Authors

Umesh Charanthimath, J N Medical CollegeFollow
Marianne Vidler, University of British Columbia
Geetanjali Katageri, S Nijalingappa Medical College
Umesh Ramadurg, S Nijalingappa Medical College
Chandrashekhar Karadiguddi, J N Medical College
Avinash Kavi, J N Medical College
Anjali Joshi, J N Medical College
Geetanjali Mungarwadi, J N Medical College
Sheshidhar Bannale, S Nijalingappa Medical CollegeFollow
Sangamesh Rakaraddi, S Nijalingappa Medical College
Diane Sawchuck, Vancouver Island Health Authority
Rahat Qureshi, Aga Khan University
Sumedha Sharma, University of British Columbia
Beth A. Payne, University of British Columbia
Peter von Dadelszen, King's College London
Richard Derman, Thomas Jefferson UniversityFollow
Laura A. Magee, King's College London
Shivaprasad Goudar, J N Medical College
Ashalata Mallapur, S Nijalingappa Medical College
Mrutyunjaya Bellad, J N Medical CollegeFollow
Zulfiqar Bhutta, S Nijalingappa Medical College
Sheela Naik, S Nijalingappa Medical College
Anis Mulla, S Nijalingappa Medical College
Namdev Kamle, S Nijalingappa Medical College
Vaibhav Dhamanekar, S Nijalingappa Medical College
Sharla K. Drebit, S Nijalingappa Medical College
Chirag Kariya, S Nijalingappa Medical College
Tang Lee, S Nijalingappa Medical College
Jing Li, S Nijalingappa Medical College
Mansun Lui, S Nijalingappa Medical College
Asif R Khowaja, S Nijalingappa Medical College
Domena K. Tu, S Nijalingappa Medical College
Amit Revankar, S Nijalingappa Medical College

Document Type

Article

Publication Date

6-22-2018

Comments

This article has been peer reviewed. It is the author’s final published version in Reproductive Health, Volume 15, June 2018, Article number 101.

The published version is available at https://doi.org/10.1186/s12978-018-0532-5. Copyright © Charanthimath et al.

Abstract

BACKGROUND: Hypertensive disorders are the second highest direct obstetric cause of maternal death after haemorrhage, accounting for 14% of maternal deaths globally. Pregnancy hypertension contributes to maternal deaths, particularly in low- and middle-income countries, due to a scarcity of doctors providing evidence-based emergency obstetric care. Task-sharing some obstetric responsibilities may help to reduce the mortality rates. This study was conducted to assess acceptability by the community and other healthcare providers, for task-sharing by community health workers (CHW) in the identification and initial care in hypertensive disorders in pregnancy.

METHODS: This study was conducted in two districts of Karnataka state in south India. A total of 14 focus group discussions were convened with various community representatives: women of reproductive age (N = 6), male decision-makers (N = 2), female decision-makers (N = 3), and community leaders (N = 3). One-to-one interviews were held with medical officers (N = 2), private healthcare OBGYN specialists (N = 2), senior health administrators (N = 2), Taluka (county) health officers (N = 2), and obstetricians (N = 4). All data collection was facilitated by local researchers familiar with the setting and language. Data were subsequently transcribed, translated and analysed thematically using NVivo 10 software.

RESULTS: There was strong community support for home visits by CHW to measure the blood pressure of pregnant women; however, respondents were concerned about their knowledge, training and effectiveness. The treatment with oral antihypertensive agents and magnesium sulphate in emergencies was accepted by community representatives but medical practitioners and health administrators had reservations, and insisted on emergency transport to a higher facility. The most important barriers for task-sharing were concerns regarding insufficient training, limited availability of medications, the questionable validity of blood pressure devices, and the ability of CHW to correctly diagnose and intervene in cases of hypertensive disorders of pregnancy.

CONCLUSION: Task-sharing to community-based health workers has potential to facilitate early diagnosis of the hypertensive disorders of pregnancy and assist in the provision of emergency care. We identified some facilitators and barriers for successful task-sharing of emergency obstetric care aimed at reducing mortality and morbidity due to hypertensive disorders of pregnancy.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

Language

English

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