Community health worker knowledge and management of pre-eclampsia in southern Mozambique
Tóm tắt
Mozambique has drastically improved an array of health indicators in recent years, including maternal mortality rates which decreased 63 % from 1990–2013 but the rates still high. Pre-eclampsia and eclampsia constitute the third major cause of maternal death in the country. Women in rural areas, with limited access to health facilities are at greatest risk. This study aimed to assess the current state of knowledge and the regular practices regarding pre-eclampsia and eclampsia by community health workers in southern Mozambique. This mixed methods study was conducted from 2013 to 2014, in Maputo and Gaza Provinces, southern Mozambique. Self-administered questionnaires, in-depth interviews and focus group discussions were conducted with CHWs, district medical officers, community health workers’ supervisors, Gynaecologists-Obstetricians and matrons. Quantitative data were entered into a database written in REDCap and subsequently analyzed using Stata 13. Qualitative data was imported into NVivo10 for thematic analysis. Ninety-three percent of CHW had some awareness of pregnancy complications. Forty-one percent were able to describe the signs and symptoms of hypertension. In cases of eclampsia, CHWs reported to immediately refer the women. The vast majority of the CHWs surveyed reported that they could neither measure blood pressure nor proteinuria (90 %). Fewer reported confidence in providing oral antihypertensives (14 %) or injections in pregnancy (5 %). The other community health care providers are matrons. They do not formally offer health services, but assists pregnant women in case of an emergency. Regarding pre-eclampsia and eclampsia, matrons were unable to recognise these biomedical terms. Although CHWs are aware of pregnancy complications, they hold limited knowledge specific to pre-eclampsia and eclampsia. There is a need to promote studies to evaluate the impact of enhancing their training to include additional content related to the identification and management of pre-eclampsia and eclampsia.
Tài liệu tham khảo
World Health Statistics 2014. Geneva; 2014. Availabe on: http://apps.who.int/iris/bitstream/10665/112738/1/9789240692671_eng.pdf?ua=1. Accessed 23 Aug 2016.
WHO, UNICEF, UNFPA WBG, Division and the UNP. Trends in maternal mortality 1990 to 2015. 2015; Available from: http://apps.who.int/iris/bitstream/10665/194254/1/9789241565141_eng.pdf?ua=1 in Maternal Mortality 1990 to 2015 full report. PDF. Accessed 3 May 2016.
Granja AC, Machungo F, Bergstrom S. Avoidability of maternal death in Mozambique: audit and retrospective risk assessment in 106 consecutive cases. Afr J Heal Sci. 2000;7(3–4):83–7.
David E, Machungo F, Zanconato G, Cavaliere E, Fiosse S, Sululu C, et al. Maternal near miss and maternal deaths in Mozambique: a cross-sectional, region-wide study of 635 consecutive cases assisted in health facilities of Maputo province. BMC Pregnancy Childbirth [Internet]. 2014;14:401.
Menendez C, Romagosa C, Ismail MR, Carrilho C, Saute F, Osman N, et al. An autopsy study of maternal mortality in Mozambique: The contribution of infectious diseases. PLoS Med. 2008;5(2):0220–6.
WHO. Mozambique Health Workforce. Situational analysis. Regional Officer for Africa. Available on: http://www.afro.who.int/en/mozambique/country-programmes/health-systems/human-resources-for-health.html. Accessed 24 Aug 2016.
WHO. World Health Organization Work Force Observatory [Internet]. [cited 2016 May 13]. Available from: http://gamapserver.who.int/gho/interactive_charts/health_workforce/PhysiciansDensity_total/tablet/atlas.html. Accessed 23 Aug 2016.
Cumbi A, Pereira C, Malalane R, Vaz F, McCord C, Bacci A, et al. Major surgery delegations to mid-level health practitioners in Mozambique: health professional’s perceptions. Hum Resour Health. 2007;5:27.
Declaration of Alma Ata. In: International Conference on primary Health care. Alma-Ata; 1978.
Fulton BD, Scheffler RM, Sparkes SP, Auh EY, Vujicic M, Soucat A. Health workforce skill mix and task shifting in low income countries: a review of recent evidence. Hum Resour Health. 2011;9:1.
Saprii L, Richards E, Kokho P, Theobald S. Community health workers in rural India: analysing the opportunities and challenges Accredited Social Health Activists (ASHAs) face in realising their multiple roles. Hum Resour Health. 2015;13(1):95.
Okuga M, Kemigisa M, Namutamba S, Namazzi G, Waiswa P. Engaging community health workers in maternal and newborn care in eastern Uganda. Glob Health Action. 2015;8(1):1–10.
Lassi ZS, Das JK, Salam RA, Bhutta ZA. Evidence from community level inputs to improve quality of care for maternal and newborn health: intervention and findings. Reprod Health. 2014;11 suppl 2:S2.
Chilundo BG, Cliff JL, Mariano AR, Rodriguez DC, George A. Relaunch of the official community health workers programme in Mozambique: is there a sustainable basis for iCCM policy? Health Policy Plan. 2015;30(2):ii54–64.
Ellard DR, Chimwaza W, Davies D, O’Hare JP, Kamwendo F, Quenby S, et al. Can training in advanced clinical skills in obstetrics, neonatal care and leadership, of non-physicians clinicians in Malawi impact on clinical services improvements (the ETATMBA project): a process evaluation. BMJ Open. 2014;4(8), e005551.
WHO. WHO Recomendations. Optumizing health worker role to improve access to key maternal and newborn health onterventions through task shifting. Geneva: OPTIMIZE MNH. 2012.
MISAU. Manual de Formacao dos Agentes Polivalentes Elementares (APEs): Modulo II PROMOCAO DE SAUDE E PREVENCAO DE DOENCAS. Maputo; 2015. (2a Edicao Revisao).
Rodrigues Z. Práticas culturais e comunitárias de promoção de saúde sexual e reprodutiva em 3 províncias de Moçambique: Nampula. Maputo: Sofala e Inhambane; 2010.
Gloyd S, Floriano F, Seunda M, Chadreque MA, Nyangezi JM, Platas A. Impact of traditional birth attendant training in Mozambique: A controlled study. J Midwifery Women’s Heal. 2001;46(4):210–6.
INE. III Recenseamento Geral da Populacao e Habitacao. Maputo: Instituto Nacional de Estatistica. 2007; Available from: Cited 2016 April 26. Available from:http://www.ine.gov.mz/operacoes-estatisticas/censos/censo-2007/rgph-2007/indicadores-socio-demograficos-provincia-de-maputo-2007.pdf/
INE. III Recenseamento Geral da Populacao e Habitacao. Gaza: Instituto Nacional de Estatistica. Reprod Health BMC. 2016;13(Suppl 1);56:1–15. Available from: Cited 2016 April 26. Available from: http://www.ine.gov.mz/operacoes-estatisticas/censos/censo-2007/rgph-2007/indicadores-socio-demograficos-provincia-de-gaza-2007.pdf/.
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research Electronic Data Capture (REDCap) - A metadata driven methodology and workflow process for providing translational research informatict support. J Biomed Inform. 2009;42(2):377–81.
Mohedas I, Anderson FW, Adomako J, Sienko KH. Discrepancies between clinicians and rural healthcare workers regarding referral procedures based on blood pressure measurements. Int J Gynecol Obstet. 2013;123:244–51.
Sengwana MJ, Puoane T. Knowledge, beliefs and attitudes of community health workers about hypertension in the Cape Peninsula. South Africa Curationis. 2004;27(1):65–71.
Lehmann U, Sanders D. Community health workers: What do we know about them? World Heal Organ Geneva [Internet]. 2007;(January):34 pp. Available from: http://www.who.int/hrh/documents/community_health_workers.pdf. Accessed 20 May 2016.
George A, Young M, Nefdt R, Basu R, Sylla M, Clarysse G, et al. Community health workers providing government community case management for child survival in sub-Saharan Africa: who are they and what are they expected to do? Am J Trop Med Hyg. 2012;87(5 Suppl):85–91.
Dhakal G, Subedi M, Paudel K. Magnesium sulphate in management of severe pre-eclampsia and eclampsia. J Nepal Health Res Counc. 2012;10(21):113–7.
Bugalho A, Bacci A, Bergström S. Risk factors in Mozambican women with eclampsia: a case-referent study. Afr J Reprod Health. 2001;5(2):30–5.
Bennett S, George A, Rodriguez D, Shearer J, Diallo B, Konate M, et al. Policy challenges facing integrated community case management in Sub-Saharan Africa. Trop Med Int Health. 2014;19(7):872–82.
Sevene E, Lewin S, Mariano A, Woelk G, Woelk G, Oxman AD, et al. System and market failures: The unavailability of magnesium sulphate for the treatment of eclampsia and pre-eclampsia in Mozambique and Zimbabwe. Br Med J. 2005;331(7519):765–9.
Aaserud M, Lewin S, Innvaer S, Paulsen EJ, Dahlgren AT, Trommald M, et al. Translating research into policy and practice in developing countries: a case study of magnesium sulphate for pre-eclampsia. BMC Health Serv Res. 2005;5:68.
Kim YM, Ansari N, Kols A, Tappis H, Currie S, Zainullah P, et al. Prevention and management of severe pre-eclampsia/eclampsia in Afghanistan. BMC Pregnancy Childbirth. 2013;13(1):186.
Bigdeli M, Zafar S, Assad H, Ghaffar A. Health System Barriers to Access and Use of Magnesium Sulfate for Women with Severe Pre-Eclampsia and Eclampsia in Pakistan: Evidence for Policy and Practice. PLoS One. 2013;8(3), e59158.
Harvey SA, Ayabaca P, Bucagu M, Djibrina S, Edson WN, Gbangbade S, et al. Skilled birth attendant competence: An initial assessment in four countries, and implications for the Safe Motherhood movement. Int J Gynecol Obstet. 2004;87(2):203–10.
Stanback J, Mbonye AK, Bekiita M. Contraceptive injections by community health workers in Uganda: A nonrandomized community trial. Bull World Health Organ. 2007;85(10):768–73.
Malarcher S, Meirik O, Lebetkin E, Shah I, Spieler J, Stanback J. Provision of DMPA by community health workers: What the evidence shows. Contraception. 2011;83:495–503.
Brunie A, Hoke TH, Razafindravony B. La distribuituion a base communautaire de contraceptifs onjectables dans le contexte africain: essai en communaute a Madagascar. Sante. 2011;21(1):21–6.
Socio-serve. Towards an effective collaboration for quality maternal and neonatal health delivery: The role of the traditional birth attendant and the Ghana health service. 2012
Schwitters A, Lederer P, Zilversmit L, Gudo PS, Ramiro I, Cumba L, et al. Barriers to health care in rural Mozambique: a rapid ethnographic assessment of planned mobile health clinics for ART. Glob Heal Sci Pract. 2015;3(1):109–16.