Knowledge of pre-eclampsia and eclampsia in Bangladesh

In Bangladesh between 1,000 and 1,200 women die every year from pre-eclampsia and eclampsia (PE/E), contributing to 20 percent of maternal deaths. It is the country’s second leading direct cause of maternal mortality. In addition to the burden of maternal mortality, when a mother dies her baby is at increased risk of dying during the first year of life. To fully understand community perceptions of PE/E, the Population Council conducted a landscape analysis in 12 upazilas in four districts. This brief presents those research findings, and concludes that stronger awareness of the importance of early antenatal care and of seeking care at facilities when women experience complications during pregnancy, specifically symptoms of PE/E, will empower women and their families, and fewer deaths of women and babies will result from PE/E

Knowledge and practices for pre-eclampsia and eclampsia care in Bangladesh

The Bangladesh Maternal Mortality Survey revealed that pre-eclampsia and eclampsia (PE/E) is the second most common direct cause of maternal deaths—between 1,000 and 1,200 maternal deaths (20 percent) each year. Early detection and treatment during antenatal care visits are instrumental in reducing deaths from PE/E. In Bangladesh, however, primary healthcare providers have limited knowledge of the condition, and in many cases are unaware of how to detect, manage, and treat it. This research brief presents the findings of a landscape analysis that was conducted to better understand service providers’ maternal health knowledge, attitudes, and practices, particularly around PE/E

Life-saving medicines and equipment in facilities in Bangladesh

This research brief is a part of a larger landscaping analysis by Population Council, with support from USAID and the MacArthur Foundation. In Bangladesh, in 12 upazilas in four districts, it assessed the capacity of primary health facilities to manage pre-eclampsia and eclampsia (PE/E). This brief shares findings from 134 facilities on required infrastructure for providing maternal and newborn health (MNH) services, human resources, facility readiness, and MNH commodities and supplies. Facility readiness is vital to providing quality services to antenatal care (ANC) patients, especially to women with PE/E. Without functioning equipment, ANC/PNC registers, essential medicines, electricity, and running water, women are less likely to seek and receive services in a timely manner. The brief includes recommendations based on the study’s findings

Policies for pre-eclampsia and eclampsia prevention and management in Bangladesh

Bangladesh experiences between 5,000 and 6,000 maternal deaths each year. Of those deaths, 20 percent are from pre-eclampsia and eclampsia (PE/E), the second most common direct cause of maternal mortality in the country. In Bangladesh, best practices to prevent PE/E using aspirin and calcium and managing it through task sharing and use of magnesium sulphate and anti-hypertensive drugs have not been optimally examined. To appreciate the enormity of the problem, the Population Council conducted a landscape analysis in 12 upazilas in four districts. The study was cross sectional, and data collection activities included in-depth interviews (IDIs) with policymakers, development partners, program managers, and ob/gyn professionals and primary facility providers. The study’s objective was to identify existing national policies and guidelines for PE/E management and prevention, as well as to document gaps in antenatal care specifically related to PE/E

Assessing the effect of a primary health care intervention for improving pre-eclampsia and eclampsia knowledge and practice in Bangladesh

In resource-poor countries such as Bangladesh, proven life-saving commodities for pregnant women have not been optimally examined, such as magnesium sulphate (MgSO4) to manage severe pre-eclampsia/eclampsia, use of anti-hypertensives to manage high blood pressure during pregnancy, aspirin prophylaxis for pregnant women at high risk of PE/E, as well as task shifting to lower health-worker cadres, and community involvement. There has been no systematic review of research and programming on PE/E prevention, early detection, and treatment in Bangladesh. With support from USAID, the Ending Eclampsia project has been expanding access to proven, underutilized interventions and commodities for PE/E prevention, early detection, and management, particularly expansion of MgSO4 access in several countries through primary health care (PHC) providers. In 2015, a landscaping analysis identified articles reporting PE/E burdens, common risk factors, incidence, adverse outcomes, and mortality rates; few studies, however, discuss implementation research (IR) for improving PE/E prevention, detection, and timely management, particularly within PHC facilities. Following a two-year intervention expanding MgSO4 provision through PHC providers in 12 subdistricts of Bangladesh, this endline report describes the IR conducted by the Population Council from 2015 to 2018

Assessing the feasibility of primary health care provider prescription of anti-hypertensive medication to pregnant women in Bangladesh

Hypertensive disorders of pregnancy (HDPs)—which are major contributors of maternal and newborn mortality, morbidity, and disability—are preventable. About 24 percent of maternal deaths in Bangladesh each year are due to pre-eclampsia and eclampsia (PE/E). A known cause of death in women with PE/E is cerebrovascular accident, which occurs due to rapidly increasing blood pressure (BP). Elevated BP associated with pregnancy should be detected and appropriately managed before onset of convulsions (eclampsia) and other life-threatening complications. For women presenting with severe PE/E, magnesium sulphate (MgSO4) is the recommended drug for convulsion management. Anti-hypertensive medicines are also recommended for control of high BP, but the authorization to prescribe these drugs, both for preventing and managing PE/E, is limited within lower-level primary health-care (PHC) facilities in Bangladesh. This report details implementation research findings assessing the feasibility of PHC providers identifying HDP and prescribing alpha methyldopa prior to referring patients to a higher-level facility for MgSO4 administration, if needed. The study was part of the Ending Eclampsia project to scale up a PHC model for early detection, prevention, and management of PE/E

Landscape analysis on pre-eclampsia and eclampsia in Bangladesh

Globally more than 800 women die every day from preventable complications related to pregnancy and childbirth, and 99 percent of these deaths occur in developing countries. Every day approximately 7,200 babies are stillborn. Pre-eclampsia and eclampsia (PE/E) contribute significantly to these mortalities. Eclampsia is the second most common direct cause of maternal death in Bangladesh followed by post-partum hemorrhage. Through the Ending Eclampsia project, the Population Council is seeking to expand access to proven, underutilized interventions and commodities for the prevention, early detection, and treatment of PE/E. In resource-poor countries, particularly Bangladesh, magnesium sulphate (MgSO4) for management of severe PE/E, anti-hypertensives to manage high blood pressure during pregnancy, aspirin prophylaxis for pregnant women at high risk of developing PE/E, task shifting to lower level cadres, and community involvement have not been optimally examined. There has been no systematic review of research and programming on PE/E prevention, early detection, and treatment in Bangladesh. The Council conducted a landscape analysis on PE/E in Bangladesh in August and September 2015, and this report provides major findings

Hypertensive disorders in pregnancy: Assessing postnatal quality of care and outcomes for women and their infants in Bangladesh

Hypertensive disorders in pregnancy (HDPs) are the second leading cause of maternal mortality in Bangladesh, responsible for 24 percent of maternal deaths. Various factors, such as lack of health-care provider capacities for detecting, preventing, and managing pre-eclampsia and eclampsia (PE/E), late referrals, late (or lack of) antenatal care (ANC), and poor awareness of PE/E, are factors in most of these deaths. While some information was available on the prenatal and postnatal periods, an evidence gap existed in information after delivery through the first year postnatal, and beyond. In this prospective cohort study, the Ending Eclampsia project recruited married women ages 15 to 49 years with HDP, along with their infants, around the time of delivery and prospectively followed them for up to one year to evaluate their care, assess their health statuses, and identify any pattern of morbidities. Numerous conclusions and recommendations emerged from this report to help health-care providers, public health experts, policy decision-makers, health administrators, and developmental partners in Bangladesh provide better services to women with HDPs

Knowledge of pharmacy workers on antihypertensive and anticonvulsant drugs for managing pre-eclampsia and eclampsia in Bangladesh

Background: Pharmacy workers in Bangladesh play an important role in managing pregnancy complications by dispensing, counselling and selling drugs to pregnant women and their families. This study examined pharmacy workers’ drug knowledge and practice for pre-eclampsia and eclampsia (PE/E) management, including antihypertensives and anticonvulsants, and determine factors associated with their knowledge. Methods: A cross-sectional survey with 382 pharmacy workers in public facilities (government) and private pharmacies and drug stores assessed their knowledge of antihypertensive and anticonvulsant drugs. ‘Pharmacy workers’ include personnel who work at pharmacies, pharmacists, family welfare visitors (FWVs), sub-assistant community medical officers (SACMOs), drug storekeepers. Exploratory and multivariate logistic models were used to describe association between knowledge of medicines used in pregnancy and demographic characteristics of pharmacy workers. Results: Overall, 53% pharmacy workers interviewed were drug store owners in private pharmacies while 27% FWVs/SACMOs, who are government service providers also work as drug prescribers and/or dispensers in public facility pharmacies. Majority of pharmacy workers had poor knowledge compared to correct knowledge on both antihypertensive (77.8% vs 22.3%; p \u3c 0.001) and anticonvulsant drugs (MgSO4) (82.2% vs 17.8%; p \u3c 0.001). Multivariate analysis showed SACMOs and FWVs were greater than 4 times more likely to have correct knowledge on anti-hypertensives (AOR = 4.2, 95% CI:1.3–12.3, P \u3c 0.01) and anticonvulsant drugs (AOR = 4.9, 95% CI:1.3–18.1, P \u3c 0.01) compared to pharmacists. Pharmacy workers who had received training were more likely to have correct knowledge on antihypertensive and anticonvulsant drugs than those who had no training. Conclusions: Pharmacy workers’ knowledge and understanding of antihypertensive and anticonvulsant drugs, particularly for prevention and management of PE/E is limited in Bangladesh. Most pharmacies surveyed are private and staffed with unskilled workers with no formal training on drugs. Expansion of maternal and newborn health programs should consider providing additional skills training to pharmacy workers, as well as regulating these medicines at informal pharmacies to mitigate any harmful practices or adverse outcomes of unauthorized and incorrectly prescribed and used drugs. It is important that correct messaging and medicines are available as drug stores are often the first point of contact for most of the women and their families

Pathways to service access for pre-eclampsia and eclampsia in rural Bangladesh: Exploring women\u27s care-seeking

Background: While women in low- and middle-income countries face a range of barriers to accessing care for hypertensive disorders of pregnancy, there is little understanding of the pathways taken to overcome these constraints and reach the services they need. This study explores the perspectives of women and communities on the influences that impact care-seeking decisions and pathways to health services. Methods: To understand individual perspectives, we conducted 22 in-depth interviews (IDIs) with pre-eclampsia and eclampsia survivors (PE/E) in a tertiary hospital, where they received care after initiating PE/E services in different parts of the country. In four districts, we conducted one male and one female focus group discussion (FGD) to unearth care-seeking pathways and explore normative perspectives and the range of internal and external influences. Careful thematic analysis using Atlas-ti was applied. Results: Prevailing views of women and communities across settings in Bangladesh indicate varied pathways to care throughout their pregnancy, during childbirth, and in the postnatal period influenced by internal and external factors at the individual, familial, social, and health systems levels. Internal influences draw on women’s own awareness of hypertension complications and options, and their ability to decide to seek care. External factors include social influences like family and community norms, culturally-accepted alternatives, and community perceptions of the health system’s capacity to provide quality care. The interaction of these factors often delay care seeking and can lead to complex pathways to care. Conclusion: Women’s individual pathways to care were diverse, despite the homogenous community perceptions of the influences on women’s care-seeking behaviors. This finding supports the need for improving quality of care in primary healthcare facilities and strengthening gender equity and community-based promotion activities through targeted policy and programming