Challenges in Providing Quality Obstetric Care for Pre-eclampsia and Eclampsia in Nigeria: Assessing Health Providers' P

1. PERSISTING CHALLENGES IN THE PROVISION OF QUALITY OBSTETRIC CARE TO WOMEN WITH PRE-ECLAMPSIA AND ECLAMPSIA IN NIGERIA: ASSESSMENT OF HEALTH PROVIDERS' PREPAREDNESS AND FACILITY READINESS Gloria Adoyi Salisu Mohammed Ishaku; Oginni Ayodeji Babatunde; Karen Kirk. 20th World Congress meeting of the International Society for the Study of Hypertension in Pregnancy (ISSHP) 24 October 2016 Sao Paulo, Brazil.

2. Background In Nigeria, an estimated 40 percent of pregnant women experienced pregnancy-related health problems during or after pregnancy and childbirth (Mutihir, 2011). Common maternal health problems/complications a woman may experience during pregnancy include Pre-eclampsia and Eclampsia (PE/E). Screening, early antenatal detection, and timely management are the most effective ways for preventing morbidity and mortality from these pregnancy-related disorders However, low level of access to, and utilization of quality obstetric care is a major contributing factor to why most maternal deaths occur in Nigeria.

3. Objectives To assess the preparedness of frontline health care providers and facilities readiness for early detection and management of PE/E in seven states in Nigeria To analyze the gaps in providers’ competence to prevent, detect and manage PE/E To determine facility capacity to manage PE/E

4. FACILITY INSIGHTS EARLY DETECTION OF PE

5. Study area

6. methodology Data collection : June to August, 2015 Study sites: Secondary, primary health care facilities and a few tertiary Study Design: Quantitative research using a self- administered, semi-structured questionnaires. Provider Assessment Facility Inventory

7. Summary of quantitative data

8. HEALTH PROVIDERS' PREPAREDNESS findings

9. Type of facility (inventory)

10. Distribution of health provider respondents by: (n=376) Level of health facility Type of provider

11. PROVIDER KNOWLEDGE: A pregnant woman was seen in the ANC at 12 weeks gestation with BP of 160/100 mmHg with no proteinuria. What is the diagnosis?

12. PROVIDER KNOWLEDGE:What are the signs/symptoms of PE, SPE & E?

13. PROVIDER PRACTICE: Assessing the risk of PE, screening for PE and advising client of danger signs of PE/E

14. PROVIDER KNOWLEDGE: Less than 21% were aware of prophylactic drugs for prevention of PE

15. PROVIDER KNOWLEDGE • Only 12% providers knew correct loading dose of MgSO4 (Pritchard regime) • 10% knew the correct maintenance dose • 7% knew which drug used to manage MgSO4 toxicity • <11% providers could list 3 ways to monitor MgSO4 toxicity

16. FACILITY READINESS

17. FACILITY INVENTORY: How do facilities obtain MgSO4?

18. Availability of guidelines for management of PE/E , ANC equipment and MgSO4 You see, the problem here is that, all these policies are available at the national level; but we the implementers don’t have or see the copies.

19. INVENTORY: Is MgSO4 used for treating Pre-eclampsia or eclampsia in this facility? (n-96)

20. Conclusion Reduction in PE/E-related mortality and morbidity hinges on health care providers’ ability to recognize PE/E and have essential tools and commodities available to manage cases Attention must be paid to the in-service training of frontline antenatal care providers (in Nigeria, these include nurses, midwives and community health extension workers) to be able to early detect, prevent and manage PE/E effectively. Health care facilities should be equipped with essential tools and live-saving commodities for managing women with PE/E.