Barriers to identify and manage Severe Pre-Eclampsia and Eclampsia in primary and secondary health facilities in Bangladesh

In Bangladesh pre-eclampsia/eclampsia (PE/E) is the second leading cause of maternal death and accounts for 24% death. The correct knowledge of primary health care providers (PHCs), who are the first contact point for antenatal care (ANC) clients, and reliable availability of drugs and equipment are important to prevent, detect and manage PE/E. We examined service provider’s knowledge, facility capacity to perform certain activities for severe preeclampsia/eclampsia (SPE/E) services, ANC and PNC service provision, MNH logistics and infrastructure for providing MNH services. A total of 289 service providers including Physicians and other service providers (nurse, midwives and paramedics) were interviewed and facility inventory assessments were conducted in 134 facilities using a checklist. Written guideline or protocol for diagnosing and managing PE/E are prerequisite for PE/E management were mostly not available. Only 13.4% of secondary facilities had printed guideline and no guideline available in primary facilities. Out of 20 secondary facilities, only 4 had the supply of magnesium sulphate (MgSO4 ), however primary facilities had no supply. Only four secondary facilities always used MgSO4 and none of the PHC facility used it. Physicians and other service providers had reasonably good knowledge on the signs and symptoms of PE/ SPE/E but had poor knowledge on correct timing for introducing anti-hypertensives.