45 Persisting challenges in the provision of quality obstetric care to women with pre-eclampsia and eclampsia in nigeria: Assessment of health providers’ preparedness and facility readiness

Abstract

Introduction In Nigeria, pre-eclampsia and eclampsia (PE/E) are leading causes of maternal and perinatal mortality and morbidity. Screening, early antenatal detection, and timely management are the most effective for preventing morbidity and mortality from these pregnancy-related disorders. Objective This study assessed the preparedness of frontline health care providers and facilities readiness for early detection and management of PE/E in seven states in Nigeria. Methods From each of the six geo-political zones in Nigeria, at least one state was selected for a landscape analysis on PE/E. In each study state, secondary and primary health care facilities were purposively selected and assessed in terms of provider knowledge, attitude and practice as well as availability of essential tools, drugs and commodities at facilities for the prevention, early detection and appropriate management of PE/E over a 3-month period (June to August, 2016). Three hundred and seventy-nine (379) health care providers and ninety-six (96) health facilities were assessed using a self- administered, semi-structured questionnaires. Data were entered using Epi Info and were exported to SPSS software for analysis. Results Providers’ knowledge on PE/E was grossly inadequate and skills were similarly lacking. Essential tools such as blood pressure measuring machines (sphygmomanometers and stethoscopes), urine dipsticks for rapid assessment of urine sample for significant proteinuria, drugs including magnesium sulphate (MgSO 4 ) and anti-hypertensives were not available in the majority of the facilities evaluated. Less than one third (31%) of all facilities had all the necessary equipment and supplies, a little more than one-third (34%) had MgSO 4 available in the labor and maternity units and less than one-fifth (19%) of all facilities had correct guidelines in place for managing PE/E, including for the administration of MgSO 4 . Only 12% and 10% of health care providers, respectively, knew the correct loading dose and maintenance doses of MgSO 4 , and none of the providers interviewed knew the blood pressure threshold for introducing anti-hypertensives in women with hypertensive disorders in pregnancy. Conclusions Reduction in PE/E-related mortality and morbidity hinges on health care providers’ ability to recognize PE/E and have essential tools and commodities available to manage cases; the current state of frontline providers’ knowledge and facility readiness would make this reduction near impossible. In order to improve health outcomes relating to PE/E, attention must be paid to the in-service training of frontline antenatal care providers (in Nigeria, these include nurses, midwives and community health extension workers). Similarly, health care facilities should be equipped with essentials tools and live-saving commodities for managing women with PE/E.