Management of Preeclampsia, Severe Preeclampsia, and Eclampsia at Primary Care Facilities in Bangladesh

Introduction: Eclampsia-related conditions are the second leading direct cause of obstetric deaths in Bangladesh. Efforts to prevent such deaths in low- and middle-income countries are increasingly focused on task shifting at the primary care level to enable frontline providers to screen and initiate treatment for women with preeclampsia, severe preeclampsia, and eclampsia (PE/SPE/E). The MaMoni Health Systems Strengthening project (funded by the United States Agency for International Development) implemented a magnesium sulfate intervention at primary care facilities in 4 Bangladesh districts in 2016 and 2017. Methods: The project trained frontline providers through a cascade approach from the national to the union level. A PE/SPE/E patient algorithm, digital blood pressure machines, and eclampsia kits with magnesium sulfate were supplied to service providers at each facility. We conducted a retrospective record review of facility-level data to assess the degree to which newly trained frontline providers adhered to a protocol that incorporated the use of magnesium sulfate for SPE/E in primary care settings. Results: In total, 283 women were found to have PE/SPE/E. Fifty-four percent were managed according to the protocol. The required supplies were present at each facility, but some issues existed with regard to availability and functionality of blood pressure apparatuses. Discussion: Challenges related to recordkeeping and service quality limited the analysis. Frontline providers need refresher trainings, ongoing supervision, properly calibrated blood pressure devices, and performance monitoring support in order to improve screening and management of PE/SPE/E in primary care facilities.