Community health workers’ knowledge and practice in relation to pre-eclampsia in Ogun State, Nigeria: an essential bridge to maternal survival

  • Reproductive Health, Volume 13, Year 2016

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Study Justification:
This study aimed to determine the knowledge and practice of community health workers in relation to pre-eclampsia in Ogun State, Nigeria. Pre-eclampsia is a leading cause of maternal and fetal morbidity and mortality worldwide. Early detection and treatment have been successful in reducing case fatality in high-income countries. However, in low-income countries like Nigeria, community health workers play a crucial role in providing maternal care services and need to have adequate knowledge and skills to identify and provide emergency care for women with pre-eclampsia.
Highlights:
– Community-based health care providers in Ogun State, Nigeria were found to be aware of the causes and features of pre-eclampsia.
– They were capable of identifying women at risk, initiating care, and referring women with pre-eclampsia.
– However, some community health workers were not comfortable managing the condition due to limitations in their “Standing Order” guidelines.
– Regular training and retraining of community health workers, combined with availability of equipment, could improve maternal health in rural areas.
Recommendations:
– Provide regular training and retraining for community health workers to enhance their knowledge and skills in identifying and managing pre-eclampsia.
– Update the “Standing Order” guidelines to explicitly authorize community health extension workers to treat pre-eclampsia in the community.
– Ensure availability of necessary equipment for the identification and management of pre-eclampsia in primary health centers.
Key Role Players:
– Traditional birth attendants
– Community health extension workers
– Nurses and midwives
– Chief nursing officers
– Medical officers
– Health administrators
Cost Items for Planning Recommendations:
– Training and retraining programs for community health workers
– Updating and printing of “Standing Order” guidelines
– Procurement of necessary equipment for pre-eclampsia identification and management in primary health centers

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Background: Pre-eclampsia is a leading cause of maternal and fetal morbidity and mortality worldwide. Early detection and treatment have been instrumental in reducing case fatality in high-income countries. To achieve this in a low-income country, like Nigeria, community health workers who man primary health centres must have adequate knowledge and skills to identify and provide emergency care for women with pre-eclampsia. This study aimed to determine community health workers’ knowledge and practice in the identification and treatment of pre-eclampsia, as they are essential providers of maternal care services in Nigeria. Methods: This study was part of a multi-country evaluation of community treatment of pre-eclampsia. Qualitative data were obtained from four Local Government Areas of Ogun State, in south western Nigeria by focus group discussions (N = 15) and in-depth interviews (N = 19). Participants included a variety of community-based health care providers – traditional birth attendants, community health extension workers, nurses and midwives, chief nursing officers, medical officers – and health administrators. Data were transcribed and validated with field notes and analysed with NVivo 10.0. Results: Community-based health care providers proved to be aware that pre-eclampsia was due to the development of hypertension and proteinuria in pregnant women. They had a good understanding of the features of the condition and were capable of identifying women at risk, initiating care, and referring women with this condition. However, some were not comfortable managing the condition because of the limitation in their ‘Standing Order’; these guidelines do not explicitly authorize community health extension workers to treat pre-eclampsia in the community. Conclusion: Community-based health care providers were capable of identifying and initiating appropriate care for women with pre-eclampsia. These competencies combined with training and equipment availability could improve maternal health in the rural areas. There is a need for regular training and retraining to enable successful task-sharing with these cadres. Trial registration: NCT01911494 .

This was part of the feasibility study for the Community Level Intervention for Pre-eclampsia (CLIP) cluster randomized controlled trial in Ogun State, Nigeria ({“type”:”clinical-trial”,”attrs”:{“text”:”NCT01911494″,”term_id”:”NCT01911494″}}NCT01911494). The qualitative exploratory study was a conducted in four Local Government Areas (LGA) of Ogun State, Nigeria: Yewa South, Remo North, Sagamu (Ogijo-Axis), and Imeko Afon. An ethnographic approach was utilized to identify similarities and differences between groups. Where feasible, focus groups were convened; however, some groups were not possible to gather in large numbers, in these cases in-depth interviews were conducted (Tables 1 and ​and2).2). These participants represent supervisors and managerial positions, of which there are few in each LGA. Focus group discussions (FGD) (N = 15) and in-depth interviews (IDI) (N = 19) were conducted in each LGA. Focus group participants included traditional birth attendants (TBA) (n = 36), Community Health Extension Workers (CHEW) (n = 83), nurses and midwives (n = 43), and representatives of the Society of Obstetricians and Gynaecologists (n = 9). Interviews were held with the Head of the LGA administration (HOLGA) (n = 4), the head of the TBAs (n = 4), the head of the CHEWs (n = 4), the Chief Nursing Officer (CNO) (n = 4), medical officers of health (MOH) (n = 2), and one TBA (n = 1). Focus group participants In-depth interview participants A convenience sample was used. FGDs and IDIs were conducted in central community locations, to ease access for all participants. All sessions were audio-recorded and transcribed verbatim by the field researchers in the original language (Yoruba) using a structured transcription format. Transcriptions were validated by observations and review of field notes. All transcripts underwent another round of consistency checks by moderators. The validated data was then translated to English and analysed using NVivo 10.0. Ethical approval for the study was obtained from the Olabisi Onabanjo University Teaching Hospital, Sagamu Nigeria (OOUTH/DA/326/431), and University of British Columbia, Vancouver, Canada (H12-00132).

The recommendation to improve access to maternal health in Nigeria is to provide regular training and retraining for community-based health care providers. These providers, including traditional birth attendants, community health extension workers, nurses and midwives, chief nursing officers, and medical officers, have shown a good understanding of pre-eclampsia and the ability to identify and initiate appropriate care for women with this condition. However, some providers expressed discomfort in managing pre-eclampsia due to limitations in their “Standing Order” guidelines.

By offering regular training and retraining, these community-based health care providers can enhance their knowledge and skills in identifying and treating pre-eclampsia. This would enable successful task-sharing and improve maternal health outcomes in rural areas. Additionally, ensuring the availability of necessary equipment and resources would further support these providers in delivering effective care.

This recommendation is based on a qualitative exploratory study conducted in Ogun State, Nigeria, as part of the feasibility study for the Community Level Intervention for Pre-eclampsia (CLIP) cluster randomized controlled trial. The study involved focus group discussions and in-depth interviews with various community-based health care providers and health administrators. The findings highlight the potential of community health workers in improving access to maternal health, but also emphasize the need for training and support to fully utilize their capabilities.

Source: “Community health workers’ knowledge and practice in relation to pre-eclampsia in Ogun State, Nigeria: an essential bridge to maternal survival” (Reproductive Health, Volume 13, Year 2016)
AI Innovations Description
Based on the information provided, the recommendation to improve access to maternal health is to provide regular training and retraining for community-based health care providers in Nigeria. These providers, including traditional birth attendants, community health extension workers, nurses and midwives, chief nursing officers, and medical officers, have shown a good understanding of pre-eclampsia and the ability to identify and initiate appropriate care for women with this condition. However, some providers expressed discomfort in managing pre-eclampsia due to limitations in their “Standing Order” guidelines.

By offering regular training and retraining, these community-based health care providers can enhance their knowledge and skills in identifying and treating pre-eclampsia. This would enable successful task-sharing and improve maternal health outcomes in rural areas. Additionally, ensuring the availability of necessary equipment and resources would further support these providers in delivering effective care.

This recommendation is based on a qualitative exploratory study conducted in Ogun State, Nigeria, as part of the feasibility study for the Community Level Intervention for Pre-eclampsia (CLIP) cluster randomized controlled trial. The study involved focus group discussions and in-depth interviews with various community-based health care providers and health administrators. The findings highlight the potential of community health workers in improving access to maternal health, but also emphasize the need for training and support to fully utilize their capabilities.

Publication: Reproductive Health, Volume 13, Year 2016
AI Innovations Methodology
To simulate the impact of the main recommendations mentioned in the abstract on improving access to maternal health, a potential methodology could involve the following steps:

1. Baseline Assessment: Conduct a comprehensive assessment of the current knowledge and practices of community-based health care providers in relation to pre-eclampsia in the selected areas of Ogun State, Nigeria. This assessment should include surveys, interviews, and focus group discussions to gather data on their understanding, skills, and comfort level in managing pre-eclampsia.

2. Training and Retraining: Develop a training program tailored to the specific needs and gaps identified in the baseline assessment. The training should focus on enhancing the knowledge and skills of community-based health care providers in identifying and treating pre-eclampsia. It should cover topics such as early detection, risk assessment, appropriate care, and referral protocols. The training program should be delivered through workshops, seminars, and practical sessions.

3. Implementation: Implement the training program by organizing regular training sessions for community-based health care providers in the selected areas. Ensure that the training is accessible and convenient for the providers, taking into consideration their work schedules and locations. Provide necessary resources and equipment to support the implementation of the training recommendations.

4. Monitoring and Evaluation: Establish a monitoring and evaluation system to assess the impact of the training program on the knowledge and practices of community-based health care providers. This can be done through pre- and post-training assessments, follow-up surveys, and on-site observations. Evaluate the providers’ ability to identify and manage pre-eclampsia cases, as well as their confidence and comfort level in doing so.

5. Feedback and Continuous Improvement: Based on the monitoring and evaluation findings, provide feedback to the community-based health care providers and relevant stakeholders. Use the feedback to identify areas for improvement and make necessary adjustments to the training program. Continuously update and refine the training materials and delivery methods to ensure effectiveness and relevance.

6. Scaling Up: Once the impact of the training program has been demonstrated, consider scaling up the intervention to other areas in Ogun State or even to other states in Nigeria. Collaborate with local health authorities, NGOs, and other stakeholders to expand the reach of the training program and improve access to maternal health on a larger scale.

By following this methodology, it would be possible to assess the impact of regular training and retraining on community-based health care providers’ knowledge and practices in relation to pre-eclampsia. This would help improve access to maternal health and contribute to reducing maternal and fetal morbidity and mortality in Nigeria.

Statistics:
Citations: 10
Authors: 11
Identifiers:
DOI: 10.1186/s12978-016-0218-9
Research Areas:
Community Interventions, Health System and Policy, Maternal and Child Health, Noncommunicable Diseases, Quality of Care, Social Determinants, Workforce
Study Countries:
Nigeria
Study Design:
Ethnographic Study, Exploratory Study, randomised-control-trial
Study Approach:
Mixed-methods, Qualitative, Quantitative
Participants Gender:
Female
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