A study by Aga Khan University researchers has suggested ways to reduce the burden of a leading cause of maternal death and disease in Pakistan, pre-eclampsia, a pregnancy-related disorder linked to high blood pressure.
Up to a quarter of all deaths of pregnant women in the country are caused by high blood pressure. Yet, there is little awareness among the public and some healthcare providers of the importance of monitoring blood pressure as part of antenatal care practices.
“There is no word for pre-eclampsia in prominent regional languages like Sindhi,” says Dr Rahat Qureshi, the study’s co-principal investigator in Pakistan and an associate professor at Aga Khan University. “Unlike other childbirth complications, signs of pre-eclampsia cannot be identified easily which limits the chances of early detection and leaves many pregnant women vulnerable to its dangerous complications.”
The findings of the CLIP, Community-Level Interventions for Pre-eclampsia, Pakistan study published in The Lancet suggest that community health workers can play an important role in tackling delays in triaging women, providing initial treatment and in ensuring transport to a health facility.
The study saw lady health workers (LHWs) in Matiari and Hyderabad visit over 35,000 women over a three-year period. LHWs asked mothers in the intervention arm about a variety of symptoms related to pre-eclampsia and also measured their blood pressure and oxygen saturation levels on the spot. This information was then entered into a smartphone-based mobile health application allowing a quick assessment of the risk of severe pre-eclampsia.
If warnings signs were noted, LHWs were trained to provide prompt treatment by providing anti-hypertensive tablets and/or by administering magnesium sulfate. They also created awareness about antenatal care seeking and birth preparedness during pregnancy and referred at-risk mothers to nearby hospitals.
The trial demonstrates that LHWs can use technology to provide accurate referral advice to communities within their homes. The analysis shows that when there were enough LHWs to provide care there were fewer deaths of mothers, fewer stillbirths and fewer deaths of newborns.
The number of LHWs should be sufficient to ensure at least 8 antenatal care visits to help reduce the risk of adverse pregnancy outcomes, researchers added. Findings also support the World Health Organization’s recommendation of the benefits of regular antenatal visits to lower the risk of pregnancy-related complications.
Researchers also noted that improvements are needed in the quality of care offered at facilities and the availability of key commodities in order to reduce the incidence of women dying during their pregnancy or immediately after giving birth.
“The findings of the CLIP Pakistan study once again reinforce the need to work on multiple fronts to address the burden of maternal and newborn mortality,” said AKU’s Professor Zulfiqar A. Bhutta, a co-principal investigator of the Pakistan study. “Addressing this challenge through well-trained LHWs linked to quality care in our referral facilities is critically important in our quest to reduce preventable maternal and newborn deaths.”
The objectives of the study are in line with global efforts to achieve targets under goal 3 of the sustainable development goals, ensure healthy lives and promote well-being for all at all ages, which calls for special efforts to reduce preventable deaths of mothers and newborns by 2030.
Dr Sana Sadiq Sheikh and Dr Zahra Hoodbhoy were co-investigators on the CLIP Pakistan study. The Pakistan study was conducted in partnership with researchers from the University of British Columbia, King’s College London and the Centre for Global Child Health at the Hospital For Sick Children in Toronto. The global CLIP study spanned over 70,000 women in Pakistan, India and Mozambique.
