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Open Access 01-09-2016 | Research

Potential for task-sharing to Lady Health Workers for identification and emergency management of pre-eclampsia at community level in Pakistan

Authors: Rehana A. Salam, Rahat Najam Qureshi, Sana Sheikh, Asif Raza Khowaja, Diane Sawchuck, Marianne Vidler, Peter von Dadelszen, Shujaat Zaidi, Zulfiqar Bhutta, the CLIP working group

Published in: Reproductive Health | Special Issue 2/2016

Abstract

Background

An estimated 276 Pakistani women die for every 100,000 live births; with eclampsia accounting for about 10 % of these deaths. Community health workers contribute to the existing health system in Pakistan under the banner of the Lady Health Worker (LHW) Programme and are responsible to provide a comprehensive package of antenatal services. However, there is a need to increase focus on early identification and prompt diagnosis of pre-eclampsia in community settings, since women with mild pre-eclampsia often present without symptoms. This study aims to explore the potential for task-sharing to LHWs for the community-level management of pre-eclampsia and eclampsia in Pakistan.

Methods

A qualitative exploratory study was undertaken February-July 2012 in two districts, Hyderabad and Matiari, in the southern province of Sindh, Pakistan. Altogether 33 focus group discussions (FGDs) were conducted and the LHW curriculum and training materials were also reviewed. The data was audio-recorded, then transcribed verbatim for thematic analysis using QSR NVivo-version10.

Results

Findings from the review of the LHW curriculum and training program describe that in the existing community delivery system, LHWs are responsible for identification of pregnant women, screening women for danger signs and referrals for antenatal care. They are the first point of contact for women in pregnancy and provide nutritional counselling along with distribution of iron and folic acid supplements. Findings from FGDs suggest that LHWs do not carry a blood pressure device or antihypertensive medications; they refer to the nearest public facility in the event of a pregnancy complication. Currently, they provide tetanus toxoid in pregnancy. The health advice provided by lady health workers is highly valued and accepted by pregnant women and their families. Many Supervisors of LHWs recognized the need for increased training regarding pre-eclampsia and eclampsia, with a focus on identifying women at high risk. The entire budget of the existing lady health worker Programme is provided by the Government of Pakistan, indicating a strong support by policy makers and the government for the tasks undertaken by these providers.

Conclusion

There is a potential for training and task-sharing to LHWs for providing comprehensive antenatal care; specifically for the identification and management of pre-eclampsia in Pakistan. However, the implementation needs to be combined with appropriate training, equipment availability and supervision.

Trial registration

ClinicalTrial.gov, NCT01911494

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Title: Potential for task-sharing to Lady Health Workers for identification and emergency management of pre-eclampsia at community level in Pakistan
Authors: Rehana A. Salam
Rahat Najam Qureshi
Sana Sheikh
Asif Raza Khowaja
Diane Sawchuck
Marianne Vidler
Peter von Dadelszen
Shujaat Zaidi
Zulfiqar Bhutta
the CLIP working group
Publication date: 01-09-2016
Publisher: BioMed Central
Published in: Reproductive Health / Issue Special Issue 2/2016
Electronic ISSN: 1742-4755
DOI: https://doi.org/10.1186/s12978-016-0214-0

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Potential for task-sharing to Lady Health Workers for identification and emergency management of pre-eclampsia at community level in Pakistan

Abstract

Background

Methods

Results

Conclusion

Trial registration

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Trial registration

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