Barriers to the detection, management and prevention of preeclampsia/eclampsia in Ethiopia

ABSTRACT

BACKGROUND: Preeclampsia is the third leading cause of maternal mortality in Ethiopia accounting for 11% of maternal deaths. Barriers to the diagnosis, management and prevention of Preeclampsia are not well studied in Ethiopia.

OBJECTIVE: To explore barriers to the detection, management and prevention of preeclampsia/ Eclampsia in Ethiopia

METHODS: review of scientific papers on preeclampsia detection, management and prevention was made after employing search strategy and browsing through data bases (PubMed, Google Scholar,) using both text words and medical subject headings as appropriate. A simple word data extraction format was prepared to extract data from national documents including the availability and content of policy, guidelines, protocols and training materials on preeclampsia as well as the procurement process and availability of essential drugs in management and prevention of preeclampsia. Eight in-depth interviews were conducted with relevant stake holders at all levels of health care provision to get insight on their opinion on the challenges in the detection management and prevention of preeclampsia at individual, health care facility and policy level. Data was transcribed verbatim. Framework for analysis of barriers at three levels (health system, care provision and individual) was devised and narrative synthesis of findings done

RESULTS: Findings from eight primary studies; three demographic surveys (DHS), 11 national documents (2 policy papers; 2 legislations; 4 guidelines; 1 protocol and 2 training materials) and transcribed data from the in-depth interviews were included for the narrative synthesis. The barriers at health system level include : lack of national policy or protocol exclusively on preeclampsia.; very outdated management guidelines and protocols; poor drug procurement process and distribution; shortage of drugs (magnesium sulphate); restrictive protocol for administration of 1st dose of magnesium by frontline workers; lack of well-defined protocol on elements of referral and pre-referral care; inadequate CeMONC facilities and training of health professionals on management of preeclampsia; lack of recommendation to use aspirin and calcium for preeclampsia prevention in the protocols/ guidelines.

At health facility level inadequate training; perceived inability to provide magnesium; lack of local protocols; substandard quality of care and poor knowledge on preeclampsia by health providers and fear of administering magnesium sulphate were barriers whereas delayed care seeking; seeking alternative cultural remedies and poor awareness on preeclampsia were barriers at community level.

CONCLUSIONS: There are substantial barriers to the detection, management and prevention of preeclampsia at all levels of health care provision which should be addressed with concerted effort from all responsible stakeholders.

KEY WORDS: Preeclampsia, Eclampsia, Barriers, Diagnosis, Management, Prevention, Ethiopia

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