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  • Competency of health workers in detecting and managing gestational hypertension, pre-eclampsia, severe pre-eclampsia and eclampsia during antenatal check-ups in primary care health facilities in Bangladesh: a cross-sectional study

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Health services research
Original research
Competency of health workers in detecting and managing gestational hypertension, pre-eclampsia, severe pre-eclampsia and eclampsia during antenatal check-ups in primary care health facilities in Bangladesh: a cross-sectional study
  1. Sk Masum Billah1,2,
  2. Abdullah Nurus Salam Khan1,3,
  3. S M Rokonuzzaman1,
  4. Nafisa Lira Huq1,
  5. Marufa Aziz Khan4,
  6. Sabrina Sharmin Priyanka1,
  7. Imteaz Ibne Mannan5,
  8. Setara Rahman6,
  9. Shams El Arifeen1,
  10. Joby George7
  1. 1Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
  2. 2Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
  3. 3Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
  4. 4Shukhi Jibon, Pathfinder International, Dhaka, Bangladesh
  5. 5Urban Health Initiative, JHPIEGO, Kabul, Afghanistan
  6. 6Maternal Health & Family Planning, JHPIEGO, Dhaka, Bangladesh
  7. 7MaMoni Health Systems Strengthening, Save the Children Bangladesh, Dhaka, Bangladesh
  1. Correspondence to Sk Masum Billah; billah{at}icddrb.org

Abstract

Study objective To evaluate the competency of trained health workers in detecting and managing hypertensive disorders of pregnancy during routine antenatal check-ups (ANCs) at primary care facilities in Bangladesh.

Study design and settings Cross-sectional study; conducted in 26 primary care facilities.

Outcome measures Accurate diagnosis of the hypertensive disorders of pregnancy.

Method In total 1560 ANC consultations provided by primary health workers, known as Family Welfare Visitors (FWVs), were observed using a structured checklist between October 2017 and February 2018. All consultations were reassessed by study physicians for validation.

Result Of the ‘true’ cases of gestational hypertension (n=32), pre-eclampsia (n=29) and severe pre-eclampsia (n=16), only 3%, 7% and 25%, respectively, were correctly diagnosed by FWVs. Per cent agreement for the diagnosed cases of any hypertensive disorders of pregnancy was 9% and kappa statistics was 0.50 (p value 0.0125). For identification of any hypertensive disorders by FWVs, sensitivity and positive predictive values were 14% and 50%, respectively. There was a moderate positive correlation between the blood pressure measurements taken by FWVs and study physicians. Only 27% of those who had ‘some protein’ in urine were correctly identified by FWVs. Women diagnosed with any of the hypertensive disorders of pregnancy by FWVs were more likely to be counselled on at least one danger sign of pre-eclampsia (severe headache, blurring of vision and upper abdominal pain) than those without any such diagnosis (41% vs 19%, p value 0.008). All four cases of severe pre-eclampsia diagnosed by FWVs were given a loading dose of intramuscular magnesium sulphate and three among them were referred to a higher facility.

Conclusion The FWVs should be appropriately trained on risk assessment of pregnant women with particular emphasis on accurately assessing the diagnostic criteria of hypertensive disorders of pregnancy and its management.

  • epidemiology
  • quality in health care
  • maternal medicine
  • primary care
  • public health

Data availability statement

Data are available in a public, open access repository. Technical appendix, statistical code and dataset available from a public repository (https://doi.org/10.6084/m9.figshare.12554330.v1).

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2020-046638

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    Data availability statement

    Data are available in a public, open access repository. Technical appendix, statistical code and dataset available from a public repository (https://doi.org/10.6084/m9.figshare.12554330.v1).

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    Footnotes

    • Contributors SMB, SEA and JG conceptualised the paper. SMB, ANSK, SMR, NLH, MAK, SSP and IIM were involved in data acquisition, analysis, interpretation and literature review. SMB, ANSK and SMR prepared the first draft. SMB, ANSK, SMR, NLH, MAK, IIM, SR, SEA and JG contributed to the revision and preparation of the final draft. All authors have reviewed and approved the final manuscript.

    • Funding This study was undertaken, and the article was produced as a part of MaMoni Health Systems Strengthening’s (MaMoni HSS) learning agenda with the generous support of the American people through the US Agency for International Development (USAID); Associate Cooperative Agreement No. AID-338-LA-13-00004. The views expressed in this article are solely the views of the authors and do not reflect the views of the US Agency for International Development or the US Government.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.