title: Community health worker knowledge and management of pre-eclampsia in rural Karnataka State, India.
abstract: BACKGROUND
  In India, the hypertensive disorders of pregnancy and postpartum haemorrhage are responsible for nearly 40 % of all maternal deaths. Most of these deaths occur in primary health settings which frequently lack essential equipment and medication, are understaffed, and have limited or no access to specialist care. Community health care workers are regarded as essential providers of basic maternity care; and the quality of care they provide is dependent on the level of knowledge and skills they possess. However, there is limited research regarding their ability to manage pregnancy complications. This study aims to describe the current state of knowledge regarding pre-eclampsia and eclampsia among community health care workers (auxiliary nurse midwives, accredited social health activists, staff nurses) in northern Karnataka, India. Furthermore, this study describes the treatment approaches used by various cadres of community health workers for these conditions. The findings of this study can help plan focussed training sessions to build upon their strengths and to address the identified gaps.
  
  
  METHODS
  Data were collected as part of a larger study aimed at assessing the feasibility of community-based treatment for pre-eclampsia. Eight focus group discussions were conducted in 2012-2013 in northern Karnataka State: four with staff nurses and auxiliary nurse midwives and four with accredited social health activists. In addition, twelve auxiliary nurse midwives and staff nurses completed questionnaires to explore their competence and self-efficacy in managing pre-eclampsia. Qualitative data were audio-recorded, transcribed verbatim and translated for thematic analysis using NVivo 10.
  
  
  RESULTS
  Community health workers described their understanding of the origins of hypertension and seizures in pregnancy. Psychological explanations of hypertension were most commonly reported: stress, tension, and fear. The most common explanation for eclampsia was not receiving a tetanus vaccination. Despite some common misperceptions regarding aetiology, these community health workers demonstrated a good grasp of the potential consequences of hypertension in pregnancy. According to auxiliary nurse midwives and staff nurses, if hypertension was detected they encouraged rest, decreased salt intake, iron supplementation and tetanus vaccination. In addition, some staff nurses administered antihypertensives, MgSO4, or other anticonvulsants. All auxiliary nurse midwives had some awareness of MgSO4, but none had administered it themselves.
  
  
  CONCLUSIONS
  This study showed that knowledge regarding the aetiology of pre-eclampsia was limited. Nevertheless, their basic knowledge and skills could be strengthened to more effectively manage the hypertensive disorders of pregnancy in their communities.
  
  
  BACKGROUND
  NCT01911494.
authors.affiliation: Department of Community Medicine, S Nijalingappa Medical College, Bagalkot, Navanagar, 587102, India.
authors.forename: Umesh
authors.initials: U
authors.lastname: Ramadurg
authors.affiliation: Department of Obstetrics and Gynaecology, and the Child and Family Research Unit, University of British Columbia, Vancouver, V5Z 4H4, Canada. marianne.vidler@cw.bc.ca.
authors.forename: Marianne
authors.initials: M
authors.lastname: Vidler
authors.affiliation: KLE University's Jawaharlal Nehru Medical College, Neharu Nagar, Belgaum, 590010, India.
authors.forename: Umesh
authors.initials: U
authors.lastname: Charanthimath
authors.affiliation: Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Navanagar, 587102, India.
authors.forename: Geetanjali
authors.initials: G
authors.lastname: Katageri
authors.affiliation: KLE University's Jawaharlal Nehru Medical College, Neharu Nagar, Belgaum, 590010, India.
authors.forename: Mrutyunjaya
authors.initials: M
authors.lastname: Bellad
authors.affiliation: Department of Obstetrics and Gynaecology, S Nijalingappa Medical College, Bagalkot, Navanagar, 587102, India.
authors.forename: Ashalata
authors.initials: A
authors.lastname: Mallapur
authors.affiliation: KLE University's Jawaharlal Nehru Medical College, Neharu Nagar, Belgaum, 590010, India.
authors.forename: Shivaprasad
authors.initials: S
authors.lastname: Goudar
authors.affiliation: Department of Pharmacology, S Nijalingappa Medical College, Bagalkot, Navanagar, 587102, India.
authors.forename: Shashidhar
authors.initials: S
authors.lastname: Bannale
authors.affiliation: KLE University's Jawaharlal Nehru Medical College, Neharu Nagar, Belgaum, 590010, India.
authors.forename: Chandrashekhar
authors.initials: C
authors.lastname: Karadiguddi
authors.affiliation: Department of Research, Vancouver Island Health Authority, Victoria, V8R 1J8, Canada.
authors.forename: Diane
authors.initials: D
authors.lastname: Sawchuck
authors.affiliation: Division of Women and Child Health, Aga Khan University, Karachi, Pakistan.
authors.forename: Rahat
authors.initials: R
authors.lastname: Qureshi
authors.affiliation: Molecularand Clinical Sciences Research Institute, St George's, University of London, and Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, SW17 0RE, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: von Dadelszen
authors.affiliation: Department of Obstetrics and Gynaecology, Thomas Jefferson University, Philadelphia, 19107, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Derman
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003153:Community Health Services / Q000592:standards*; D003150:Community Health Workers / Q000193:education*; D019468:Disease Management; D005240:Feasibility Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D007194:India; D017410:Practice Guidelines as Topic / Q000592:standards*; D011225:Pre-Eclampsia / Q000503:physiopathology / Q000517:prevention & control*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D011256:Pregnancy Outcome; D036301:Qualitative Research; D012640:Seizures / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control
keywords: Blood pressure; Community health services; Community health workers; Developing countries; Eclampsia; Hypertension; India; Magnesium sulfate; Maternal health; Maternal mortality; Nurse midwives; Pre-eclampsia; Pregnancy; Proteinuria; Public health; Referral and consultation; Rural health