Feasibility and acceptability of community health extension workers to identify and treat hypertension associated with pregnancy: Implementation research report

Nwala, Emmanuel; Anaba, Udochisom; Sripad, Pooja; Ishaku, Salisu Mohammed; Warren, Charlotte E.

doi:10.31899/rh11.1007

Cited by 4 publications

(4 citation statements)

References 17 publications

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“…Overstretched health facility-based staff with inadequate access to accurate and reliable equipment to measure vital signs causes delayed treatment initiation for pre-eclampsia and eclampsia in resource-poor settings [20]. There are however policy issues to overcome in LMICs for level 1 CHWs to take part in managing hypertension in pregnancy [26,28].…”

Section: Discussionmentioning

confidence: 99%

“…Some services they offer include the provision of safe delivery services for pregnant women and health education on non-communicable diseases [22,25]. While the role of CHWs does not include managing pregnancy conditions like pre-eclampsia and eclampsia [26,27], the evidence suggests that level 2 CHWs can detect abnormal blood pressure and treat the diseases in some LMICs [27][28][29][30].…”

Section: Introductionmentioning

confidence: 99%

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Implementing a community-level intervention to control hypertensive disorders in pregnancy using village health workers: lessons learned

Shobo

Okolo

Longtoe

et al. 2020

Implement Sci Commun

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Introduction Hypertensive disorders in pregnancy result in about 76,000 maternal deaths per year worldwide. Pre-eclampsia and eclampsia cause the most deaths. Interventions for managing these disorders are available in health facilities. We assess the effect of monitoring pregnant women’s blood pressure (BP) in their homes using village health workers (VHWs) equipped with a BP-measuring device on hypertension in pregnancy, in a resource-poor setting. Also, we assess the VHWs’ competence with the BP device, acceptability and appropriateness of the intervention, and factors that affect the implementation of the intervention. Method This is a mixed method study comprising quantitative and qualitative data collection. We implemented the intervention over 6 months across three local government areas in Gombe state, northeast Nigeria. The Replicating Effective Program (REP) framework guided the development of the implementation strategy. The quantitative data include routine measurement of pregnant women’s blood pressure and observation of 118 VHW-client interactions. The routine data collection occurred between February and June 2019, and the observation occurred in January and June 2019. The qualitative data collection occurred via six focus group discussions with VHWs and ten in-depth interviews with community health extension workers in June 2019. We analyzed the data from the quantitative arm with SPSS version 23. For the qualitative arm, we transcribed the audio files, coded the texts, and categorized them using thematic analysis. Result Nine thousand pregnant women were recruited into the program. We observed a significant reduction in the prevalence of hypertension in pregnancy from 1.5 to 0.8% (Z = 4.04; p < 0.00001) after starting the program. Also, we found that VHWs can assess pregnant women’s BP using a semi-automatic BP-measuring device. The intervention is acceptable and appropriate in resource-poor settings. Poor payment of VHW stipend and cooperation of local health staff are barriers to sustaining the intervention. Conclusion In resource-poor settings, health systems can train and equip non-technical people to identify and refer cases of high blood pressure in pregnancy to local health facilities on time. This may contribute to reducing maternal mortality and morbidity in these settings.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Implementing a community-level intervention to control hypertensive disorders in pregnancy using village health workers: lessons learned

Shobo

Okolo

Longtoe

et al. 2020

Implement Sci Commun

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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%

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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“…Some early evidence has also emerged specifically related to task sharing for prevention, detection and management of hypertensive disorders in pregnancy [1,[28][29][30][31].…”

Section: Bringing Services Closer To Women To Improve and Increase Detection And Management Of Hdp Casesmentioning

confidence: 99%

High Impact Practices—Task sharing for hypertensive disorders in pregnancy: Improving early detection and management of hypertensive disorders in pregnancy

Kirk¹

2020

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Feasibility and acceptability of community health extension workers to identify and treat hypertension associated with pregnancy: Implementation research report

Cited by 4 publications

References 17 publications

Implementing a community-level intervention to control hypertensive disorders in pregnancy using village health workers: lessons learned

Implementing a community-level intervention to control hypertensive disorders in pregnancy using village health workers: lessons learned

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

High Impact Practices—Task sharing for hypertensive disorders in pregnancy: Improving early detection and management of hypertensive disorders in pregnancy

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