Table 3 Case management: percentage of providers responding correctly to case scenario related to severe pe/e symptoms, by provider type, provider training, and facility type
From: Prevention and management of severe pre-eclampsia/eclampsia in Afghanistan
| Â | Provider type | Provider training | Facility type | |||||||
|---|---|---|---|---|---|---|---|---|---|---|
Correct responses to case scenario | Doctors (n = 79) | Midwives (n = 139) | p-value | Untrained providers (n = 44) | Trained providers (n = 174) | p-value | CHCs and district hospitals (n = 43) | Provincial hospitals (n = 25) | Regional and specialized hospitals (n = 10) | p-value |
I. Information needed immediately to start emergency management (%) | ||||||||||
Level of consciousness | 92.2 | 83.6 | 0.228 | 80.0 | 89.7 | 0.076 | 80.3 | 93.3 | 90.9 | 0.046 |
Presence of current convulsions | 88.4 | 87.3 | 0.949 | 69.4 | 90.5 | <0.001 | 80.0 | 92.3 | 91.1 | 0.082 |
Vital signs | 96.9 | 96.4 | 0.929 | 100.0 | 95.8 | 0.214 | 97.0 | 96.3 | 97.0 | 0.970 |
II. Diagnosis of eclampsia (%) | ||||||||||
Diagnosis of eclampsia | 77.2 | 62.3 | 0.120 | 66.7 | 67.8 | 1.000 | 60.5 | 66.3 | 81.1 | 0.282 |
III. Urgent actions to manage presenting condition (%) | ||||||||||
Bed resta | 44.3 | 42.5 | 0.725 | 58.3 | 38.2 | 0.019 | 31.4 | 53.7 | 50.0 | 0.008 |
MgSO4 | 96.2 | 88.5 | 0.051 | 82.3 | 93.3 | 0.035 | 87.2 | 92.6 | 94.7 | 0.297 |
IV. Immediate actions if woman is having convulsions when admitted (%) | ||||||||||
Give oxygen at 4–6 L per min. | 88.6 | 81.3 | 0.153 | 83.3 | 86.0 | 0.638 | 79.1 | 85.3 | 92.1 | 0.171 |
Place in side-lying position | 88.6 | 85.6 | 0.622 | 77.1 | 87.6 | 0.098 | 83.7 | 92.6 | 78.9 | 0.062 |
Protect woman from injury | 79.2 | 75.0 | 0.696 | 75.0 | 75.8 | 1.000 | 68.6 | 78.9 | 86.8 | 0.064 |
V. Essential equipment and supplies to manage most urgent condition (%) | ||||||||||
IV with saline or Ringers Lactate | 78.4 | 87.7 | 0.070 | 83.3 | 83.7 | 0.823 | 83.7 | 86.3 | 76.3 | 0.372 |
Indwelling urinary catheter/ bag | 87.0 | 83.1 | 0.361 | 85.4 | 82.6 | 0.830 | 74.4 | 90.5 | 89.4 | 0.008 |
Suction and suction catheter | 87.3 | 78.2 | 0.098 | 68.8 | 76.4 | 0.335 | 68.6 | 87.4 | 92.1 | 0.001 |
Oxygen and adult mask | 91.1 | 84.2 | 0.142 | 77.1 | 88.8 | 0.049 | 82.6 | 87.4 | 86.8 | 0.633 |
VI. Appropriate actions after convulsions are controlled (%) | ||||||||||
Repeat dose of MgSO4 in 4Â hours | 71.4 | 77.9 | 0.301 | 64.6 | 77.5 | 0.083 | 74.4 | 73.7 | 84.2 | 0.409 |
Continue anti-hypertensives | 81.0 | 66.2 | 0.024 | 56.3 | 74.7 | 0.016 | 70.9 | 67.4 | 81.6 | 0.072 |
Monitor labor, begin partograph | 79.2 | 80.9 | 0.532 | 77.3 | 81.4 | 0.672 | 72.1 | 89.5 | 79.0 | 0.262 |
Check respirations hourly (auscultate lungs if needed) | 59.5 | 54.7 | 0.683 | 35.4 | 61.8 | 0.002 | 50.0 | 62.1 | 60.1 | 0.012 |
Document intake/output hourly | 75.9 | 69.1 | 0.269 | 68.8 | 71.4 | 0.854 | 62.8 | 76.8 | 73.7 | 0.232 |
VII. Appropriate actions after vaginal delivery (%) | ||||||||||
Continue MgSO4 for 24Â hours | 80.5 | 77.2 | 0.995 | 72.7 | 80.8 | 0.302 | 72.1 | 83.2 | 84.2 | 0.130 |
Assess vital signs every 15Â minutes for 2Â hours after birth | 90.9 | 90.4 | 0.652 | 88.6 | 91.6 | 0.771 | 91.9 | 92.6 | 84.2 | 0.288 |