in Mozambique were trained to identify the basic danger signs of pregnancy; however, they have not been trained to manage obstetric emergencies. Furthermore, barriers at health facilities were identified, including lack of equipment, shortage of supervisors, and irregular drug availability. All primary and the majority of secondary-level facilities (57%) do not provide blood transfusions or have surgical capacity, and thus such cases must be referred to the tertiary-level. Although most healthcare facilities (96%) had access to an ambulance for referrals, no transport was available from the community to the healthcare facility.ConclusionsThis study showed that task-sharing for screening and pre-referral management of pre-eclampsia and eclampsia were deemed feasible and acceptable at the community-level, but an effort should be in place to address challenges at the health system level.

【 授权许可】

CC BY