Pre-eclampsia and Eclampsia Prevention and Management: Quality of Care in Madagascar

Transcription

1 Pre-eclampsia and Eclampsia Prevention and Management: Quality of Care in Madagascar Jean Pierre Rakotovao (MCHIP Chief of Party), Eva Bazant (Sr. Monitoring, Evaluation and Research Advisor), Vandana Tripathi (Consultant, Jhpiego), Justin Ranjalahy Rasolofomanana (Professor of Higher Learning and Public Health Research)

2 Introduction This assessment provides the first data regarding quality of actual PE/E-related practices in Madagascar This analysis focuses on facility readiness, provider knowledge, and interventions related to pre-eclampsia and eclampsia(pe/e).

3 Context Population: 20 M DHS IV TFR: 4.8 CPR : 40% /Modern method: 29% ANC: 86% at least one MMR: 498 deaths per live births Home delivery: 64 % EMONC survey 2010 Major causes of maternal death Hemorrhage : 38.89% Prolonged labor: %PE/E Infection: 20.37% PE/E: 14.81%

4 Objective To provide information on quality of prevention and management interventions in facility-based care that address maternal complications.

5 Materials and Methods A cross-sectional national assessment in facilities with higher caseload of birth (>2 per day) Descriptive statistical analysis was conducted Inventories : 36 facilities Interview : 139 providers, largely midwives Observations : 323 ANC consultations and 347 labor & delivery (L&D) mostly in hospitals. Review of Data from observation of each of 10 suspected PE/E cases.

6 Results (1) Inventory The mean score for availability of drugs, supplies, and equipment related to PE/E was 63%, Injectable anticonvulsants were available in 72% of L&D wards, Magnesium sulphate (MgSO4) and antihypertensives were available in only half of facilities. Characteristic N=36 Facilities Availability of injectable anticonvulsant in L&D ward 72% Availability of MgSO4 47% Availability of calcium gluconate/lidocaine 53% Availability of antihypertensives 50% Mean score for availability of drugs/equipment related to PE/E (e.g., anticonvulsants, antihypertensives, syringes) 63% Functioning BP apparatus 82% Use of parenteral anticonvulsants in past 3 months 53%

7 Results (2) Provider knowledge Nearly all providers interviewed correctly identified a PE/E diagnosis on case scenario, Overall mean score on examination, diagnosis, and management was 51%, and Only a third of providers knew to stabilize with MgSO4 and antihypertensives.

8 Results (3) Observation Nearly all ANC clients had blood pressure (BP) taken and were asked about danger signs of PE/E, only half of cases had BP taken with correct technique, and just 29% received a urine test. Multigravidae women were rarely asked about convulsions or hypertension in prior pregnancies. PE/E screening was performed less often in L&D than in ANC.

9 Results (4) PE/E cases observed MgSO4 was available in 4 of 7 facilities where suspected PE/E cases were observed. MgSO4 was not administered in any of these cases, and diazepam was administered in 5 cases. One case experienced convulsions: MgSO4 was reportedly available but not administered. Observation Number Convulsing or conscious 1 Magnesium sulfate administered 0 Diazepam administered 5 Antihypertensive administered 2 Maternal deaths 0 Newborn deaths 1

10 Conclusions Correct practices in ANC regarding PE/E screening/detection and management in L&D using MgSO4 and antihypertensives urgently need to be adopted. Providers need support to ensure complete provision of PE/E interventions. Recommendations include making an operational plan related to PE/E from policy documents, ensuring adequate supply of MgSO4, related drugs, and visible job aids at each facility, and sustained training and regular supervision of providers. All effective antihypertensives need to be on the Essential Drug List

11 Bibliography 1. Institut National de la Statistique (INSTAT) et ICF Macro Enquête Démographique et de Santé de Madagascar [Demographic and Health Survey In French.] Antananarivo, Madagascar: INSTAT et ICF Macro. 2. Khan S, Wojdyla D, Say L, Gulmezoglu AM, Van Look PA WHO Analysis of causes of maternal death: a systematic review. Lancet 2006; 367: World Health Organization, Department of Reproductive Health and Research Proportion of births attended by a skilled health worker 2008 updates. [Fact Sheet] Geneva, Switzerland: WHO Stanton C, Armbruster D, Knight R et al Use of active management of the third stage of labour in seven developing countries. Bull World Health Organ 87: Averting Death and Disability, Columbia University (AMDD) Needs Assessment of Emergency Obstetric and Newborn Care. Data Collector s Manual. AMDD: New York, NY. 7. National Coordinating Agency for Population and Development (NCAPD) [Kenya], Ministry of Medical Services (MOMS) [Kenya], Ministry of Public Health and Sanitation (MOPHS) [Kenya], Kenya National Bureau of Statistics (KNBS) [Kenya], ICF Macro Kenya Service Provision Assessment Survey Nairobi, Kenya: National Coordinating Agency for Population and Development, Ministry of Medical Services, Ministry of Public Health and Sanitation, Kenya National Bureau of Statistics, and ICF Macro. 8. Population Reference Bureau The World s Women and Girls, 2011 Data Sheet. Washington DC: PRB. 9. Institut National de la Statistique (INSTAT) et ICF Macro Enquête Démographique et de Santé de Madagascar [Demographic and Health Survey In French.] Antananarivo, Madagascar: INSTAT et ICF Macro. 11

12 Bibliography 10. World Health Organization Trends in Maternal Mortality: 1990 to Estimates developed by WHO, UNICEF, UNFPA, and the World Bank. Geneva, Switzerland: WHO. 11. Vice Primature Charge de Sante Publique, UNFPA, UNICEF, World Health Organization, AMDD, and MSIS Evaluation des besoins en matiere de soins obstetricaux et neonatals d urgence à Madagascar, Rapport final, Mars [Needs assessment for emergency obstetric and neonatal care in Madagascar, Final report in French, March 2010.] UNFPA. Antananarivo, Madagascar. 12. Fujioka A, Smith J Prevention and Management of Postpartum Hemorrhage and Pre-Eclampsia/Eclampsia: National Programs in Selected USAID Program-Supported Countries. USAID/MCHIP. Accessed August 29, 2011 from World Health Organization Pregnancy, Childbirth, Postpartum and Newborn Care: A Guide for Essential Practice, Integrated Management of Pregnancy and Childbirth Toolkit. Geneva, Switzerland: WHO. 14. World Health Organization Managing Complications in Pregnancy and Childbirth: A Guide for Midwives and Doctors. Geneva, Switzerland: WHO. 15. Institut National De La Statistique (Instat) et ICF Macro Enquête Démographique Et De Santé De Madagascar Antananarivo, Madagascar: Instat et ICF Macro. 16. MCHIP, Jhpiego Et Tandem Rapport de Mise En Œuvre. Evaluation de la Qualité de Service pour la Prévention, L identification et la Prise en Charge des Complications Courantes Maternelles et Neonatales. [Report on the Implementation. Evaluation of quality of Care for the Prevention, Identification, and Management of Common Maternal and Newborn Complications. In French.] : MCHIP/Jhpiego/Tandem. 12