AJOG Global Reports (May 2024)

Implementation challenges in preeclampsia care: perspectives from health care professionals in urban UgandaAJOG MFM at a Glance

  • Imelda Namagembe, MD,
  • Babu Karavadra, BSc Hons, MBBS, PhD,
  • Lawrence Kazibwe, MBChB, MMed,
  • Joseph Rujumba, PhD,
  • Noah Kiwanuka, MBChB, MPH, PhD,
  • Brandon Smith, BSc Hons, PhD,
  • Josaphat Byamugisha, PhD,
  • Ashley Moffett, MB/BChir, PhD,
  • Tom Bashford, MBBS, MBiochem, PhD, MRCP, FRCA,
  • Annettee Nakimuli, MD, PhD,
  • Catherine E. Aiken, MB/BChir, MA, PhD, MRCOG, MRCP

Journal volume & issue
Vol. 4, no. 2
p. 100348

Abstract

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BACKGROUND: Sub-Saharan Africa bears the burden of 70% of maternal deaths worldwide, of which ∼10% are attributable to hypertensive disorders of pregnancy, primarily complications of preeclampsia. In other global settings, outcomes of pregnancies affected by preeclampsia are improved with timely and effective medical care. OBJECTIVE: This study aimed to explore the perspectives of local health care professionals on how preeclampsia care is currently delivered in the study setting and what challenges they experience in providing prompt and safe care. We identified specific objectives of exploring stakeholder perceptions of (1) recognizing preeclampsia and (2) timely intervention when preeclampsia is diagnosed. We also explored the wider system factors (eg, cultural, financial, and logistic challenges) that health care professionals perceived as affecting their ability to deliver optimal preeclampsia care. STUDY DESIGN: Individual semistructured interviews were conducted with health care professionals and stakeholders. The findings were analyzed using thematic analysis. RESULTS: Thirty-three participants contributed to the study, including doctors and midwives with varying degrees of clinical experience and external stakeholders. The following 5 key themes emerged: delayed patient presentation, recognizing the unwell patient with preeclampsia, the challenges of the existing triage system, stakeholder disconnect, and ways of learning from each other. Health care professionals referenced an important psychosocial perspective associated with preeclampsia in the study setting, which may influence the likelihood of seeking care through traditional healers rather than hospital-based routes. CONCLUSION: We identify the key barriers to improving maternal and neonatal outcomes of preeclampsia, described at both the institutional level and within the wider setting. The study provides invaluable contextual information that suggests that a systems-based approach to health care quality improvement may be effective in reducing rates of maternal and neonatal morbidity and mortality.

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