The ability and safety of community-based health workers to safely initiate lifesaving therapies for pre-eclampsia in Ogun State, Nigeria: An analysis of 260 community treatments with MgSO4 and/or methyldopa.

Abstract

OBJECTIVES:

To evaluate community-based health workers' ability to identify cases of hypertension in pregnancy, safely deliver methyldopa and magnesium sulphate and make referrals when appropriate.

STUDY DESIGN:

This was part of Nigeria Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomized controlled trial (NCT01911494). Community-based Health Workers (CHW) recruited pregnant women from five Local Government Areas (clusters) and used mobile health aid for clinical assessment of pre-eclampsia.

MAIN OUTCOME MEASURES:

The primary outcome was the number of adverse events that occurred after the administration of magnesium sulphate and/or methyldopa to pregnant women by CHWs.

FINDINGS:

Of 8790 women receiving mobile health-guided care, community-based health workers in Nigeria provided 309 women with hypertension (4.2% of delivered women), and safely administered 142 doses of intramuscular magnesium sulphate. Community Heath Extension Workers (CHEWs) and nurses gave fifty-two and sixty-seven doses of intramuscular magnesium sulphate respectively, twenty-three doses were given by other health care workers (midwives, community health officers, health assistants). The high rate of administration by nurses can be explained by turf protection as well as their seniority within the health system. Also, CHEWs and nurses gave 124 doses of oral methyldopa and 126 urgent referrals were completed. There were no complications related to administration of treatment or referral.

INTERPRETATION:

These findings demonstrate the ability of community-based health workers to safely administer methyldopa and intramuscular magnesium sulphate. The use of task-sharing, therefore, could drastically reduce the three delays (triage, transport and treatment) associated with high maternal mortality and morbidity in rural communities in low- and middle-income countries.

• Authors: Akinmade A Adepoju, Marianne Vidler, Adebayo A Akadri, Ebun Jaiyesimi, Chimaobi C Nwankpa, Oluwafayokemi O Odubena, Sumedha Sharma, Larry Li, Domena Tu, Sharla Drebit, Beth Payne, David O Akeju, Zulfiqar Bhutta, Laura A Magee, Hannah L Nathan, Andrew H Shennan, John Sotunsa, Olalekan O Adetoro, Peter von Dadelszen, Olukayode A Dada, Olaokun Soyinka, CLIP Nigeria Working Group
• Journal: Pregnancy hypertension (Pregnancy Hypertens) Vol. 25 Pg. 179-184 (Aug 2021) ISSN: 2210-7797 [Electronic] Netherlands
• PMID: 34175582 (Publication Type: Journal Article)
• Copyright: Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.

Chemical References

• Antihypertensive Agents
• Methyldopa
• Magnesium Sulfate

Topics

• Adolescent
• Adult
• Antihypertensive Agents (administration & dosage, therapeutic use)
• Benchmarking
• Clinical Competence
• Community Health Services (standards)
• Female
• Humans
• Magnesium Sulfate (administration & dosage, therapeutic use)
• Methyldopa (adverse effects, therapeutic use)
• Middle Aged
• Nigeria
• Pre-Eclampsia (prevention & control)
• Pregnancy
• Young Adult