title: Potential for task-sharing to Lady Health Workers for identification and emergency management of pre-eclampsia at community level in Pakistan.
abstract: BACKGROUND
  An estimated 276 Pakistani women die for every 100,000 live births; with eclampsia accounting for about 10 % of these deaths. Community health workers contribute to the existing health system in Pakistan under the banner of the Lady Health Worker (LHW) Programme and are responsible to provide a comprehensive package of antenatal services. However, there is a need to increase focus on early identification and prompt diagnosis of pre-eclampsia in community settings, since women with mild pre-eclampsia often present without symptoms. This study aims to explore the potential for task-sharing to LHWs for the community-level management of pre-eclampsia and eclampsia in Pakistan.
  
  
  METHODS
  A qualitative exploratory study was undertaken February-July 2012 in two districts, Hyderabad and Matiari, in the southern province of Sindh, Pakistan. Altogether 33 focus group discussions (FGDs) were conducted and the LHW curriculum and training materials were also reviewed. The data was audio-recorded, then transcribed verbatim for thematic analysis using QSR NVivo-version10.
  
  
  RESULTS
  Findings from the review of the LHW curriculum and training program describe that in the existing community delivery system, LHWs are responsible for identification of pregnant women, screening women for danger signs and referrals for antenatal care. They are the first point of contact for women in pregnancy and provide nutritional counselling along with distribution of iron and folic acid supplements. Findings from FGDs suggest that LHWs do not carry a blood pressure device or antihypertensive medications; they refer to the nearest public facility in the event of a pregnancy complication. Currently, they provide tetanus toxoid in pregnancy. The health advice provided by lady health workers is highly valued and accepted by pregnant women and their families. Many Supervisors of LHWs recognized the need for increased training regarding pre-eclampsia and eclampsia, with a focus on identifying women at high risk. The entire budget of the existing lady health worker Programme is provided by the Government of Pakistan, indicating a strong support by policy makers and the government for the tasks undertaken by these providers.
  
  
  CONCLUSIONS
  There is a potential for training and task-sharing to LHWs for providing comprehensive antenatal care; specifically for the identification and management of pre-eclampsia in Pakistan. However, the implementation needs to be combined with appropriate training, equipment availability and supervision.
  
  
  BACKGROUND
  ClinicalTrial.gov, NCT01911494.
authors.affiliation: Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan.
authors.forename: Rehana A
authors.initials: RA
authors.lastname: Salam
authors.affiliation: Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan. rahat.qureshi@aku.edu.|Department of Obstetrics and Gynaecology, Aga Khan University, Stadium Road, Karachi, Pakistan. rahat.qureshi@aku.edu.
authors.forename: Rahat Najam
authors.initials: RN
authors.lastname: Qureshi
authors.affiliation: Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan.
authors.forename: Sana
authors.initials: S
authors.lastname: Sheikh
authors.affiliation: Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan.
authors.forename: Asif Raza
authors.initials: AR
authors.lastname: Khowaja
authors.affiliation: Department of Research, Vancouver Island Health Authority, Victoria, V8R1J8, Canada.
authors.forename: Diane
authors.initials: D
authors.lastname: Sawchuck
authors.affiliation: Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British Columbia, Vancouver, V5Z 4H4, Canada.
authors.forename: Marianne
authors.initials: M
authors.lastname: Vidler
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, The Aga Khan University, Karachi, Pakistan.
authors.forename: Shujaat
authors.initials: S
authors.lastname: Zaidi
authors.affiliation: Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan.|Centre for Global Child Health, The 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 / Q000592:standards*; D003150:Community Health Workers / Q000193:education*; D019468:Disease Management; D004632:Emergency Medical Services / Q000592:standards*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D010154:Pakistan; D017410:Practice Guidelines as Topic / Q000592:standards*; D011225:Pre-Eclampsia / Q000175:diagnosis / Q000517:prevention & control*; D011247:Pregnancy; D011295:Prenatal Care / Q000592:standards*; D036301:Qualitative Research
keywords: Community health workers; Community-based interventions; Obstetric care; Task-sharing