Abstract
BackgroundPreeclampsia and eclampsia (PE/E) are major contributors to maternal and neonatal deaths in developing countries, associated with 10–15% of direct maternal deaths and nearly a quarter of stillbirths and newborn deaths, many of which are preventable with improved care. We present results related to WHO-recommended interventions for screening and management of PE/E during antenatal care (ANC) and labor and delivery (L & D) from a study conducted in six sub-Saharan African countries.MethodsFrom 2010 to 2012, cross-sectional studies which directly observed provision of ANC and L & D services in six sub-Saharan African countries were conducted. Results from 643 health facilities of different levels in Ethiopia (n = 19), Kenya (n = 509), Madagascar (n = 36), Mozambique (n = 46), Rwanda (n = 72), and Tanzania (n = 52), were combined for this analysis. While studies were sampled separately in each country, all used standardized observation checklists and inventory assessment tools.Results2920 women receiving ANC and 2689 women in L & D were observed. Thirty-nine percent of ANC clients were asked about PE/E danger signs, and 68% had their blood pressure (BP) taken correctly (range 48–96%). Roughly half (46%) underwent testing for proteinuria. Twenty-three percent of women in L & D were asked about PE/E danger signs (range 11–34%); 77% had their BP checked upon admission (range 59–85%); and 6% had testing for proteinuria. Twenty-five cases of severe PE/E were observed: magnesium sulfate (MgSO4) was used in 15, not used in 5, and for 5 use was unknown. The availability of MgSO4 in L & D varied from 16% in Ethiopia to 100% in Mozambique.ConclusionsObserved ANC consultations and L & D cases showed low use of WHO-recommended practices for PE/E screening and management. Availability of MgSO4 was low in multiple countries, though it was on the essential drug list of all surveyed countries. Country programs are encouraged to address gaps in screening and management of PE/E in ANC and L & D to contribute to lower maternal and perinatal mortality.
Highlights
Preeclampsia and eclampsia (PE/E) are major contributors to maternal and neonatal deaths in developing countries, associated with 10–15% of direct maternal deaths and nearly a quarter of stillbirths and newborn deaths, many of which are preventable with improved care
Screening for PE/E in antenatal care (ANC) Asking women about danger signs in ANC consultations was generally poorly performed by health workers, with 27% of ANC clients asked about headache or blurred vision, the same number asked about swollen hands or face, and 39% asked about either danger signs (Table 2)
Blood pressure (BP) assessment in ANC consultations was relatively higher, with 68% of ANC clients having their blood pressure (BP) taken with proper technique
Summary
Preeclampsia and eclampsia (PE/E) are major contributors to maternal and neonatal deaths in developing countries, associated with 10–15% of direct maternal deaths and nearly a quarter of stillbirths and newborn deaths, many of which are preventable with improved care. We present results related to WHO-recommended interventions for screening and management of PE/E during antenatal care (ANC) and labor and delivery (L & D) from a study conducted in six sub-Saharan African countries. Pre-eclampsia/eclampsia (PE/E) is one of the leading causes of maternal, fetal and neonatal morbidity and mortality. It affects 2–8% of pregnancies worldwide, is associated with 10–15% of direct maternal deaths and up to 25% of stillbirths and newborn deaths in developing countries [1]. Screening for pre-eclampsia, which should occur during ANC, upon admission to and throughout L & D, includes measurement of blood pressure and urine protein, and enquiring about PE/E related danger signs [5]
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