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

Abstract

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.

Improving access to maternal health services among rural hard-to-reach fishing communities in Uganda, the role of community health workers

“…Involvement of CHWs in home-based early diagnosis and management of hypertensive disorders have been shown to cost effectively improve health in other settings. 23 , 24 , 46 …”

“…The diagnosis and management of non-communicable diseases in rural hard-to-reach settings have been facilitated by the active involvement of CHWs, including counseling, measurement, and linkage to care for diseases like diabetes and hypertension. 23 , 24 …”

“…[20][21][22] The diagnosis and management of non-communicable diseases in rural hard-to-reach settings have been facilitated by the active involvement of CHWs, including counseling, measurement, and linkage to care for diseases like diabetes and hypertension. 23,24 CHWs have been in existence following their establishment by the Uganda Ministry of Health in 2001, though serving with challenges. 25 In the presence of an ongoing critical shortage of SBAs, task shifting components of maternal health services may improve maternal health-seeking behavior and avert maternal deaths among island hard-to-reach FCs on Lake Victoria, Uganda.…”

Eclampsia and Its Treatment Modalities: A Review Article

“…For eclampsia at any gestational age, aggressive early delivery is advised when the mother and fetus have stabilized. If the mother and fetus are stable, vaginal birth with an IV oxytocin infusion should be tried [ 14 - 16 ].…”

From Research to Practice in OBGYN: How to Critically Interpret Studies in Implementation

“…This use of a 3-phase analysis provides additional support that another intervention or secular trend was not responsible for the observed improvements. The perceived fit, relevance, or compatibility of the intervention within a given setting Mixed-methods analysis of the appropriateness and feasibility of monitoring pregnant women's blood pressure in their homes using village health workers to improve outcomes in hypertension in pregnancy in resourcepoor settings in Nigeria 28…”