Assessing the effect of a primary health care intervention for improving pre-eclampsia and eclampsia knowledge and practice in Bangladesh

Hossain, Shahdat; Roy, Shongkour; Sultana, Kanij; Warren, Charlotte E.

doi:10.31899/rh11.1005

Cited by 4 publications

(38 citation statements)

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“…government) pharmacies often due to periodic stock outs at government pharmacies. This study found that only 3% of public pharmacies had a loading dose of MgSO 4 injection for PE/E management [19]. While most pharmacy staff surveyed in this study's four districts work in private pharmacies or drug stores, there were significant disparities between public and private pharmacy workers' knowledge of antihypertensive drugs.…”

Section: Discussionmentioning

confidence: 73%

“…Twelve sub-districts were selected as Ending Eclampsia project implementation sites, to typify and represent rural Bangladesh. The project conducted a landscape analysis prior to developing project interventions to strengthen selected government health facilities for PE/E detection, prevention, and management [19]. The 12 implementation sub-districts featured 116 Union Health and Family Welfare Centers (UH&FWCs), 11 Upazilla Health Complexes (UHCs), five Mother and Child Welfare Centers (MCWCs), four district hospitals, 136 government pharmacies, and more than 1500 private pharmacies or drug stores in the areas selected for the study [14].…”

Section: Study Sitementioning

confidence: 99%

“…FWVs and SACMOs provide primary health care (PHC) services to the general populace including pregnant women. These two PHC provider cadres are trained to detect PE/E by checking blood pressure and urine protein and are authorized to administer a loading dose of MgSO 4 (10 mg) intramuscular injection in severe cases, and then refer women to a referral hospital [19]. Drug store clerks and managers are not trained in PE/E nor hypertension detection, nor any other medical indications, and should not prescribe or administer medications, but it appears they often informally learn about medical prescription from either individuals with a medical degree, unqualified health care providers, or inherit and learn their trade informally [20].…”

Section: Introductionmentioning

confidence: 99%

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Knowledge of pharmacy workers on antihypertensive and anticonvulsant drugs for managing pre-eclampsia and eclampsia in Bangladesh

Roy¹,

Sultana²,

Hossain³

et al. 2020

BMC Health Serv Res

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Background Pharmacy workers in Bangladesh play an important role in managing pregnancy complications by dispensing, counselling and selling drugs to pregnant women and their families. This study examined pharmacy workers’ drug knowledge and practice for pre-eclampsia and eclampsia (PE/E) management, including antihypertensives and anticonvulsants, and determine factors associated with their knowledge. Methods A cross-sectional survey with 382 pharmacy workers in public facilities (government) and private pharmacies and drug stores assessed their knowledge of antihypertensive and anticonvulsant drugs. ‘Pharmacy workers’ include personnel who work at pharmacies, pharmacists, family welfare visitors (FWVs), sub-assistant community medical officers (SACMOs), drug storekeepers. Exploratory and multivariate logistic models were used to describe association between knowledge of medicines used in pregnancy and demographic characteristics of pharmacy workers. Results Overall, 53% pharmacy workers interviewed were drug store owners in private pharmacies while 27% FWVs/SACMOs, who are government service providers also work as drug prescribers and/or dispensers in public facility pharmacies. Majority of pharmacy workers had poor knowledge compared to correct knowledge on both antihypertensive (77.8% vs 22.3%; p < 0.001) and anticonvulsant drugs (MgSO4) (82.2% vs 17.8%; p < 0.001). Multivariate analysis showed SACMOs and FWVs were greater than 4 times more likely to have correct knowledge on anti-hypertensives (AOR = 4.2, 95% CI:1.3–12.3, P < 0.01) and anticonvulsant drugs (AOR = 4.9, 95% CI:1.3–18.1, P < 0.01) compared to pharmacists. Pharmacy workers who had received training were more likely to have correct knowledge on antihypertensive and anticonvulsant drugs than those who had no training. Conclusions Pharmacy workers’ knowledge and understanding of antihypertensive and anticonvulsant drugs, particularly for prevention and management of PE/E is limited in Bangladesh. Most pharmacies surveyed are private and staffed with unskilled workers with no formal training on drugs. Expansion of maternal and newborn health programs should consider providing additional skills training to pharmacy workers, as well as regulating these medicines at informal pharmacies to mitigate any harmful practices or adverse outcomes of unauthorized and incorrectly prescribed and used drugs. It is important that correct messaging and medicines are available as drug stores are often the first point of contact for most of the women and their families.

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Section: Discussionmentioning

confidence: 73%

Section: Study Sitementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Knowledge of pharmacy workers on antihypertensive and anticonvulsant drugs for managing pre-eclampsia and eclampsia in Bangladesh

Roy¹,

Sultana²,

Hossain³

et al. 2020

BMC Health Serv Res

Self Cite

View full text Add to dashboard Cite

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“…This project has been pushing the agenda forward to provide better care for women on HDPs and PE/E and has an expanded view of what is needed [26,27,29,30]. Ensuring services are available at lower levels providers opportunities to identify pre-eclampsia early, timely delivery and effective treatment for those with a severe form of the condition [14].…”

Section: Critical Issues To Considermentioning

confidence: 99%

“…We are also considering reviewing the cost-effectiveness. If the mission of a public health system is to protect and improve pregnant women and their babies' healthcare, it will be imperative for Ministries of Health to act comprehensively in addressing the issues of PE/E and MNH more broadly and specifically at PHC level [15,18,24,30].…”

Section: Critical Issues To Considermentioning

confidence: 99%

A primary health care model for managing pre-eclampsia and eclampsia in low- and middle- income countries

Warren

Hossain²,

Ishaku

et al. 2020

Reprod Health

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Background: Hypertensive disorders in pregnancy, specifically pre-eclampsia and eclampsia (PE/E), are the second biggest killer of pregnant women globally and remains the least understood and most challenging maternal morbidity to manage. Although great strides were made in reducing maternal and newborn mortality between 1990 and 2015, this was clearly not enough to achieve the global health goals. To reduce maternal deaths: 1) early detection of PE needs to be improved; 2) effective management of PE/E needs to occur at lower health system levels and should encourage timely care-seeking; and 3) prioritizing the scale up of a comprehensive package of services near to where women live. Findings: This commentary describes a pragmatic approach to test scalable and sustainable strategies for expanding access to quality under-utilized maternal health commodities, interventions and services. We present a primary health care (PHC) PE/E Model based on implementation research on identified gaps in care in several countries, accepted global best practice and built on the basic premise that PHC providers can take on additional skills with adequate capacity building, coaching and supervision, and community members desire control over their own health. The PHC PE/E model displays the linkages and opportunities to prevent and treat PE/E in a simplified way; however, there are numerous interlinking factors, angles, and critical points to consider including leadership, policies and protocols; relevant medicines and commodities, ongoing capacity building strategies at lower levels and understanding what women and their communities want for safe pregnancies. Conclusion: The PHC model described here uses PE/E as an entry to improve the quality of ANC and by extension the pregnancy continuum. Bringing preventive and treatment services nearer to where pregnant women live makes sense.Abstract (Continued on next page)

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Factors affecting use of magnesium sulphate for pre‐eclampsia or eclampsia: a qualitative evidence synthesis

Eddy

Vogel

Zahroh

et al. 2021

BJOG

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Background Hypertensive disorders account for 14% of global maternal deaths. Magnesium sulphate (MgSO 4 ) is recommended for prevention and treatment of pre-eclampsia/eclampsia. However, MgSO 4 remains underused, particularly in low-and middle-income countries (LMICs).Objective This qualitative evidence synthesis explores perceptions and experiences of healthcare providers, administrators and policy-makers regarding factors affecting use of MgSO 4 to prevent or treat pre-eclampsia/eclampsia.

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Assessing the effect of a primary health care intervention for improving pre-eclampsia and eclampsia knowledge and practice in Bangladesh

Cited by 4 publications

References 0 publications

Knowledge of pharmacy workers on antihypertensive and anticonvulsant drugs for managing pre-eclampsia and eclampsia in Bangladesh

Knowledge of pharmacy workers on antihypertensive and anticonvulsant drugs for managing pre-eclampsia and eclampsia in Bangladesh

A primary health care model for managing pre-eclampsia and eclampsia in low- and middle- income countries

Factors affecting use of magnesium sulphate for pre‐eclampsia or eclampsia: a qualitative evidence synthesis

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