The feasibility of community level interventions for pre-eclampsia in South Asia and Sub-Saharan Africa: a mixed-methods design.

Asif Raza Khowaja,Zulfiqar A Bhutta,Marianne Vidler,Helena Edith Boene,Rahat Najam Qureshi,Elizabeth A Orenuga,Umesh Charantimath,Ashalata Mallapur,Diane Sawchuck,Mrutyunjaya Bellad,Peter Von Dadelszen,Olufemi T Oladapo,Khátia Munguambe,Olalekan O Adetoro,Esperança Sevene

doi:10.1186/s12978-016-0133-0

Abstract

BackgroundGlobally, pre-eclampsia and eclampsia are major contributors to maternal and perinatal mortality; of which the vast majority of deaths occur in less developed countries. In addition, a disproportionate number of morbidities and mortalities occur due to delayed access to health services. The Community Level Interventions for Pre-eclampsia (CLIP) Trial aims to task-shift to community health workers the identification and emergency management of pre-eclampsia and eclampsia to improve access and timely care. Literature revealed paucity of published feasibility assessments prior to initiating large-scale community-based interventions. Arguably, well-conducted feasibility studies can provide valuable information about the potential success of clinical trials prior to implementation. Failure to fully understand the study context risks the effective implementation of the intervention and limits the likelihood of post-trial scale-up. Therefore, it was imperative to conduct community-level feasibility assessments for a trial of this magnitude.MethodsA mixed methods design guided by normalization process theory was used for this study in Nigeria, Mozambique, Pakistan, and India to explore enabling and impeding factors for the CLIP Trial implementation. Qualitative data were collected through participant observation, document review, focus group discussion and in-depth interviews with diverse groups of community members, key informants at community level, healthcare providers, and policy makers. Quantitative data were collected through health facility assessments, self-administered community health worker surveys, and household demographic and health surveillance.ResultsRefer to CLIP Trial feasibility publications in the current and/or forthcoming supplement.ConclusionsFeasibility assessments for community level interventions, particularly those involving task-shifting across diverse regions, require an appropriate theoretical framework and careful selection of research methods. The use of qualitative and quantitative methods increased the data richness to better understand the community contexts.Trial registrationNCT01911494Electronic supplementary materialThe online version of this article (doi:10.1186/s12978-016-0133-0) contains supplementary material, which is available to authorized users.

Highlights

Pre-eclampsia and eclampsia are major contributors to maternal and perinatal mortality; of which the vast majority of deaths occur in less developed countries
Management of pre-eclampsia and eclampsia has focused on hospital-based interventions [3], and the only intervention possible at the community level is stabilization and referral to higher-level facility [4]
A package of evidence-based interventions that are applicable in the home and primary health centre (PHC) represents a critical step towards addressing excess maternal and perinatal deaths and disabilities resulting from the failure to identify and rapidly manage pre-eclampsia and eclampsia at the community level

Summary

Introduction

Pre-eclampsia and eclampsia are major contributors to maternal and perinatal mortality; of which the vast majority of deaths occur in less developed countries. A package of evidence-based interventions that are applicable in the home and primary health centre (PHC) represents a critical step towards addressing excess maternal and perinatal deaths and disabilities resulting from the failure to identify and rapidly manage pre-eclampsia and eclampsia at the community level. Such a package would require community health care providers to use a simplified triaging tool to identify women at high risk of adverse outcomes, provide emergency treatment and facilitate their referral to hospital. A systematic review of strategies to improve maternal and perinatal health in LMICs demonstrated the benefits of using such community-based interventions for improving maternal and newborn outcomes [7]

Methods

Discussion

Conclusion