Early Detection of Preeclampsia in Low-Resource Setting: Examining Risk Factors, Mean Arterial Blood Pressure (MAP), Body Mass Index (BMI), and Urine Protein at Public Primary Health Care

BackgroundPublic primary health care (PHC) facilities are for many individuals the first point of contact with the formal health care system. These facilities are managed by professional nurses or clinical officers who are recognised to play a key role in implementing health sector reforms and facilitating initiatives aimed at strengthening community involvement. Little in-depth research exists about the dimensions and challenges of these managers’ jobs, or on the impact of decentralisation on their roles and responsibilities. In this paper, we describe the roles and responsibilities of PHC managers–or ‘in-charges’ in Kenya, and their challenges and coping strategies, under accelerated devolution.MethodsThe data presented in this paper is part of a wider set of activities aimed at understanding governance changes under devolution in Kenya, under the umbrella of a ‘learning site’. A learning site is a long term process of collaboration between health managers and researchers deciding together on key health system questions and interventions. Data were collected through seven formal in depth interviews and observations at four PHC facilities as well as eight in depth interviews and informal interactions with sub-county managers from June 2013 to July 2014. Drawing on the Aragon framework of organisation capacity we discuss the multiple accountabilities, daily routines, challenges and coping strategies among PHC facility managers.ResultsPHC in-charges perform complex and diverse roles in a difficult environment with relatively little formal preparation. Their key concerns are lack of job clarity and preparedness, the difficulty of balancing multidirectional accountability responsibilities amidst significant resource shortages, and remuneration anxieties. We show that day-to-day management in an environment of resource constraints and uncertainty requires PHC in-charges who are resilient, reflective, and continuously able to learn and adapt. We highlight the importance of leadership development including the building of critical soft skills such as relationship building.

Preeclampsia is a pregnancy hypertension disorder that significantly affects the morbidity and mortality of mothers worldwide. Preeclampsia occurs in 5-7% of all pregnancies and is the leading cause of maternal mortality in developing countries. The purpose of this community devotion to detect preeclampsia in pregnant women with body mass index, ROT (Rool Over Test) and, MAP (Mean Arterial Pressure). Method of community service by conducting a collection of pregnant mothers at local midwives in PMB Sumarti, SST at Kapor village, Burneh, Bangkalan, after that gathered all pregnant women on the day of the specified and explained the purpose of devotion and counseling about preeclampsia in pregnant women, continued weighing weight, measuring height and measured Body Mass Index (BMI), performing blood pressure measurements in pregnant women through ROT and MAP and performed Interviews with providing questionnaires, giving an explanation of preeclampsia early detection on pregnant women, explaining how to prevent and what to do if preeclampsia, monitoring every month until birth. The results of this community devotion from 16 pregnant mothers who performed preeclampsia detection with BMI, ROT, and MAP were obtained 3 (18.75)% positive preeclampsia because there are 2 positive signs after the examination of the sign seen from MAP ≥ 90 and BMI ≥ 30. The Conclusion that early detection of preeclampsia is necessary to prevent complications during pregnancy, childbirth and postpartum.

Background Preeclampsia occurs in up to 5% of all pregnancies, in 10% of first pregnancies, and 20–25% of women with a history of chronic hypertension. Objective This study aims to assess the determinants of preeclampsia among women attending delivery services in public hospitals of central Tigray, Ethiopia. Methods Hospital-based unmatched case-control study design was conducted. Women diagnosed with preeclampsia were cases, and women who had no preeclampsia were controls admitted to the same hospitals. A systematic sampling technique was used to select study participants for both cases and controls. The data were entered in EPI data 3.1 statistical software and, then, exported to SPSS Version 22 for cleaning and analysis. Results Family history of hypertension (AOR: 2.60; 95% CI: 1.15, 5.92), family history of preeclampsia (AOR: 5.24; 95% CI: 1.85, 14.80), history of diabetes mellitus (AOR: 4.31; 95% CI: 1.66, 11.21), anemia (AOR: 3.23; 95% CI: 1.18, 8.86), history of preeclampsia on prior pregnancy (AOR: 5.55; 95% CI: 1.80, 17.10), primigravida (AOR: 5.41; 95% CI: 2.85, 10.29), drinking alcohol during pregnancy (AOR: 4.06; 95% CI: 2.20, 7.52), and vegetable intake during pregnancy (AOR: 0.39; 95% CI: 0.21, 0.74) were significantly associated with preeclampsia. Conclusion This study concludes that a family history of hypertension and preeclampsia; a history of diabetes mellitus and anemia; and a history of preeclampsia on prior pregnancy, primigravida, and drinking alcohol were found to be risk factors for preeclampsia. However, vegetable intake was found to be a protective factor for the development of preeclampsia.

Dexmedetomidine sedation for radiological imaging studies is a relatively recent application for this drug. Previous studies have demonstrated some haemodynamic effects of dexmedetomidine, however, the effects remain poorly described in children. The aim of this study was to better define the effect of age on heart rate (HR) and blood pressure changes in children sedated for CT imaging with dexmedetomidine. At our institution dexmedetomidine is given for sedation for CT imaging as a bolus of 2 mcg.kg(-1) over 10 min followed by an infusion of 1 mcg.kg(-1).h(-1) with a second bolus if required. Detailed quality assurance data sheets document patient demographics, sedation outcomes, adverse events, and hemodynamic data are recorded for each patient. A total of 250 patients (range 0.1-10.6 years) received dexmedetomidine. ANOVA revealed strong evidence for changes in HR and mean arterial blood pressure during bolus and infusion relative to presedation values (P < 0.001). These changes were apparent in each age group and similar between groups. During the first bolus and during infusion, 82% and 93% of patients respectively were within the age-based normal range for HR. For mean arterial blood pressure, 70% of patients were within the normal range during first bolus and 78% during infusion. In the pediatric population studied, intravenous dexmedetomidine sedation was associated with modest fluctuations in HR and blood pressure. Hemodynamic changes were independent of age, required no pharmacologic interventions and did not result in any adverse events. By anticipating these possible hemodynamic effects and avoiding dexmedetomidine in those patients who may not tolerate such fluctuations in HR and blood pressure, dexmedetomidine is an appropriate sedative for children undergoing CT imaging.

INTRODUCTION: The early detection of the risk of PE may improve the outcome by increasing patient surveillance or by initiating a therapeutic intervention. After taking family history and medical history of obstetric events, hypertension, renal disease, or thrombophilia can help to stratify the risk of hypertensive disorders of pregnancy and history alone will identify fewer than half the women who later develop pre-eclampsia. Routine screening for specific risk factors for pre-eclampsia i.e. nullipara, older age, high body mass index (BMI), family history of pre-eclampsia, multiple pregnancy, more than 10 years between pregnancies, and a personal history of pre-eclampsia is advised.&#x0D; MATERIAL AND METHODS:Detail history of all the participants was taken which comprises of age, parity, and past obstetric complications. Medical history was taken and pregnant ladies. Blood pressure measurement was done by standard mercury sphygmomanometer. Mean arterial pressure was calculated by Burton’s formula. Waist circumference was measured midway between the lowest rib and the iliac crest. Waist circumference of &gt;80 cm was used as a cut off.&#x0D; RESULTS: Majority of the patients who developed pre eclampsia were in the age group of 20 to 25 years (66%).in our study primigravida were 60% who developed pre eclampsia. In our study 40 (20%) had mean arterial pressure &gt;90 mmHg 22 developed preeclampsia while out of 160 (80%) patients having mean arterial pressure &lt;90 mmHg 24 developed preeclampsia. sensitivity, specificity, positive predictive value and negative predictive value was 47.83 %, 88.31 %, 55.00% and 85.00 % respectively.86 women had waist circumference &gt;80 cm out of 80 women 34 developed preeclampsia while 52 were normotensive. Out of 114 women having waist circumference &lt;80 cm 12 developed preeclampsia while 102 remain normotensive with sensitivity, specificity, positive predictive value and negative predictive value of 73.91%, 66.23%, 39.53% and 89.47% respectively.&#x0D; CONCLUSION: Mean arterial pressure is a good predictor of preeclampsia with high specificity and negative predictive value. Waist circumference is a simple, and reproducible method with high negative predictive value.

PP114. First trimester multi-parameter prediction of pre-eclampsia

Laboratory studies suggest elevated blood pressure after resuscitation from cardiac arrest may be protective; however, clinical data are limited. We sought to test the hypothesis that elevated postresuscitation mean arterial blood pressure is associated with neurologic outcome. Preplanned analysis of a prospective cohort study. Six academic hospitals in the United States. Adult, nontraumatic cardiac arrest patients treated with targeted temperature management after return of spontaneous circulation. Mean arterial blood pressure was measured noninvasively after return of spontaneous circulation and every hour during the initial 6 hours after return of spontaneous circulation. We calculated the mean arterial blood pressure and a priori dichotomized subjects into two groups: mean arterial blood pressure 70-90 and greater than 90 mm Hg. The primary outcome was good neurologic function, defined as a modified Rankin Scale less than or equal to 3. The modified Rankin Scale was prospectively determined at hospital discharge. Of the 269 patients included, 159 (59%) had a mean arterial blood pressure greater than 90 mm Hg. Good neurologic function at hospital discharge occurred in 30% of patients in the entire cohort and was significantly higher in patients with a mean arterial blood pressure greater than 90 mm Hg (42%) as compared with mean arterial blood pressure 70-90 mm Hg (15%) (absolute risk difference, 27%; 95% CI, 17-37%). In a multivariable Poisson regression model adjusting for potential confounders, mean arterial blood pressure greater than 90 mm Hg was associated with good neurologic function (adjusted relative risk, 2.46; 95% CI; 2.09-2.88). Over ascending ranges of mean arterial blood pressure, there was a dose-response increase in probability of good neurologic outcome, with mean arterial blood pressure greater than 110 mm Hg having the strongest association (adjusted relative risk, 2.97; 95% CI, 1.86-4.76). Elevated blood pressure during the initial 6 hours after resuscitation from cardiac arrest was independently associated with good neurologic function at hospital discharge. Further investigation is warranted to determine if targeting an elevated mean arterial blood pressure would improve neurologic outcome after cardiac arrest.

Malaria infection is one of the most significant public health problems and the leading cause of global morbidity and mortality. Pregnant women and under-five (U5) children are particularly at risk in areas where malaria is endemic. The U5 children account for about 80% of all malaria-related deaths. This study aims to assess the adherence to the national guidelines for administering seasonal malaria chemoprevention (SMC) in U5 children by healthcare workers (HCWs) working in public Primary Health Care (PHC) facilities in Edo State, Nigeria. A cross-sectional study design was employed to assess the sociodemographic characteristics, awareness, and prescription of chemo-preventive therapy for the U5 by 200 HCWs in public PHC facilities in Edo State, with the aid of the researcher-designed pretested, self-administered, semi-structured questionnaire. Descriptive and inferential data analyses were carried out using the IBM SPSS version 20 software. All p-values had two tails and were deemed statistically significant if &lt; 0.05. The majority of HCWs (71.5%) did not adhere to the national guideline for using chemo-preventive treatment for malaria in children, and there was a statistically significant relationship between many sociodemographic factors and compliance. The length of the HCW’s work (in years) was a critical indicator of compliance with the recommendation. In conclusion, the use of malaria chemo-preventive treatment in accordance with the Nigerian malaria diagnosis and treatment guidelines is being practiced ineffectively by HCWs in public PHCs in Edo State. A longer period of employment (in years) predicts a better practice. Keywords: Implementation, Nigeria, Primary healthcare (PHC), Seasonal malaria chemoprevention (SMC), Under-five children.

Inter-rater agreement of scores to assess quality of care in public sector primary health care facilities – A pattern of performance

Background: Lassa fever is endemic in Nigeria and health care workers are at a high risk of contracting and transmitting the infection. This study compares Lassa fever prevention practices among health care providers in public and private Primary Health Care facilities in Jos.Methods: The study used a comparative cross-sectional design to study health care workers in 29 Primary Health Care facilities selected using a two-stage sampling technique. All health care workers who attended to patients were interviewed using a semistructured interviewer-administered questionnaire. Data were analysed using Statistical Package for Social Sciences version 23 and a p-value of ≤ 0.5 was considered statistically significant.Results: Majority of the respondents had neither received on-the-job training on Lassa fever prevention (91.9%) nor Universal Standard Precautions (88.7%). Private Primary Health Care facilities had better supplies and equipment for Lassa fever prevention compared to their public counterparts. Majority (65.8%) of respondents had poor Lassa fever prevention practices and this was worse in the private (75.4%) than the public (55.6%) facilities. No facility met all the requirements for Lassa fever prevention. Training had a statistically significant association with good practice among public Primary Health Care facilities. Conclusion: Noncompliance with Lassa fever prevention practice is still common in Primary Health Care facilities. This is worse in private facilities. Continuous training and improved supplies of materials and equipment are necessary for effective Lassa fever prevention among these health care providers.

In the context of the national debate on the extension of health insurance to farming households in Senegal, information on 504 households and 18 public primary health care (PHC) facilities was collected to analyse health care utilisation in an area where people live on 1.17 USD per day and where only 6% have health insurance coverage. Despite the high level of poverty, 84% of the individuals sought treatment from a qualified health provider during their last illness. The high rate of utilisation in the area is found to be attributable to the characteristics of the PHC facilities. Indeed, PHC facilities are highly accessible and offer good medical services at a low price. The low price of medical services in the sample explains why the demand for curative care is found to be price-inelastic. This latter result suggests that policies that will reduce the price of medical services to increase the health care use are not likely to be effective.

BackgroundThe South African government is striving for universal access to HIV counselling and testing (HCT), a fundamental component of HIV care and prevention. In the Cape Town district, Western Cape Province of South Africa, HCT is provided free of charge at publically funded primary health care (PHC) facilities and through non-governmental organizations (NGOs). This study investigated the availability and accessibility of HCT services; comparing health seeking behaviour and client experiences of HCT across public PHC facilities (fixed sites) and NGO mobile services.MethodsThis qualitative study used semi-structured interviews. Systematic sampling was used to select 16 participants who accessed HCT in either a PHC facility (8) or a NGO mobile service (8). Interviews, conducted between March and June 2011, were digitally recorded, transcribed and where required, translated into English. Constant comparative and thematic analysis was used to identify common and divergent responses and themes in relation to the key questions (reasons for testing, choice of service provider and experience of HCT).ResultsThe sample consisted of 12 females and 4 males with an age range of 19–60 years (median age 28 years). Motivations for accessing health facilities and NGO services were similar; opportunity to test, being affected by HIV and a perceived personal risk for contracting HIV. Participants chose a particular service provider based on accessibility, familiarity with and acceptability of that service. Experiences of both services were largely positive, though instances of poor staff attitude and long waiting times were reported at PHC facilities. Those attending NGO services reported shorter waiting times and overall positive testing experiences. Concerns about lack of adequate privacy and associated stigma were expressed about both services.ConclusionsRealised access to HCT is dependent on availability and acceptability of HCT services. Those who utilised either a NGO mobile service or a public PHC facility perceived both service types as available and acceptable. Mobile NGO services provided an accessible opportunity for those who would otherwise not have tested at that time. Policy makers should consider the perceptions and experiences of those accessing HCT services when increasing access to HCT.

This systematic review investigated available evidence on the stand-alone and incremental predictive performance of ophthalmic artery Doppler (OAD) for pre-eclampsia. Systematic review. We conducted a literature search from PubMed (Medline), the Cochrane CENTRAL, EMBASE and Scopus from inception to 8 April 2025. Studies eligible for inclusion were prospective or retrospective cohort studies, case-control studies or randomised controlled trials that reported on the predictive performance of OAD for pre-eclampsia in singleton pregnancies; and conducted in either high-income country (HIC) or low- and middle-income country (LMIC). Two reviewers independently screened and assessed articles for inclusion. One reviewer then extracted data using a standardised data extraction sheet, and any uncertainties were discussed with a second reviewer. The Prediction model Risk of Bias Assessment Tool was used for quality and risk of bias assessment. Findings were summarised and reported according to the Preferred Reporting Items for Systematic Review and Meta-Analyses statement and synthesised qualitatively. We identified and included 11 observational studies (3 from HIC and 8 from LMICs) with a total of 12 150 singleton pregnancies, of which 517 (4.3%) were complicated by pre-eclampsia at end of follow-up. The included studies were of varied quality, with three at low risk of bias, four at unclear risk and four at high risk. No interventional study was identified. Three studies (27.3%) recruited high-risk pregnancies (defined according to the American College of Obstetricians and Gynecologists (ACOG) criteria as one or more of the following: chronic hypertension, personal or family history of pre-eclampsia, early (≤18 years) or late (≥40 years) first pregnancy, primipaternity, chronic kidney disease, increased body mass index >30 kg/m2, presence of diabetes mellitus prior to pregnancy, autoimmune disease and thrombophilia), while eight studies (72.7%) recruited undetermined risk pregnancies. Stand-alone performance of OAD (interpreted by area under the receiver operating curve at 95% CI) showed that in the first trimester, the peak systolic velocity (PSV) ratio demonstrated very good predictive ability (0.97, 95% CI 0.92 to 1.0) (n=1 study), and the second PSV (PSV2) demonstrated very good predictive ability (0.91, 95% CI 0.82 to 0.99) (n=1 study). Also, PSV2 demonstrated fair predictive ability (0.61, 95% CI 0.42 to 0.79; and 0.53, 95% CI 0.40 to 0.66) for early and late pre-eclampsia, respectively (n=1 study). In the second trimester, the PSV ratio demonstrated very good predictive ability (0.88, 95% CI 0.84 to 0.91) (n=1 study), and PSV2 demonstrated good predictive ability (0.73, 95% CI 0.66 to 0.81; and 0.76, 95% CI 0.71 to 0.81) for pre-eclampsia (n=2 studies). In the third trimester, the PSV ratio demonstrated good predictive ability (0.82, 95% CI 0.73 to 0.89; and 0.77, 95% CI 0.71 to 0.82) for preterm and term pre-eclampsia, respectively (n=1 study). Also, PSV2 demonstrated good predictive ability 0.70 (0.57 to 0.84) (n=1 study).Subsequently, in the second trimester, PSV ratio demonstrated better incremental predictive performance than uterine artery pulsatility index for preterm pre-eclampsia, when added to maternal factors and mean arterial pressure (MAP) (56.1%-80.2% vs 56.1%-74.8% detection rate (DR) at 10% FPR) (n=1 study). Also in the third trimester, adding PSV ratio to maternal factors and MAP was superior to soluble fms-like tyrosine kinase-1/placental growth factor ratio in predicting pre-eclampsia at <3 weeks after screening (96.7% vs 70% DR, p value 0.027) (n=1 study). The ophthalmic artery PSV ratio and PSV2 are potentially useful ultrasound markers for pre-eclampsia prediction. Particularly in the second trimester, adding PSV ratio to maternal factors and MAP significantly improved the prediction of preterm pre-eclampsia. Given the burden of early and preterm pre-eclampsia in low-resource settings, OAD appears promising for pre-eclampsia screening in these settings where serum biomarkers may be expensive and inaccessible, and where uterine artery Doppler may not be technically feasible. However, the extent to which this novel marker is implemented in routine antenatal care should be guided by larger and sufficiently powered validation studies. CRD42022324569.

Hypertensive disorders during pregnancy

OS088. First trimester triple vascular test for pre-eclampsia prediction