KLE Academy of Higher Education and Research's, J N Medical College, Belagavi, Karnataka, India.
Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British, Columbia, Vancouver, BC, Canada.
Reprod Health. 2018 Jun 22;15(Suppl 1):101. doi: 10.1186/s12978-018-0532-5.
Hypertensive disorders are the second highest direct obstetric cause of maternal death after haemorrhage, accounting for 14% of maternal deaths globally. Pregnancy hypertension contributes to maternal deaths, particularly in low- and middle-income countries, due to a scarcity of doctors providing evidence-based emergency obstetric care. Task-sharing some obstetric responsibilities may help to reduce the mortality rates. This study was conducted to assess acceptability by the community and other healthcare providers, for task-sharing by community health workers (CHW) in the identification and initial care in hypertensive disorders in pregnancy.
This study was conducted in two districts of Karnataka state in south India. A total of 14 focus group discussions were convened with various community representatives: women of reproductive age (N = 6), male decision-makers (N = 2), female decision-makers (N = 3), and community leaders (N = 3). One-to-one interviews were held with medical officers (N = 2), private healthcare OBGYN specialists (N = 2), senior health administrators (N = 2), Taluka (county) health officers (N = 2), and obstetricians (N = 4). All data collection was facilitated by local researchers familiar with the setting and language. Data were subsequently transcribed, translated and analysed thematically using NVivo 10 software.
There was strong community support for home visits by CHW to measure the blood pressure of pregnant women; however, respondents were concerned about their knowledge, training and effectiveness. The treatment with oral antihypertensive agents and magnesium sulphate in emergencies was accepted by community representatives but medical practitioners and health administrators had reservations, and insisted on emergency transport to a higher facility. The most important barriers for task-sharing were concerns regarding insufficient training, limited availability of medications, the questionable validity of blood pressure devices, and the ability of CHW to correctly diagnose and intervene in cases of hypertensive disorders of pregnancy.
Task-sharing to community-based health workers has potential to facilitate early diagnosis of the hypertensive disorders of pregnancy and assist in the provision of emergency care. We identified some facilitators and barriers for successful task-sharing of emergency obstetric care aimed at reducing mortality and morbidity due to hypertensive disorders of pregnancy.
高血压疾病是仅次于出血的第二大导致产妇死亡的直接产科病因，占全球产妇死亡的 14%。妊娠高血压会导致产妇死亡，特别是在中低收入国家，这是因为提供循证急救产科护理的医生稀缺。分担一些产科责任可能有助于降低死亡率。本研究旨在评估社区和其他医疗保健提供者对社区卫生工作者（CHW）在妊娠高血压中识别和初步护理方面的任务分担的接受程度。
本研究在印度南部卡纳塔克邦的两个地区进行。共召集了 14 次焦点小组讨论，参与者包括不同的社区代表：育龄妇女（N=6）、男性决策者（N=2）、女性决策者（N=3）和社区领袖（N=3）。还与医疗官（N=2）、私营医疗保健妇产科专家（N=2）、高级卫生行政人员（N=2）、塔鲁卡（县）卫生官员（N=2）和妇产科医生（N=4）进行了一对一访谈。所有数据收集均由熟悉当地情况和语言的当地研究人员进行。随后使用 NVivo 10 软件对数据进行转录、翻译和主题分析。
社区强烈支持 CHW 家访测量孕妇的血压；然而，受访者担心他们的知识、培训和效果。社区代表接受了用口服降压药和硫酸镁治疗紧急情况，但医务人员和卫生行政人员对此持保留意见，并坚持将患者紧急送往更高一级的医疗机构。任务分担的最重要障碍是对培训不足、药物有限供应、血压设备有效性存疑以及 CHW 正确诊断和干预妊娠高血压疾病的能力的担忧。
将任务分担给以社区为基础的卫生工作者有可能促进妊娠高血压疾病的早期诊断，并协助提供紧急护理。我们确定了成功分担旨在降低妊娠高血压疾病死亡率和发病率的紧急产科护理任务的一些促进因素和障碍。
