Main Article Content
Background: The Federal Ministry of Health in Nigeria developed a national guideline for the management of severe preeclampsia/eclampsia (Severe PE/E). Effective compliance with these guidelines is essential for delivery of quality care to women with these conditions. This study sought to determine the availability of the national guidelines and assess compliance by healthcare workers (HCWs) in public health facilities in Bayelsa State.
Methodology: This is a mixed-method (quantitative and qualitative) descriptive study involving 155 HCWs responding to a self-administered structured questionnaire and 29 in-depth interviews with health facility managers in 16 randomly selected health facilities in Bayelsa state. Thirty-six questions and 16 questions assessed knowledge of severe preeclampsia and compliance with guideline respectively among respondents. Respondents were scored and graded as poor, fair and good level of knowledge and compliance. Chi-squared test and logistic regression were used to identify factors influencing level of compliance with the national guideline. The in-depth interviews were analyzed along thematic areas using NVivo 11.0 QSR software. Level of significance was set at p<0.05.
Results: Slightly above half of the respondents (58.1%) had at least a local treatment guideline in their facility. However, only 69 study respondents (44.5%) knew about the existence of a national guideline on the management of Severe PE/E and even less than this (36.1%) reported that the national guideline was available in their centres. Less than a fifth of participants (17.4%) were found to have good level of compliance with the guidelines. The factors that influenced compliance included level of healthcare (OR – 26.13; p – 0.001) and level of knowledge. (OR- 53.90; p<0.001). From the in-depth interviews the main theme affecting compliance is non-availability of the national guideline at the centres.
Conclusion: The level of compliance with the national guideline on the management of severe PE/E is low in Bayelsa state. Level of knowledge among health workers and non-availability of these guidelines are contributory factors. Training of health workers and provision of the guideline at all levels of care are recommended to guarantee quality care for women with severe PE/E.
Gaym A, Bailey P, Pearson L, Admasu K, Gebrehiwot Y et al. Disease burden due to preeclampsia/eclampsia and the Ethiopian health system’s response. Int J Gynecol Obstet 2011;115:112-116.
Magee L, Pels A, Helewa M, Rey E, von Dadelszen P. Diagnosis, evaluation and management of hypertensive disorders of pregnancy. Int. Journal of women’s cardiovascular health. 2014;4(2)105-45.
Singh S, Ahmed EB, Egondu SC, Ikechuku NE. Hypertensive disorders in pregnancy among pregnant women in a Nigerian teaching hospital.Niger Med J. 2014;55(5):384.
Esike C.O,Chukwuemeka UI, Anozie OB, Eze JN, Aluka OC, Twomey DE. Eclampsia in Rural Nigeria: The unmitigating catastrophe. Ann Afri Med. 2017;16(4):175.
Hogan M, Foreman KJ, Naghavi M, Ahn SY, Wang M, Makela SM et al. Maternal mortality for 181 countries,1980-2008: a systematic analysis of progress towards MDG5.Lancet 2010;375:1609-1623.
Tukur J, Ahonsi B, Ishaku SM, Araoyinbo I, Okereke E,Oginni AB. Maternal and fetal outcomes after introduction of magnesium sulphate for treatment of preeclampsia and eclampsia in selected secondary facilities: A low-cost Intervention. Matern Child Health J. 2013;17:1191-1198.
Ridge A, Eero L, Hill S. Identifying barriers to the availability and use of magnesium sulfate injection in resource poor countries: A case study in Zambia. BMC Health Serv Res 2010;(1):340.
Brown MC, Best KE, Pearce MS, Waugh J, Robson SC, Bell R. Cardiovascular disease risk in women with pre-eclampsia: systematic review and meta-analysis. European Journal of epidemiology. 2013;28(1):1-19
World Health Organization. WHO recommendations for Prevention and treatment of preeclampsia and eclampsia. WHO; 2011.
Magnesium sulphate for the prevention and treatment of preeclampsia and eclampsia in Pakistan. Review article. White Ribbon Alliance Pakistan. Pakistan Center for Communication Programs September, 2012.
Ekele BA, Use of magnesium sulphate for the treatment of severe preeclampsia/eclampsia in Nigeria: overcoming the odds. Ann Afr Med. 2009;8:73-5.
Federal Ministry of Health, Nigeria. National standard treatment guidelines. Abuja Federal Ministry of health; 2nd edition; 2016.
Oguntunde O, Charyeva Z, Cannon M, Sambisa W, Orobabon N et al. Factors influencing the use of magnesium sulphate in preeclampsia/eclampsia management in health facilities in Northern Nigeria: a mixed method study.BMC Pregnancy and childbirth. 2015;130(15):1-8.
Tukur J. The use of the magnesium sulphate for the treatment of preeclampsia and eclampsia. Ann Afr Med. 2009;8:76-80
Barua, A., Mundle, S., Bracken, H., Easterling, T., Winikoff, B. Facility and personnel factors influencing magnesium sulfate use for eclampsia and pre-eclampsia in 3 Indian hospitals. International Journal of Gynaecology and Obstetrics. 2011;115(3):231–234.
Lotufo FA, Parpinelli MA, Osis MJ, Surita FA, Costa ML et al. Situational analysis to availability and utilization of magnesium sulfate for eclampsia and severe preeclampsia in the public health system in Brazil. BMC preg Childbirth. 2016;16(1):254.
Ugwu E, Dim CC, Okonkwo CD, Nwankwo TO. Maternal and perinatal outcome of severe preeclampsia in Enugu, Nigeria after introduction of magnesium sulphate. Niger J Clin Pract. 2011;14:418-21.
Vata P.K, Chaulan NM, Nallathambi A, Hussein F. Assessment of prevalence of preeclampsia from Dilla region of Ethiopia. BMC RES Notes. 2015;8:816-922.
Sheikh S, Qureshi RN, Khowaja AR, Salam R, Vidler M, et al. Health care provider knowledge and routine management of pre-eclampsia in Pakistan. Reproductive Health 2016; 13(Suppl 2):113-162.
Okonofua FE, Ogu RN, Fabamwo AO, Ujah IO, Chama CM, Archibong EI, et al. Training health workers for magnesium sulphate use reduces case fatality from eclampsia: Results from a multicenter trial.Acta Obstet Gynecol Scand. 2013; 92(6):716-20.
Kirkwood B, Sterne J. Medical Statistics. Med Stat [Internet] 2003;513. Available:http://scholar.google.com/scholar
Adekanle DA, Adeyemi AS, Olowookere SA, Akinleye CA. Health workers’ knowledge on future vascular disease risk in women with preeclampsia in South Western Nigeria. BMC Res Notes. 2015;8:576-81.
Adoyi G, Ishaku SM, Ayodeji B, Kirk KR. 45 Persisting challenges in the provision of quality obstetric care to women with preeclampsia and eclampsia: Assessment of health providers’ preparedness and facility readiness: Prevention of preeclampsia. Preg Hyperten: An Int J of Women’s cardiovascular Health. 2016;6(3):158.
Smith JM, Currie S, Cannon T, Armbruster D, Perri J. Are national policies and programs for the Prevention and Management of Postpartum Hemorrhage and Pre-Eclampsia/Eclampsia adequate? A key informant survey in 37 countries. Global Health:Scien and Pract. 2014;2(3):275-84.
Danmusa S,Coeytaux F,Potts J,Wells E. Scale-up of magnesium sulfate for treatment for preeclampsia and eclampsia in Nigeria. Int J of Gynecol and Obstet. 2016;134:233-6.
Salomon A, Ishaku S, Kirk KR, Warren CE. Detecting and managing hypertensive disorders in pregnancy: A cross-sectional analysis of the quality of antenatal care in Nigeria. BMC Health Services Research. 2019;19:411.
Big Deli 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).