title: Community health worker knowledge and management of pre-eclampsia in southern Mozambique.
abstract: BACKGROUND
  Mozambique has drastically improved an array of health indicators in recent years, including maternal mortality rates which decreased 63 % from 1990-2013 but the rates still high. Pre-eclampsia and eclampsia constitute the third major cause of maternal death in the country. Women in rural areas, with limited access to health facilities are at greatest risk. This study aimed to assess the current state of knowledge and the regular practices regarding pre-eclampsia and eclampsia by community health workers in southern Mozambique.
  
  
  METHODS
  This mixed methods study was conducted from 2013 to 2014, in Maputo and Gaza Provinces, southern Mozambique. Self-administered questionnaires, in-depth interviews and focus group discussions were conducted with CHWs, district medical officers, community health workers' supervisors, Gynaecologists-Obstetricians and matrons. Quantitative data were entered into a database written in REDCap and subsequently analyzed using Stata 13. Qualitative data was imported into NVivo10 for thematic analysis.
  
  
  RESULTS
  Ninety-three percent of CHW had some awareness of pregnancy complications. Forty-one percent were able to describe the signs and symptoms of hypertension. In cases of eclampsia, CHWs reported to immediately refer the women. The vast majority of the CHWs surveyed reported that they could neither measure blood pressure nor proteinuria (90 %). Fewer reported confidence in providing oral antihypertensives (14 %) or injections in pregnancy (5 %). The other community health care providers are matrons. They do not formally offer health services, but assists pregnant women in case of an emergency. Regarding pre-eclampsia and eclampsia, matrons were unable to recognise these biomedical terms.
  
  
  CONCLUSIONS
  Although CHWs are aware of pregnancy complications, they hold limited knowledge specific to pre-eclampsia and eclampsia. There is a need to promote studies to evaluate the impact of enhancing their training to include additional content related to the identification and management of pre-eclampsia and eclampsia.
authors.affiliation: Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Vila da Manhiça, CP 1929, Moçambique.
authors.forename: Helena
authors.initials: H
authors.lastname: Boene
authors.affiliation: Department of Obstetrics and Gynaecology, and the Child and Family Research Institute, University of British Columbia, 950 West 28th Avenue, Vancouver, V5Z4H4, Canada.
authors.forename: Marianne
authors.initials: M
authors.lastname: Vidler
authors.affiliation: Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Vila da Manhiça, CP 1929, Moçambique.|Universidade Eduardo Mondlane, Faculdade de Medicina, Av. Salvador Allende, 702 R/C, Maputo, Moçambique.
authors.forename: Orvalho
authors.initials: O
authors.lastname: Augusto
authors.affiliation: Universidade Eduardo Mondlane, Faculdade de Medicina, Av. Salvador Allende, 702 R/C, Maputo, Moçambique.
authors.forename: Mohsin
authors.initials: M
authors.lastname: Sidat
authors.affiliation: Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Vila da Manhiça, CP 1929, Moçambique.|Ministério da Saúde, Av. Eduardo Mondlane, Maputo, 1008, Moçambique.
authors.forename: Eusébio
authors.initials: E
authors.lastname: Macete
authors.affiliation: Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Vila da Manhiça, CP 1929, Moçambique.|Barcelona Institute for Global Health (ISGlobal) /Hospital Clinic - Universitat de Barcelona, Calle Rosselló, 132, Barcelona, 08036, Spain.
authors.forename: Clara
authors.initials: C
authors.lastname: Menéndez
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: Department of Obstetrics and Gynaecology, St George's University London, London, SW17 0RE, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: von Dadelszen
authors.affiliation: Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Vila da Manhiça, CP 1929, Moçambique.|Universidade Eduardo Mondlane, Faculdade de Medicina, Av. Salvador Allende, 702 R/C, Maputo, Moçambique.
authors.forename: Khátia
authors.initials: K
authors.lastname: Munguambe
authors.affiliation: Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Vila da Manhiça, CP 1929, Moçambique. Esevene68@gmail.com.|Universidade Eduardo Mondlane, Faculdade de Medicina, Av. Salvador Allende, 702 R/C, Maputo, Moçambique. Esevene68@gmail.com.
authors.forename: Esperança
authors.initials: E
authors.lastname: Sevene
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003153:Community Health Services / Q000592:standards*; D003150:Community Health Workers / Q000193:education*; D019468:Disease Management; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009073:Mozambique; D017410:Practice Guidelines as Topic / Q000592:standards*; D011225:Pre-Eclampsia / Q000175:diagnosis / Q000517:prevention & control*; D011247:Pregnancy; D011787:Quality of Health Care / Q000592:standards*; D055815:Young Adult
keywords: Community health workers; Eclampsia management; Knowledge; Mozambique; Pre-eclampsia