Skip to main content

Monitoring Severe Pre-Eclampsia and Eclampsia Treatment in Resource Poor Countries: Skilled Birth Attendant Perception of a New Treatment and Monitoring Chart (LIVKAN Chart)

Abstract

The lack of easy to use protocols and monitoring charts in the management of pre-eclampsia/eclampsia contribute to substandard care of women in resource poor settings. A treatment monitoring tool (LIVKAN chart) has been developed to improve the quality of care for these women. Based on feedback from skilled birth attendants (SBAs), a two page document which provides a visual record of the treatment and monitoring of women with severe pre-eclampsia/eclampsia over a 24 h period was developed. It also contains detailed treatment guidelines as well as a summary of the woman’s treatment. A two page document on instructions for use of the chart was also developed. The chart design was evaluated by different level SBAs via a semi structured questionnaire. There was a 92% (109) response rate. About 30% (33) and 58% (63) of the respondents provided care to women in Primary Health Care and referral health care facilities respectively. Ninety eight percentage of respondents indicated that the chart would be of additional benefit in their care of women with pre-eclamptic/eclampsia. Seventy three percentage of respondents indicated that the chart would also be useful to lower health care facility SBAs. The design of the chart ensures that guidelines for managing/monitoring of patients are instantly available on a concise easy-to-use chart which confers added advantage over other chart designs. Having been evaluated by SBAs, acceptability and utilization in poor resource settings should be high. A study has been designed to evaluate the acceptability and effectiveness of this new monitoring chart in both BEOCs and CEOCs in two sub-Saharan African countries.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  1. 1.

    United Nations. (2010). The millennium development goals report 2010, vol. 5, pp. 1–80.

  2. 2.

    WHO, UNICEF, UNFPA, The World Bank. (2010). Trends in maternal mortality 1990 to 2008.

  3. 3.

    Duley, L. (1992). Maternal mortality associated with hypertensive disorders of pregnancy in Africa, Asia, Latin America, The Caribbean. British Journal of Obstetrics and Gynaecology, 99(7), 547–553.

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Duley, L. (2009). The global impact of pre-eclampsia and eclampsia. Seminars in Perinatology, 33(3), 130–137.

    PubMed  Article  Google Scholar 

  5. 5.

    Khan, K. S., Wojdyla, D., Say, L., Gülmezoglu, A. M., & Van Look, P. F. (2006). WHO analysis of causes of maternal death: A systematic review. Lancet, 367(9516), 1066–1074.

    PubMed  Article  Google Scholar 

  6. 6.

    Department of Health. (2009). National Committee on Confidential Enquiries into Maternal Health. Saving Mothers Report 2005–2007.

  7. 7.

    Adamu, Y. M., Salihu, H. M., Sathiakumar, N., & Alexander, G. R. (2003). Maternal mortality in Northern Nigeria: A population-based study. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 109(2), 153–159.

    PubMed  Article  Google Scholar 

  8. 8.

    Adetoro, O. O. (1989). A sixteen year survey of maternal mortality associated with eclampsia in Ilorin, Nigeria. International Journal of Gynaecology and Obstetrics, 30(2), 117–121.

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Ezugwu, E. C., Onah, H. E., Ezugwu, F. O., & Okafor, I. I. (2009). Maternal mortality in a transitional hospital in Enugu, south east Nigeria. African Journal of Reproductive Health, 13(4), 67–72.

    PubMed  CAS  Google Scholar 

  10. 10.

    Tukur, J., Umar, B. A., & Rabi’u, A. (2007). Pattern of eclampsia in a tertiary health facility situated in a semi-rural town in Northern Nigeria. Annals of African Medicine, 6(4), 164–167.

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Majoko, F., & Mujaji, C. (2001). Maternal outcome in eclampsia at Harare Maternity Hospital. Central African Journal of Medicine, 47(5), 123–128.

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Moodley, J. (2004). Maternal deaths associated with hypertensive disorders of pregnancy: A population-based study. Hypertension in Pregnancy, 23(3), 247–256.

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Moodley, J. (2008). Maternal deaths due to hypertensive disorders in pregnancy. Best Practice and Research: Clinical Obstetrics and Gynaecology, 22(3), 559–567.

    Article  CAS  Google Scholar 

  14. 14.

    Getaneh, W., & Kumbi, S. (2010). Use of magnesium sulphate in pre-eclampsia and eclampsia in teaching hospitals in Addis Ababa: A practice audit. Ethiopian Medical Journal, 48(2), 157–164.

    PubMed  Google Scholar 

  15. 15.

    Drost, E., Van Lonkhuijzen, L. R. C. W., Meguid, T., Landis Lewis, D., & Zeeman, G. G. (2010). Implementing safe motherhood: A low-cost intervention to improve the management of eclampsia in a referral hospital in Malawi. BJOG: An International Journal of Obstetrics and Gynaecology, 117(12), 1553–1557.

    Article  CAS  Google Scholar 

  16. 16.

    Baldwin, K. J., Leighton, N. A., Kilby, M. D., Wyldes, M., Churchill, D., Jones, P. W., et al. (2002). The ‘Severe Hypertensive Illness in Pregnancy’ (SHIP) audit: Promoting quality care using a high risk monitoring chart and eclampsia treatment pack. Journal of Obstetrics and Gynaecology, 22(4), 346–352.

    PubMed  Article  Google Scholar 

  17. 17.

    Danso, K. A., & Opare-Addo, H. S. (2010). Challenges associated with hypertensive disease during pregnancy in low-income countries. International Journal of Gynecology and Obstetrics, 110(1), 78–81.

    PubMed  Article  Google Scholar 

  18. 18.

    Grady, K., Ameh, C., Adegoke, A., Kongnyuy, E., Dornan, J., Falconer, T., et al. (2011). Improving essential obstetric and newborn care in resource-poor countries. Journal of Obstetrics and Gynaecology, 31(1), 18–23.

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Ameh, C. A., Bishop, S., Kongnyuy, E., Grady, K., & Van den Broek, N. (2009). Challenges to the provision of emergency obstetric care in Iraq. Maternal and Child Health Journal, 15(1), 4–11.

    Google Scholar 

  20. 20.

    Van Den Broek, N. (2007). Life saving skills manual-essential obstetric and newborn care. Revised edition, 2007. London: RCOG Press. ISBN 978-1-904752-28-8.

  21. 21.

    Fauveau, V., & de Bernis, L. (2006). “Good obstetrics” revisited: Too many evidence-based practices and devices are not used. International Journal of Gynecology and Obstetrics, 94(2), 179–184.

    PubMed  Article  CAS  Google Scholar 

  22. 22.

    Say, L., Souza, J. P., & Pattinson, R. C. (2009). WHO working group on maternal mortality and morbidity classifications. Maternal near miss–towards a standard tool for monitoring quality of maternal health care. Best Practice and Research Clinical Obstetrics and Gynaecology, 23(3), 287–296.

    PubMed  Article  Google Scholar 

Download references

Acknowledgments

Dr Van Den Broek and Dr Kate Grady were the lead designers of the LSTM-RCOG LSS EOC & NC training package, Dr Adetoro Adegoke, Dr Anene Chukwujama were part to the faculty who identified the problem.

Conflict of interest

All authors are facilitators of the LSTM/RCOG LSS EOC & NC training and CA contributed to further development of the LSTM-RCOG LSS EOC & NC training package.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Charles A. Ameh.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Ameh, C.A., Ekechi, C.I. & Tukur, J. Monitoring Severe Pre-Eclampsia and Eclampsia Treatment in Resource Poor Countries: Skilled Birth Attendant Perception of a New Treatment and Monitoring Chart (LIVKAN Chart). Matern Child Health J 16, 941–946 (2012). https://doi.org/10.1007/s10995-011-0832-7

Download citation

Keywords

  • Maternal mortality and morbidity
  • Resource poor countries
  • Severe pre-eclampsia/eclampsia
  • Monitoring treatment chart
  • Standard care