Professional Documents
Culture Documents
Acknowledgments
Ministries of Health and staff and clients of the study facilities in Kenya, Ethiopia, Madagascar, Mozambique, Rwanda, and Tanzania Data collection teams in each country Core study team members: Jim Ricca, David Cantor, Heather Rosen, Linda Bartlett, Eva Bazant, Rebecca Levine, Patricia Gomez, Joseph de Graft Johnson, Sheena Currie, Bob Bozsa National Coordinating Agency for Population and Development and MEASURE DHS (Kenya), Tandem consulting (Madagascar), USAID Washington colleagues
2
Summary of Samples
Assessed 643 facilities in 6 countries; observed over 2,500 deliveries and close to 3,000 ANC consults; interviewed over 1,000 health workers.
Sample Kenya Ethiopia Tanzania Zanzibar Rwanda Mada- Mozamgascar bique 19 100% 0% 318 192 107 52 23% 77% 880 489 306 9 56% 44% 274 217 106 72 58% 42% 604 293 187 36 75% 25% 670 347 268 46 46% 54% 4781 525 378 Total
-ANC consults
Health workers interviewed
1409
249
126
79
391
206
57
51
311
146
323
140
303
186
2920
1057
Note: Blue bars represent average of scores for each country and high-low line shows the by-country range.
60%
50%
40%
30% 20% 10% 0% 39% 68% 31% 46%
Both PE/E screening Perform or refer for urine elements (ask about at test least 1 danger sign and Take BP) Note: danger signs include headache/blurred vision or swollen hands/face 9
Note: Blue bars represent average of scores for each country and high-low line shows the by-country range.
60%
50% 40%
30%
20% 10% 31% Counsels to return if headache or blurred vision 24% Counsels to return if swollen hands or face
0%
10
70%
60% 50% 40% 30% 20% 10% 0%
Note: Blue bars represent average of scores for each country and high-low line shows the by-country range.
63%
75%
93%
39%
31%
Preventive HIV/syphilis testing Checks health and Asks about vaginal PE/E screening treatments at 1st at 1st visit (2) growth of baby (3) bleeding (4) visit (1) (1) Mean score of: tetanus toxoid, iron and/or folic acid (both at first visit) (2) Mean score of: HIV testing, syphilis testing (both at first visit) (3) Mean score of: weighs client, palpates for uterine height, listens for fetal heartbeat (any visit) (4) Any visit 11
Note: Blue bars represent average of scores for each country and high-low line shows the by-country range.
60%
50% 40%
30%
20% 10% 27% 77% 22% Both PE/E screening elements 7% Tests urine for presence of protein
0%
1) headache/blurred vision or swollen hands/face (any danger sign Kenya and Ethiopia)
How do results for PE/E screening during L&D compare to other elements of care?
100% 90% 80% 70% 60% 50% 40%
Note: Blue bars represent average of scores for each country and high-low line shows the by-country range.
30% 20%
10% 0% 67% Infection prevention (1) 31% Full partograph use (2) 27% AMTSL (3) 54% 64% 22%
Women-centered Immediate PE/E screening care (4) newborn care (5) in L&D
(1)Mean score of 9 IP tasks during L&D; (2) Mean score of 4 partograph components; (3) Any uterotonic given within 3 minutes of delivery with controlled cord traction and uterine massage; (4) Mean score of 10 elements of women-friendly care; (5) Mean score of 5 newborn care tasks 13
45%
16%
89%
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Health Worker Knowledge Scores for Key Areas of Maternal and Newborn Care
Pre-eclampsia/eclampsia (1) Postpartum hemorrhage (2) Obstructed labor (3) Maternal sepsis (4) 44%
40%
40% 39% 55% 51% 44% 0% 10% 20% 30% 40% 50%
Note: Blue bars represent average of scores for each country and high-low line shows the by-country range.
60%
70%
80%
90%
100%
(1)Mean score of 4 knowledge areas: examination, diagnosis, treatment, equipment (fewer treatment questions Mozambique); (2) Mean score of 2 knowledge areas: signs, tests and interventions; (3) Mean score of 2 knowledge areas: signs, tests and interventions (no data for Mozambique); (4) Mean score of 2 knowledge areas: signs, tests and interventions (signs only for Mozambique); (5) Mean score of 1 knowledge area: signs (no data Madagascar); (6) Mean score of 2 knowledge area: examinations, interventions (no data Madagascar); (7) Mean score of 2 knowledge areas: equipment, resuscitation steps (from written test or simulation); no data Mozambique
15
70%
60% 50%
Note: Blue bars represent average of scores for each country and high-low line shows the by-country range.
40%
30% 20%
10%
0% 45% Essential supplies & equipment 44% Examination actions 88% Diagnosis 56% Action to take 40% Actions if presented with convulsions 32% Actions to take 1hr later
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Note: Blue bars represent average of scores for each country and high-low line shows the by-country range.
Policy (1)
(1) MgSO4 registered, on EDL, first line PEE in SDGs and SDLs, SBAs authorized to give first dose, screening in SDGs;
(2) births attended by skilled attendants; (3) personnel received supervision within last 3 months; (4) mean score of facilities with: functioning blood pressure apparatus (in ANC room, except Kenya in delivery room), ability to conduct urine testing, magnesium sulfate in delivery room; (5) aggregate score of PE/E knowledge
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Description of problem Eclampsia Severe pre-eclampsia Mild pre-eclampsia Anti-convulsant used Magnesium sulfate Diazepam No anti-convulsant Other medication used Antihypertensive Calcium gluconate Outcomes Maternal deaths Newborn deaths
18 17 15 19 9 28 14 0 0 2
Conclusions
There are currently missed opportunities for PE screening
Screening during ANC and L&D by taking BP is high and mainly with
proper technique during ANC, BUT History taking for PE/E danger signs in both the ANC clinic and L&D ward is minimal
treatment of eclampsia is still based on diazepam or combination of diazepam and MgSO4, which could be harmful; screening for preeclampsia is missing from ANC guidelines in some countries Commodities lacking in some places: MgSO4 for treatment was available in only about half of facilities - 55% (country range 16-98%) Provider knowledge and supervision also need improvement
19
Recommendations
There needs to be a renewed emphasis on history taking and counseling, and not just physical examination and testing There is at least as much need for emphasis on training and supervision as on commodity supply
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THANK YOU!
Look for the final country study reports on the MCHIP website.
www.mchip.net
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