title: Community health workers' knowledge and practice in relation to pre-eclampsia in Ogun State, Nigeria: an essential bridge to maternal survival.
abstract: BACKGROUND
  Pre-eclampsia is a leading cause of maternal and fetal morbidity and mortality worldwide. Early detection and treatment have been instrumental in reducing case fatality in high-income countries. To achieve this in a low-income country, like Nigeria, community health workers who man primary health centres must have adequate knowledge and skills to identify and provide emergency care for women with pre-eclampsia. This study aimed to determine community health workers' knowledge and practice in the identification and treatment of pre-eclampsia, as they are essential providers of maternal care services in Nigeria.
  
  
  METHODS
  This study was part of a multi-country evaluation of community treatment of pre-eclampsia. Qualitative data were obtained from four Local Government Areas of Ogun State, in south western Nigeria by focus group discussions (N = 15) and in-depth interviews (N = 19). Participants included a variety of community-based health care providers - traditional birth attendants, community health extension workers, nurses and midwives, chief nursing officers, medical officers - and health administrators. Data were transcribed and validated with field notes and analysed with NVivo 10.0.
  
  
  RESULTS
  Community-based health care providers proved to be aware that pre-eclampsia was due to the development of hypertension and proteinuria in pregnant women. They had a good understanding of the features of the condition and were capable of identifying women at risk, initiating care, and referring women with this condition. However, some were not comfortable managing the condition because of the limitation in their 'Standing Order'; these guidelines do not explicitly authorize community health extension workers to treat pre-eclampsia in the community.
  
  
  CONCLUSIONS
  Community-based health care providers were capable of identifying and initiating appropriate care for women with pre-eclampsia. These competencies combined with training and equipment availability could improve maternal health in the rural areas. There is a need for regular training and retraining to enable successful task-sharing with these cadres.
  
  
  BACKGROUND
  NCT01911494 .
authors.affiliation: Department of Obstetrics and Gynaecology, Babcock University Teaching Hospital, Ilishan-Remo, Ogun State, Nigeria. johnsotunsa@yahoo.com.
authors.forename: J O
authors.initials: JO
authors.lastname: Sotunsa
authors.affiliation: Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British Columbia, Vancouver, V5Z 4H4, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Vidler
authors.affiliation: Department of Sociology, University of Lagos, Lagos, Nigeria.
authors.forename: D O
authors.initials: DO
authors.lastname: Akeju
authors.affiliation: Centre for Research in Reproductive Health, Sagamu, Nigeria.
authors.forename: M O
authors.initials: MO
authors.lastname: Osiberu
authors.affiliation: Centre for Research in Reproductive Health, Sagamu, Nigeria.
authors.forename: E O
authors.initials: EO
authors.lastname: Orenuga
authors.affiliation: UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
authors.forename: O T
authors.initials: OT
authors.lastname: Oladapo
authors.affiliation: Division of Women and Child Health, Aga Khan University, Karachi, Pakistan.
authors.forename: R
authors.initials: R
authors.lastname: Qureshi
authors.affiliation: Department of Research, Vancouver Island Health Authority, Victoria, V8R 1J8, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Sawchuck
authors.affiliation: Department of Obstetrics and Gynaecology, Olabisi Onabanjo University, Sagamu, Nigeria.
authors.forename: O O
authors.initials: OO
authors.lastname: Adetoro
authors.affiliation: Department of Obstetrics and Gynaecology, St George's University London, London, SW17 0RE, UK.
authors.forename: P
authors.initials: P
authors.lastname: von Dadelszen
authors.affiliation: Centre for Research in Reproductive Health, Sagamu, Nigeria.
authors.forename: O A
authors.initials: OA
authors.lastname: Dada
mesh_terms: D002983:Clinical Competence; D003153:Community Health Services / Q000592:standards*; D003150:Community Health Workers / Q000193:education*; D005240:Feasibility Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008428:Maternal Mortality / Q000639:trends*; D009549:Nigeria; D017410:Practice Guidelines as Topic / Q000592:standards*; D011225:Pre-Eclampsia / Q000175:diagnosis / Q000517:prevention & control*; D011247:Pregnancy; D036301:Qualitative Research; D015996:Survival Rate
keywords: Community health workers; Developing countries; Hypertension in pregnancy; Maternal welfare; Nigeria; Pre-eclampsia; Pregnancy