Abstract
BackgroundMozambique has drastically improved an array of health indicators in recent years, including maternal mortality rates which decreased 63 % from 1990–2013 but the rates still high. Pre-eclampsia and eclampsia constitute the third major cause of maternal death in the country. Women in rural areas, with limited access to health facilities are at greatest risk. This study aimed to assess the current state of knowledge and the regular practices regarding pre-eclampsia and eclampsia by community health workers in southern Mozambique.MethodsThis mixed methods study was conducted from 2013 to 2014, in Maputo and Gaza Provinces, southern Mozambique. Self-administered questionnaires, in-depth interviews and focus group discussions were conducted with CHWs, district medical officers, community health workers’ supervisors, Gynaecologists-Obstetricians and matrons. Quantitative data were entered into a database written in REDCap and subsequently analyzed using Stata 13. Qualitative data was imported into NVivo10 for thematic analysis.ResultsNinety-three percent of CHW had some awareness of pregnancy complications. Forty-one percent were able to describe the signs and symptoms of hypertension. In cases of eclampsia, CHWs reported to immediately refer the women. The vast majority of the CHWs surveyed reported that they could neither measure blood pressure nor proteinuria (90 %). Fewer reported confidence in providing oral antihypertensives (14 %) or injections in pregnancy (5 %). The other community health care providers are matrons. They do not formally offer health services, but assists pregnant women in case of an emergency. Regarding pre-eclampsia and eclampsia, matrons were unable to recognise these biomedical terms.ConclusionsAlthough CHWs are aware of pregnancy complications, they hold limited knowledge specific to pre-eclampsia and eclampsia. There is a need to promote studies to evaluate the impact of enhancing their training to include additional content related to the identification and management of pre-eclampsia and eclampsia.Electronic supplementary materialThe online version of this article (doi:10.1186/s12978-016-0220-2) contains supplementary material, which is available to authorized users.
Highlights
Mozambique has drastically improved an array of health indicators in recent years, including maternal mortality rates which decreased 63 % from 1990–2013 but the rates still high
This study aimed to assess the current state of knowledge and routine practices regarding hypertensive disorders of pregnancy (HDP) by community health workers (CHW)
Ninety-three percent of CHW had some awareness of pregnancy complications and forty-one percent were able to describe the signs and symptoms of hypertension
Summary
Mozambique has drastically improved an array of health indicators in recent years, including maternal mortality rates which decreased 63 % from 1990–2013 but the rates still high. Pre-eclampsia and eclampsia constitute the third major cause of maternal death in the country. Mozambique has progressively improved an array of health indicators over the last two decades, including a 63 % decrease in maternal mortality from 1,300 in 1990 to 480 deaths per 100,000 live births in 2013 [1]. Women still have a 1 in 40 lifetime risk of maternal death [2] due to avoidable causes including postpartum hemorrhage, maternal sepsis and pre-eclampsia and eclampsia that still need to be addressed [3, 4]. To overcome the shortage of medical doctors in the country, nurses and clinical officers have been trained to take some of their duties [8]
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