ABSTRACT
INTRODUCTION:
Hypertensive disorders in
pregnancy result in about 76,000
maternal deaths per year worldwide.
Pre-eclampsia and
eclampsia cause the most deaths. Interventions for managing these disorders are available in
health facilities. We assess the effect of
monitoring pregnant women's
blood pressure (BP) in their homes using
village health workers (VHWs) equipped with a BP-measuring
device on
hypertension in
pregnancy, in a
resource-poor setting. Also, we assess the VHWs'
competence with the BP
device, acceptability and appropriateness of the intervention, and factors that
affect the implementation of the intervention.
METHOD:
This is a mixed
method study comprising quantitative and qualitative
data collection. We implemented the intervention over 6 months across three
local government areas in Gombe
state, northeast
Nigeria. The Replicating Effective Program (REP) framework guided the development of the implementation strategy. The quantitative data include routine measurement of
pregnant women's
blood pressure and
observation of 118 VHW-
client interactions. The routine
data collection occurred between February and June 2019, and the
observation occurred in January and June 2019. The qualitative
data collection occurred via six
focus group discussions with VHWs and ten in-depth interviews with
community health extension
workers in June 2019. We analyzed the data from the quantitative
arm with SPSS version 23. For the qualitative
arm, we transcribed the audio files, coded the texts, and categorized them using thematic
analysis.
RESULT:
Nine thousand
pregnant women were recruited into the program. We observed a significant reduction in the
prevalence of
hypertension in
pregnancy from 1.5 to 0.8% (Z = 4.04; p < 0.00001) after starting the program. Also, we found that VHWs can assess
pregnant women's BP using a semi-automatic BP-measuring
device. The intervention is acceptable and appropriate in
resource-poor settings. Poor payment of VHW stipend and cooperation of local
health staff are barriers to sustaining the intervention.
CONCLUSION:
In
resource-poor settings,
health systems can train and equip non-technical people to identify and refer cases of
high blood pressure in
pregnancy to local
health facilities on
time. This may contribute to reducing
maternal mortality and
morbidity in these settings.
