Author:
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Boene, Helena; Vidler, Marianne; Augusto, Orvalho; Sidat, Mohsin; Macete, Eusébio; Menéndez, Clara; Sawchuck, Diane; Qureshi, Rahat; Dadelszen, Peter von; Munguambe, Khátia; Sevene, Esperança Júlia Pires; CLIP Feasibility Working Group
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Abstract:
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BACKGROUND: 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. METHODS: 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. RESULTS:
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. CONCLUSIONS: 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. |