Sie befinden Sich nicht im Netzwerk der Universität Paderborn. Der Zugriff auf elektronische Ressourcen ist gegebenenfalls nur via VPN oder Shibboleth (DFN-AAI) möglich. mehr Informationen...
58 Improving care for women with pre-eclampsia/eclampsia (PE/E) in Nigeria: Focus should go beyond providers’ certifications: Management of preeclampsia, delivery
Access to skilled antenatal care (ANC) services is considered a panacea to persisting maternal and peri-natal deaths in low-resource settings. In Nigeria, skilled health care is defined as those provided by doctors, nurses/midwives and community health extension workers (CHEWs) but with varying levels of expertise based on the length of formal health care training they receive. However in order to improve the quality of care for pregnant women with PE/E, mere certification may not suffice. Attention should focus on the quality of care the woman receive as opposed to the medical qualification of the provider.
To determine whether a health provider’s qualification is a sufficient indicator of competence in relation to management of PE/E.
Population Council conducted interviews with 379 maternal health care providers from 96 health care facilities (primary and secondary) as part of a broader landscape analysis on PE/E across six geo-political zones in Nigeria between May and August, 2015. A total of 96 health care facilities were reached and 379 healthcare providers from antenatal and maternity units were interviewed. We used a combination of self-administered questionnaires and check-list to determine knowledge and practice of providers around prevention, early detection and management of PE/E. Descriptive (frequencies and percentages) and inferential (Chi-square test) analyses were conducted to identify factors associated with outcomes of interest.
This study showed paucity of knowledge and best practices among all cadres of healthcare providers. Very few providers could state the loading dose of magnesium sulphate – MgSO4− (11.6%; p-value<0.000), maintenance dose (10.3%; p-value<0.000), monitoring for MgSO4 toxicity (11.1%; p-value<0.000), identifying signs of PE (36%), identifying signs and symptoms of E (19.3%; p-value<0.0001). Similarly, only 25%, 8.5% and 6.3% of doctors, nurses/midwives and CHEWs respectively (p<0.0020), could identify the signs and symptoms of severe PE. Knowledge and practice gaps appear to have no bearing with the actual qualifications of the providers. In some instances, there were large variations between different cadres. For example, 70% of nurses/midwives could identify signs of PE, but only 57% and 56.9% of doctors and CHEWs respectively, could do the same (p<0.0410). And the proportion of nurses/midwives who knew the definition of hypertension in pregnancy (88%) is higher than that of doctors at 74.3% (p<0.0000).
In order to significantly reduce mortality and morbidity from PE/E in low-resource setting like Nigeria, there should be change of focus from who provide maternity care based on medical certification to the kind of care received irrespective of who delivers it, as well as encouraging a team approach to providing quality maternity care service deliveries.