The feasibility of task-sharing the identification,emergency treatment,and referral for women with pre-eclampsia by community health workers in India |
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Authors: | Charanthimath Umesh Vidler Marianne Katageri Geetanjali Ramadurg Umesh Karadiguddi Chandrashekhar Kavi Avinash Joshi Anjali Mungarwadi Geetanjali Bannale Sheshidhar Rakaraddi Sangamesh Sawchuck Diane Qureshi Rahat Sharma Sumedha Payne Beth A. von Dadelszen Peter Derman Richard Magee Laura A. Goudar Shivaprasad Mallapur Ashalata Bellad Mrutyunjaya Bhutta Zulfiqar Naik Sheela Mulla Anis Kamle Namdev Dhamanekar Vaibhav Drebit Sharla K. Kariya Chirag Lee Tang Li Jing Lui Mansun Khowaja Asif R. Tu Domena K. Revankar Amit |
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Affiliation: | 1.KLE Academy of Higher Education and Research’s, J N Medical College, Belagavi, Karnataka, India ;2.Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC, Canada ;3.Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Karnataka, India ;4.Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Karnataka, India ;5.Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Karnataka, India ;6.Department of Anatomy, S Nijalingappa Medical College, Bagalkot, Karnataka, India ;7.Department of Research, Vancouver Island Health Authority, Victoria, BC, Canada ;8.Division of Women and Child Health, Aga Khan University, Karachi, Sindh, Pakistan ;9.School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, England ;10.Department Kings of Obstetrics, Thomas Jefferson University, Philadelphia, PA, USA ; |
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Abstract: | Background Hypertensive disorders are the second highest direct obstetric cause of maternal death after haemorrhage, accounting for 14% of maternal deaths globally. Pregnancy hypertension contributes to maternal deaths, particularly in low- and middle-income countries, due to a scarcity of doctors providing evidence-based emergency obstetric care. Task-sharing some obstetric responsibilities may help to reduce the mortality rates. This study was conducted to assess acceptability by the community and other healthcare providers, for task-sharing by community health workers (CHW) in the identification and initial care in hypertensive disorders in pregnancy. MethodsThis study was conducted in two districts of Karnataka state in south India. A total of 14 focus group discussions were convened with various community representatives: women of reproductive age (N = 6), male decision-makers (N = 2), female decision-makers (N = 3), and community leaders (N = 3). One-to-one interviews were held with medical officers (N = 2), private healthcare OBGYN specialists (N = 2), senior health administrators (N = 2), Taluka (county) health officers (N = 2), and obstetricians (N = 4). All data collection was facilitated by local researchers familiar with the setting and language. Data were subsequently transcribed, translated and analysed thematically using NVivo 10 software. ResultsThere was strong community support for home visits by CHW to measure the blood pressure of pregnant women; however, respondents were concerned about their knowledge, training and effectiveness. The treatment with oral antihypertensive agents and magnesium sulphate in emergencies was accepted by community representatives but medical practitioners and health administrators had reservations, and insisted on emergency transport to a higher facility. The most important barriers for task-sharing were concerns regarding insufficient training, limited availability of medications, the questionable validity of blood pressure devices, and the ability of CHW to correctly diagnose and intervene in cases of hypertensive disorders of pregnancy. ConclusionTask-sharing to community-based health workers has potential to facilitate early diagnosis of the hypertensive disorders of pregnancy and assist in the provision of emergency care. We identified some facilitators and barriers for successful task-sharing of emergency obstetric care aimed at reducing mortality and morbidity due to hypertensive disorders of pregnancy. |
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