311. Challenges to using antihypertensive drug during pregnancy by primary health care provider in primary and secondary level facility in Bangladesh

Abstract

One of the most life threatening condition for pregnant women is hypertensive disorder in pregnancy. In Bangladesh, pre-eclampsia and eclampsia causes 20% of death, the second largest cause of maternal mortality. The correct knowledge of primary health care providers (PHCs), who are the first contact point for antenatal care (ANC) clients, are important to detect and manage hypertension in pregnancy. We examined primary health care provider’s knowledge and current management practices to identify and treatment of hypertensive disorders in pregnancy. This is a cross sectional study. A semi-structured questionnaire survey was conducted among primary health care providers those are provided services at primary level from May to June 2017 in 4 upazilla of Comilla and Tangail District. Total 101 primary health care providers including Family Welfare Visitor (FWV), Sub Assistant Community Medical Officer (SACMO) and Nurses were interviewed. Data entry was conducted using CSPro and analysis was conducted using stata software version 12.0. More than 90% primary health care providers clearly define the sign/symptoms and consequences of pre- eclampsia/eclampsia. Only 30% primary health care providers clearly classify the hypertensive disorders in pregnancy. 54% PHC provider said, it is difficult to identify hypertension in the facility due to 37% service provider did not measure blood pressure. 80% FWV/Nurses and 90% SACMO heard about alpha-methyldopa as an anti-hypertensive drug during pregnancy. FWV/Nurse and SACMO have idea about Labetelol (18% vs. 8%) and Nifedipine (6% vs. 11%) and almost all of the service provider did not know about the proper dose and time schedule of use. This study found gaps in knowledge regarding classification of hypertensive disorders in pregnancy, anti- hypertensive dugs, dose and schedule. PHC providers should equipped with the appropriate knowledge, skills and training for the management of hypertension in pregnancy.