“There is no word for pre-eclampsia in prominent regional languages like Sindhi. Unlike other childbirth complications, signs of pre-eclampsia cannot be identified easily which limits the chances of early detection and leaves many pregnant women vulnerable to its dangerous complications,” says Dr Rahat Qureshi, an associate professor in the department of Obstetrics and Gynaecology at Aga Khan University.
A press statement issued by the university on Thursday said faculty from the Department of Obstetrics and Gynaecology were involved in a programme called Community Level Interventions for Pre-eclampsia (CLIP) trial in Pakistan. The CLIP intervention sought to evaluate the feasibility of a low cost, technology-focused approach to tackling pre-eclampsia and eclampsia through lady health workers (LHWs).
The statement said that over three years, 250 LHWs visited 88,000 households in Matiari and Hyderabad to screen pregnant women for symptoms of the disease. These LHWs asked mothers about a variety of symptoms related to pre-eclampsia and also measured their blood pressure and oxygen saturation levels. This information was then entered into a smartphone-based mobile health application known as PIERS On the Move, which conducted a quick assessment of the risk of severe pre-eclampsia.
In cases where warnings signs were noted, the LHWs were trained to provide prompt treatment by providing anti-hypertensive tablets and by administering magnesium sulfate injections. They also raised awareness about antenatal care seeking and birth preparedness during pregnancy and referred at-risk mothers to nearby hospitals.
Researchers of the university noted widespread support for the initiative from the community which reached 39,444 pregnant women in the two districts of Sindh. Results from the trial showed a marked improvement in awareness of the disease and in health-seeking behaviour. More than three in four at-risk mothers listened to LHWs by seeking a referral and nearly 60 percent of women accepted the treatment offered by LHWs.
“CLIP demonstrates how we can enable LHWs to tackle relevant health problems through training and the use of low-cost technology. Most pregnant women were willing to follow timely advice and treatment which helped make their pregnancies safer,” Dr Rahat said in the statement.
The research team now plans to conduct a follow-up study of LHWs involved in the programme to evaluate their experiences of using technology to assess the health of pregnant women during the trial.
The objectives of the study are in line with global efforts to achieve targets under Goal 3 of the Sustainable Development Goals which seeks to ensure healthy lives, promotes well-being for all. It also calls for special efforts to reduce preventable deaths of mothers and newborns by 2030.
Funded by the Bill and Melinda Gates Foundation, the CLIP trial in Pakistan was conducted in partnership with faculty from the University of British Columbia in Canada and St George’s, University of London, in the United Kingdom. It is part of a multi-country study that conducted similar interventions in India, Nigeria and Mozambique.
Dr Rahat Qureshi and Dr Zulfiqar Bhutta were the primary investigators on the Pakistan component of CLIP along with Dr Sana Sadiq Sheikh and Dr Zahra Hoodbhoy as co-investigators.