117. Quality of care for hypertensive disorders in pregnancy in primary health care settings in Southern Nigeria: Women’s perspectives from capacity enhancement interventions

Abstract

Introduction Quality of care, defined by WHO as effective, efficient, accessible, patient-centered, equitable and safe care, may have a multiplier effect on positive maternal and neonatal outcomes. No study in Nigeria has explored post-intervention experiences of women with hypertensive disorders in pregnancy (HDPs) on care quality at primary and referral levels. Objectives To understand the quality of care received by women with HDP during antenatal care (ANC). Methods Case studies were conducted with thirty-four women whose pregnancies were complicated by hypertension and managed by community health extension workers (CHEWs) until delivery, as part of implementation research on task-shifting. Results were analyzed with Nvivo 11. Results Diagnosis and treatment of HDP were based on WHO recommendation- blood pressure (BP) and urine protein measurements. Women identified and managed for HDP consistently reported receiving feedback and counselling on their BP measurements, and less frequently on urine protein tests. Although CHEWs prescribed antihypertensives, women could not recall the specific medications given. Often referred to higher-level hospitals within reasonable distance given antihypertensives unavailability, women lament about the long distance to referral facilities which leads to delays in accessing treatment. While some women recounted satisfactory provider-client interactions, others expressed negative experiences, including disrespect and abuse, which led to the refusal of treatment. The absence of a perceived particular caring provider often leads to women declining care. Some women reported that providers prescribed antihypertensives that were difficult to purchase locally. Gaps in communicating diagnosis to patients resulted in women being aware of their HDP status, but unaware of the seriousness of the conditions. Conclusions Despite positive experience with of evidence-based quality care, drug availability and supply, referral mechanisms, communication on the types of HDPs and names of prescribed drugs were generally insufficient. CHEWs should be mentored and supported to provide patient-centered care with respect for human dignity.