Pre-eclampsia is a life-threatening disorder characterized by high blood pressure and protein in the urine (proteinuria), which occurs only during pregnancy, childbirth, and the postpartum period. If undiagnosed and unmanaged, pre-eclampsia can rapidly progress to eclampsia (convulsions/fits)—the deadliest form of the condition. Globally, severe pre-eclampsia/eclampsia (PE/E) is the second leading cause of pregnancy-related mortality, resulting in 63,000 deaths each year. PE/E can also lead to long-term or permanent disability among women.
The majority of deaths due to PE/E are avoidable through the timely provision of effective care.In taking evidence to practice, Jhpiego has been at the forefront of ensuring that recommended lifesaving practices for PE/E prevention and treatment are implemented in the field.
The timely and appropriate administration of magnesium sulfate (MgSO4) has been shown to reduce the risk of death from eclampsia by 45%. Jhpiego training has helped ensure that frontlineproviders, as well as those in tertiary referral hospitals, are both competent and confident in the management of PE/E—including the administration of this lifesaving drug. From midwives in Ethiopia to physicians in Burkina Faso, health care providers are developing the skills necessary to prevent these unnecessary deaths. And the U. S. Agency for International Development (USAID)-funded global Maternal and Child Health Integrated Program (MCHIP), led by Jhpiego, is working closely with countries worldwide to ensure that MgSO4 is available at every health facility
Jhpiego programs work, not only to treat PE/E, but also to implement global recommendations to prevent the development of pre-eclampsia. Evidence has shown thatcalcium supplementation given to pregnant women in areas where calcium intake is low can reduce the risk of developing pre-eclampsia by 50%. In Nepal, for example, Jhpiego has led an innovative program to ensure that pregnant women receive calcium. Nearly 5,000 pregnant women have participated in the free calcium-supplementation program, which has helped to protect their health and will also inform other programs and facilitate national scale-up of this lifesaving intervention.
As part of this effort, Jhpiego has also developed a calcium preparation that is more feasible than calcium tablets for use in low-resource settings. Pregnant women can fortify their own food with “calcium sprinkles” for a fraction of the cost of tablets.
Currently, many women lack access to a skilled health care provider, such as a doctor or midwife, who can measure their blood pressure and perform other simple tests for early detection of pre-eclampsia. For such women who develop PE/E, timely treatment is unlikely. Jhpiego and partners are developing aninexpensive and reliable test for early detection of PE/E that can be used by a community health worker or the woman herself. Based on a simple urine test, this “self-test,” is currently undergoing field-testing and promises to be “extremely affordable” and easily accessible to women in low-resource settings. In partnership with the Nepal Society of Obstetricians and Gynecologists, Jhpiego developed quality standards for care of which almost 65% of health facilities achieved a high performance compared to the baseline of 14%.
To ensure global access of policymakers, managers, and clinicians to the evidence, information, and tools needed to combat PE/E, MCHIP has developed and disseminated the web-based Pre-Eclampsia/Eclampsia: Prevention, Detection and Management Toolkit. This arsenal of materials supports all aspects of PE/E programming—including advocacy, policy development, provider training, quality improvement of PE/E care, and monitoring and evaluation of results—to help ensure that women and their unborn babies no longer die of this condition.