Salam Rehana A, Qureshi Rahat Najam, Sheikh Sana, Khowaja Asif Raza, Sawchuck Diane, Vidler Marianne, von Dadelszen Peter, Zaidi Shujaat, Bhutta Zulfiqar
Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan.
Department of Obstetrics and Gynaecology, Aga Khan University, Stadium Road, Karachi, Pakistan.
Reprod Health. 2016 Sep 30;13(Suppl 2):107. doi: 10.1186/s12978-016-0214-0.
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.
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.
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.
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.
ClinicalTrial.gov, NCT01911494.
据估计，巴基斯坦每10万例活产中有276名妇女死亡；子痫占这些死亡人数的约10%。社区卫生工作者在“女性健康工作者（LHW）计划”的旗帜下为巴基斯坦现有的卫生系统做出贡献，并负责提供一整套产前服务。然而，由于轻度子痫前期妇女通常没有症状，因此需要更加关注在社区环境中早期识别和及时诊断子痫前期。本研究旨在探讨在巴基斯坦将子痫前期和子痫的社区层面管理任务分担给女性健康工作者的可能性。
2012年2月至7月在巴基斯坦南部信德省的海得拉巴德和马蒂亚里两个地区进行了一项定性探索性研究。共进行了33次焦点小组讨论（FGD），并审查了女性健康工作者的课程和培训材料。数据进行了录音，然后逐字转录，使用QSR NVivo 10版本进行主题分析。
对女性健康工作者课程和培训计划的审查结果表明，在现有的社区分娩系统中，女性健康工作者负责识别孕妇、筛查有危险迹象的妇女并转诊进行产前护理。她们是孕期妇女的第一接触点，并提供营养咨询以及分发铁和叶酸补充剂。焦点小组讨论的结果表明，女性健康工作者不携带血压测量设备或抗高血压药物；如果出现妊娠并发症，她们会转诊到最近的公共设施。目前，她们在孕期提供破伤风类毒素。女性健康工作者提供的健康建议受到孕妇及其家人的高度重视和认可。许多女性健康工作者的主管认识到需要加强关于子痫前期和子痫的培训，重点是识别高危妇女。现有的女性健康工作者计划的全部预算由巴基斯坦政府提供，这表明政策制定者和政府对这些提供者所承担的任务给予了大力支持。
有可能对女性健康工作者进行培训并分担任务，以提供全面的产前护理；特别是在巴基斯坦识别和管理子痫前期。然而，实施需要与适当的培训、设备供应和监督相结合。
ClinicalTrial.gov，NCT01911494。
