Strategies to prevent eclampsia in a developing country: I. Reorganization of maternity services.
OBJECTIVE
To determine whether changes in primary and secondary care service delivery could prevent antenatal eclampsia.


METHODS
One intervention (St. Catherine) and two control (St. Ann, Manchester) parishes were chosen. The health system in St. Catherine was restructured. Primary antenatal clinics had clear instructions for referring patients to a high-risk antenatal clinic or to hospital. Guidelines were provided to high-risk clinics and the antenatal ward for appropriate treatment of hypertension and preeclampsia when induction of labor should occur. Antenatal eclampsia incidence was monitored before and during the intervention and compared with control parishes (no intervention). Each eclampsia case was investigated to identify inadequacies in the system.


RESULTS
The process resulted in better identification of women at risk. Antenatal eclampsia incidence dropped dramatically as care improved. Compared with control areas, by completion of the study, the rate was significantly lower than at the start: OR 0.19 (95% CI: 0.13-0.27; p<0.001 trend). Antenatal admissions for hypertensive disorders declined significantly, and the number of bed days halved.


CONCLUSIONS
Reorganization of maternal care can have major public health benefits and cost savings; however, women need to be alerted to recognise and act upon signs of impending eclampsia.
McCaw-Binns
A M
AM
Department of Community Health and Psychiatry, University of the West Indies, Mona, Kingston 7, Jamaica, West Indies, Jamaica. affette.mccawbinns@uwimona.edu.jm
Ashley
D E
DE
Knight
L P
LP
MacGillivray
I
I
Golding
J
J
D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D003906:Developing Countries; D004461:Eclampsia / Q000175:diagnosis / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007563:Jamaica; D007902:Length of Stay / Q000706:statistics & numerical data; D008427:Maternal Health Services / Q000458:organization & administration*; D010343:Patient Admission / Q000706:statistics & numerical data; D011247:Pregnancy; D011320:Primary Health Care / Q000458:organization & administration*; D012017:Referral and Consultation