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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

Research output: Contribution to journalArticlepeer-review

The CLIP Nigeria Working Group

Original languageEnglish
Pages (from-to)179-184
Number of pages6
JournalPregnancy Hypertension
Volume25
DOIs
PublishedAug 2021

Bibliographical note

Funding Information: This work is part of the University of British Columbia PRE-EMPT (Pre-eclampsia/Eclampsia, Monitoring, Prevention and Treatment) initiative supported by the Bill & Melinda Gates Foundation. We would like to thank all members of the CLIP- NG team including: John Imaralu, Oluwole Ayodeji, Bisi Orengua, Bola Idowu-Ajiboye, Bimpe Osiberu, Busola Ibiezugbe, Abiodun Owoseje, and Kunle Adefabi and CLIP-CA team: Chirag Kariya, Tang Lee, Mansun Lui, Dustin Dunsmuir, Vivian Ukah, Asif Khowaja and Michelle La. Funding Information: The University of British Columbia (PRE-EMPT), a grantee of the Bill & Melinda Gates Foundation . This work was supported, in whole or in part, by the Bill & Melinda Gates Foundation [OPP1017337]. Under the grant conditions of the Foundation, a Creative Commons Attribution 4.0 Generic License has already been assigned to the Author Accepted Manuscript version that might arise from this submission. Publisher Copyright: © 2021 The Author(s) Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

King's Authors

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.

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