title: Health care provider knowledge and routine management of pre-eclampsia in Pakistan.
abstract: BACKGROUND
  Maternal mortality ratio is 276 per 100,000 live births in Pakistan. Eclampsia is responsible for one in every ten maternal deaths despite the fact that management of this disease is inexpensive and has been available for decades. Many studies have shown that health care providers in low and middle-income countries have limited training to manage patients with eclampsia. Hence, we aimed to explore the knowledge of different cadres of health care providers regarding aetiology, diagnosis and treatment of pre-eclampsia and eclampsia and current management practices.
  
  
  METHODS
  We conducted a mixed method study in the districts of Hyderabad and Matiari in Sindh province, Pakistan. Focus group discussions and interviews were conducted with community health care providers, which included Lady Health Workers and their supervisors; traditional birth attendants and facility care providers. In total seven focus groups and 26 interviews were conducted. NVivo 10 was used for analysis and emerging themes and sub-themes were drawn.
  
  
  RESULTS
  All participants were providing care for pregnant women for more than a decade except one traditional birth attendant and two doctors. The most common cause of pre-eclampsia mentioned by community health care providers was stress of daily life: the burden of care giving, physical workload, short birth spacing and financial constraints. All health care provider groups except traditional birth attendants correctly identified the signs, symptoms, and complications of pre-eclampsia and eclampsia and were referring such women to tertiary health facilities. Only doctors were aware that magnesium sulphate is recommended for eclampsia management and prevention; however, they expressed fears regarding its use at first and secondary level health facilities.
  
  
  CONCLUSIONS
  This study found several gaps in knowledge regarding aetiology, diagnosis and treatment of pre-eclampsia among health care providers in Sindh. Findings suggest that lesser knowledge regarding management of pre-eclampsia is due to lack of refresher trainings and written guidelines for management of pre-eclampsia and presentation of fewer pre-eclamptic patients at first and secondary level health care facilities. We suggest to include management of pre-eclampsia in regular trainings of health care providers and to provide management protocols at all health facilities.
  
  
  BACKGROUND
  NCT01911494.
authors.affiliation: Division of Women & Child Health, Aga Khan University, Karachi, Pakistan.
authors.forename: Sana
authors.initials: S
authors.lastname: Sheikh
authors.affiliation: Division of Women & Child Health, Aga Khan University, Karachi, Pakistan. rahat.qureshi@aku.edu.
authors.forename: Rahat Najam
authors.initials: RN
authors.lastname: Qureshi
authors.affiliation: Division of Women & Child Health, Aga Khan University, Karachi, Pakistan.|Department of Obstetrics and Gynaecology, and the Child and Family Research Institute, University of British Columbia, Vancouver, V5Z 4H4, Canada.
authors.forename: Asif Raza
authors.initials: AR
authors.lastname: Khowaja
authors.affiliation: Division of Women & Child Health, Aga Khan University, Karachi, Pakistan.
authors.forename: Rehana
authors.initials: R
authors.lastname: Salam
authors.affiliation: Department of Obstetrics and Gynaecology, and the Child and Family Research Institute, University of British Columbia, Vancouver, V5Z 4H4, Canada.
authors.forename: Marianne
authors.initials: M
authors.lastname: Vidler
authors.affiliation: Department of Research, Vancouver Island Health Authority, Victoria, V8R 1J8, Canada.
authors.forename: Diane
authors.initials: D
authors.lastname: Sawchuck
authors.affiliation: Department of Obstetrics and Gynaecology, St George's, University of London, London, SW17 0RE, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: von Dadelszen
authors.affiliation: Division of Women & Child Health, Aga Khan University, Karachi, Pakistan.
authors.forename: Shujat
authors.initials: S
authors.lastname: Zaidi
authors.affiliation: Division of Women & Child Health, Aga Khan University, Karachi, Pakistan.|Program for Global Pediatric Research, Hospital for Sick Children, Toronto, M5G 2L3, Canada.
authors.forename: Zulfiqar
authors.initials: Z
authors.lastname: Bhutta
mesh_terms: D002983:Clinical Competence; D003153:Community Health Services; D019468:Disease Management; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D010154:Pakistan; D017410:Practice Guidelines as Topic / Q000592:standards*; D011225:Pre-Eclampsia / Q000175:diagnosis / Q000517:prevention & control*; D011247:Pregnancy; D011787:Quality of Health Care / Q000592:standards*
keywords: Community health services; Community health worker; Eclampsia; Health personnel; Pakistan; Pre-eclampsia; Pregnancy