TY - JOUR
T1 - The feasibility of task-sharing the identification, emergency treatment, and referral for women with pre-eclampsia by community health workers in India
AU - Charanthimath, Umesh
AU - Vidler, Marianne
AU - Katageri, Geetanjali
AU - Ramadurg, Umesh
AU - Karadiguddi, Chandrashekhar
AU - Kavi, Avinash
AU - Joshi, Anjali
AU - Mungarwadi, Geetanjali
AU - Bannale, Sheshidhar
AU - Rakaraddi, Sangamesh
AU - Sawchuck, Diane
AU - Qureshi, Rahat
AU - Sharma, Sumedha
AU - Payne, Beth A.
AU - Von Dadelszen, Peter
AU - Derman, Richard
AU - Magee, Laura A.
AU - Goudar, Shivaprasad
AU - Mallapur, Ashalata
AU - Bellad, Mrutyunjaya
AU - Bhutta, Zulfiqar
AU - Naik, Sheela
AU - Mulla, Anis
AU - Kamle, Namdev
AU - Dhamanekar, Vaibhav
AU - Drebit, Sharla K.
AU - Kariya, Chirag
AU - Lee, Tang
AU - Li, Jing
AU - Lui, Mansun
AU - Khowaja, Asif R.
AU - Tu, Domena K.
AU - Revankar, Amit
N1 - Funding Information:
This work is part of the University of British Columbia PRE-EMPT (Pre-eclampsia/Eclampsia, Monitoring, Prevention and Treatment) initiative supported by the Bill & Melinda Gates Foundation. We gratefully acknowledge contributions of the Community Level Interventions for Pre-eclampsia (CLIP) India Feasibility Working Group: Zulfiqar Bhutta, Sheela Naik, Anis Mulla, Namdev Kamle, Vaibhav Dhamanekar, Sharla K Drebit, Chirag Kariya, Tang Lee, Jing Li, Mansun Lui, Asif R Khowaja, Domena K. Tu and Amit Revankar. We also acknowledge the support of KLE University, JN Medical College, SN Medical College, University of British Columbia, Government of Karnataka, the district health administration of Belgaum and Bagalkote Districts. We also thank health centre staff and community leaders for their participation and their efforts in motivating community participation. We additionally acknowledge the research office staff for assisting in data translation and transcription. Finally, a special thanks to all the focus group and interview participants.
Funding Information:
This study was undertaken as a part of the PRE-EMPT (Pre-eclampsia Eclampsia Monitoring Prevention and Treatment) grant awarded to the University of British Columbia, a grantee of the Bill & Melinda Gates Foundation. The funding body had no role in the design or conduct of the study or in the reporting of the results. Publication charges for this supplement were funded by the University of British Columbia PRE-EMPT (Pre-eclampsia/Eclampsia, Monitoring, Prevention and Treatment) initiative supported by the Bill & Melinda Gates Foundation.
Publisher Copyright:
© 2018 The Author(s).
PY - 2018/6/22
Y1 - 2018/6/22
N2 - Background: Hypertensive disorders are the second highest direct obstetric cause of maternal death after haemorrhage, accounting for 14% of maternal deaths globally. Pregnancy hypertension contributes to maternal deaths, particularly in low- and middle-income countries, due to a scarcity of doctors providing evidence-based emergency obstetric care. Task-sharing some obstetric responsibilities may help to reduce the mortality rates. This study was conducted to assess acceptability by the community and other healthcare providers, for task-sharing by community health workers (CHW) in the identification and initial care in hypertensive disorders in pregnancy. Methods: This study was conducted in two districts of Karnataka state in south India. A total of 14 focus group discussions were convened with various community representatives: women of reproductive age (N = 6), male decision-makers (N = 2), female decision-makers (N = 3), and community leaders (N = 3). One-to-one interviews were held with medical officers (N = 2), private healthcare OBGYN specialists (N = 2), senior health administrators (N = 2), Taluka (county) health officers (N = 2), and obstetricians (N = 4). All data collection was facilitated by local researchers familiar with the setting and language. Data were subsequently transcribed, translated and analysed thematically using NVivo 10 software. Results: There was strong community support for home visits by CHW to measure the blood pressure of pregnant women; however, respondents were concerned about their knowledge, training and effectiveness. The treatment with oral antihypertensive agents and magnesium sulphate in emergencies was accepted by community representatives but medical practitioners and health administrators had reservations, and insisted on emergency transport to a higher facility. The most important barriers for task-sharing were concerns regarding insufficient training, limited availability of medications, the questionable validity of blood pressure devices, and the ability of CHW to correctly diagnose and intervene in cases of hypertensive disorders of pregnancy. Conclusion: Task-sharing to community-based health workers has potential to facilitate early diagnosis of the hypertensive disorders of pregnancy and assist in the provision of emergency care. We identified some facilitators and barriers for successful task-sharing of emergency obstetric care aimed at reducing mortality and morbidity due to hypertensive disorders of pregnancy.
AB - Background: Hypertensive disorders are the second highest direct obstetric cause of maternal death after haemorrhage, accounting for 14% of maternal deaths globally. Pregnancy hypertension contributes to maternal deaths, particularly in low- and middle-income countries, due to a scarcity of doctors providing evidence-based emergency obstetric care. Task-sharing some obstetric responsibilities may help to reduce the mortality rates. This study was conducted to assess acceptability by the community and other healthcare providers, for task-sharing by community health workers (CHW) in the identification and initial care in hypertensive disorders in pregnancy. Methods: This study was conducted in two districts of Karnataka state in south India. A total of 14 focus group discussions were convened with various community representatives: women of reproductive age (N = 6), male decision-makers (N = 2), female decision-makers (N = 3), and community leaders (N = 3). One-to-one interviews were held with medical officers (N = 2), private healthcare OBGYN specialists (N = 2), senior health administrators (N = 2), Taluka (county) health officers (N = 2), and obstetricians (N = 4). All data collection was facilitated by local researchers familiar with the setting and language. Data were subsequently transcribed, translated and analysed thematically using NVivo 10 software. Results: There was strong community support for home visits by CHW to measure the blood pressure of pregnant women; however, respondents were concerned about their knowledge, training and effectiveness. The treatment with oral antihypertensive agents and magnesium sulphate in emergencies was accepted by community representatives but medical practitioners and health administrators had reservations, and insisted on emergency transport to a higher facility. The most important barriers for task-sharing were concerns regarding insufficient training, limited availability of medications, the questionable validity of blood pressure devices, and the ability of CHW to correctly diagnose and intervene in cases of hypertensive disorders of pregnancy. Conclusion: Task-sharing to community-based health workers has potential to facilitate early diagnosis of the hypertensive disorders of pregnancy and assist in the provision of emergency care. We identified some facilitators and barriers for successful task-sharing of emergency obstetric care aimed at reducing mortality and morbidity due to hypertensive disorders of pregnancy.
KW - Antihypertensives
KW - Blood pressure
KW - Community health workers
KW - Magnesium sulphate
KW - Pre-eclampsia
KW - Task-sharing
UR - http://www.scopus.com/inward/record.url?scp=85049017405&partnerID=8YFLogxK
U2 - 10.1186/s12978-018-0532-5
DO - 10.1186/s12978-018-0532-5
M3 - Article
C2 - 29945662
AN - SCOPUS:85049017405
SN - 1742-4755
VL - 15
JO - Reproductive Health
JF - Reproductive Health
M1 - 101
ER -